Another look at the Amish and health insurance

The Amish potential-exemption-from-health-insurance-requirement story has shot around the net and become something of a hot sub-story to the health care issue. Frankly I thought it would get some attention but the amount of media coverage surprised me a bit.

A scan of commentary reveals some upset at what’s been called a ‘get-out-of-jail-free’ card for the Amish (and, presumably other religious groups who meet the criteria), and with the predictable jokes about joining the Amish health care club to get the exemption.

Some are even wondering if Christians who are against abortion can argue for a religious exemption in the event that a final bill mandates federal coverage for abortion. I am quite skeptical that would be allowed however, as it would conceivably exempt tens of millions of Americans.

The Amish benefit from being small, relatively obscure, and by garnering public sympathies. Amish are generally perceived in a positive light, admired for the lives they live.

It’s obvious for even those largely unfamiliar with the Amish that they ‘walk-the-talk’, proven in a very visible and concrete way by their manner of living. This lends strength to the argument that their beliefs are genuine, and that they are thus worthy of exemption. So the Amish have a lot working in their favor when arguing for exclusions from government mandates. It’s not so clear, on the other hand, how to discern an intangible such as “religious sincerity” in such a large and diverse group as “Christians.”

Amish case weaker this time around?

On the other hand, maybe I’m missing something but it seems to me that the case for Amish exemption is weaker here than it would be in the case of mandatory participation in a program like Social Security.

After all, even under the proposed health care plan, they would have a legitimate out–paying the exemption fine like other Americans, who, for whatever reason, would choose to opt out as well.

By paying the fine, it seems they technically wouldn’t be financially supporting what they see as an insurance plan (as would be the case were they forced to pay into Social Security)–simply paying for the privilege to be exempt from it.

Why do the Amish object to insurance programs like Social Security?

There are three main reasons Amish have a problem with participating in government administered programs such as Social Security, and in traditional insurance programs in general, for that matter.

Peter Ferrara, in The Amish and the State, examines the issues Amish had with the program. Social Security is technically an insurance program, with portions of the program entitled the “Old Age and Survivors Insurance Program” and “Disability Insurance Program” providing funds to guard against hardship of individuals in retirement or unable to work due to disability.

Amish arguments against participation in government insurance programs include the following:

Firstly, there is the religious belief argument. As Ferrara writes, participating in Social Security would contradict “the bibilical commands that members of the church provide for their own families and assist those in the community in need. Participation in Social Security is also seen as lacking in trust in God to provide the necessities of life for his people, promised by several biblical passages.”

Secondly there is the importance of maintaining a separation from the world. Amish see themselves as “a people apart.” Paying into an insurance system would draw the Amish into closer ties with the world and cause them to be “unequally yoked together with unbelievers.” Amish fear that growing closer to the world will threaten their communities and values.

Finally there is the aspect of need. With their self-supporting communal aspect, Amish feel that they simply have no need for government assistance.

The Amish argument

In the 1950’s, Amish were originally told by IRS agents that the contributions to Social Security were indeed a “tax”, and not technically contributions to an insurance system–despite the fact that “the government has always proclaimed to the rest of the country that Social Security is an insurance system, with its own trust funds, and that payments into the system were not taxes but “contributions.” The Amish saw through the ruse, as Ferrara writes:

The Amish pointed to the numerous government proclamations that Social Security was indeed insurance, including the official legal title of the program–Old Age, Survivors, and Disability Insurance. The Amish might have chosen to pay the Social Security tax but refuse the program’s benefits, just as they pay general government taxes but refuse other government social welfare benefits. But the Amish could not accept the close link between Social Security taxes, or “contributions,” and the program’s benefits, proclaimed over and over again by the government. Amish leaders feared that if their members paid Social Security, future generations would be unable to resist receiving the benefits for which they had already paid. Payment of the taxes would be seen as participation in the system, and if paying in was allowed, then how could receiving benefits be prohibited?

This seems to be the big issue. If you are technically paying in, what’s to prevent this or future generations from taking out? The very real possibility in the case of Social Security is a fear that Amish society could be eroded by feeding a worldly system, the benefits of which future generations may be tempted to see as rightfully theirs.

Amish in some limited situations have already succumbed to the temptation of government assistance, most recently in the instance of northern Indiana Amish accepting unemployment compensation, a situation that had previously occurred at least one other time, in the case of some Lancaster Amish laid off from factory jobs during a recession in the mid-1970s (see Amish Enterprise: From Plows to Profits).

Paying for private health insurance, as the proposed bill would require of all Americans–even with the understanding or sincere intention that members of the community would refuse to seek benefits from the program in the case of misfortune–would naturally lead to similar temptations.

There are some variables here, such as, what will the final exemption penalty be? Will it be $750, as in the Senate version, or 2.5% of annual income, as in the House version? It seems that that can make a big difference, as in the former case, the amount paid would be likely less than a year’s worth of insurance premiums, and thus the cheaper option, while in the latter, depending on the individual, the amount could be much greater, leading some to be tempted to purchase insurance, the cheaper alternative in such a case. So I think these and other question marks make the issue difficult to fully assess at this point.

But, in the fact that there is essentially an alternate to required participation in the system–the payment of what is essentially an “exemption penalty”–seems to me to make this different from the Social Security issue.

I am curious, what do you think on this issue?

UPDATE: An Amish friend informs me that if a person is exempted from Social Security by way of the 4029 exemption as the Amish are, that person is prohibited from holding health insurance. Taking a look at the accompanying IRS publication, the following is stated:

As a follower of the established teachings of the sect or division, you must be conscientiously opposed to accepting benefits of any private or public insurance that makes payments for death, disability, old age, retirement, or medical care, or provides services for medical care.

So it seems like the “conscientiously opposed to accepting benefits…” bit would support this idea. Perhaps there’s other language in there as well, but as tends to be the case with IRS docs, my eyes began to glaze over after a few paragraphs. In any case, sounds like one would be prevented from even having insurance with a 4029 exemption.

Tags: Amish and the Government, Health and Illness