The Amish don't believe in insurance. Here's how they help pay everybody's medical bills

As an auctioneer pressed his Hartly audience toward the highest bid possible for a set of dishes, an Amish man watched from the side of the tent, his arms crossed as he leaned on a tent pole.

No older than 40, he has buried two children in the past year.

Not too far away stood an Amish bishop whose daughter had heart surgery at age 20. She will likely have a pacemaker for the rest of her life.

Another nearby man, who lost his first son to a rare genetic disease, looked at piglets and chickens with his daughters. 

For the past two decades, the Dover Amish have held a public auction every May to help pay for community members’ medical expenses. Amish and non-Amish can buy pies, farming equipment, antiques, livestock, pets and even buggies.

The auctions can raise tens of thousands of dollars, all of which is dedicated to families’ hospital bills.

Many in Delaware’s small Amish community know someone faced with staggering medical bills —  a neighbor, a best friend, a cousin, a daughter or themselves. Some of the sickest children in the community die from rare genetic diseases. 

Since the Amish do not believe in insurance, they pay for medical bills themselves. When a child becomes sick, families pool money to help cover health care expenses.

Donald Kraybill, a professor at Elizabethtown College and an expert on Anabaptist groups, said the Amish don't buy insurance because the “Bible teaches them that Christians should help take care of one another.”

It's one reason the Amish are exempt from paying into and receiving Social Security. They do pay income, property, sales, estate corporate and public school taxes — in addition to paying a tax for private Amish schools. 

Amish views on healthcare often depend on the views of each congregation, Kraybill says. Since there are 2,400 congregations in the United States, there are about 2,400 ways to be Amish, he said.

Kraybill believes the development of the Clinic for Special Children in Strasburg, Pennsylvania, has helped change Lancaster and Dover Amish's views on medical treatment.

The clinic has cared for Amish children with genetic diseases for three decades. Doctors there have gained the trust of the community, resulting in the Amish being willing to try a wider variety of treatment than might be expected.

“That really opened up the Amish here to accept modern health care, particularly DNA and genetic testing,” Kraybill said.

Dover resident Toby Miller isn’t sure how he and his wife Laura could have paid for their son John David’s medical bills without his community.

John David, who died in 2015 at 25 months, suffered from a rare genetic condition. Doctors' efforts to help resulted in hospital bills that were nearing the millions.

“There were times we were down to the nitty gritty,” Toby recalled.

When family members or friends would visit the Millers at Nemours/A.I. duPont Hospital for Children, many would hand them money because they knew the family needed it. The community held several fundraising dinners for the Millers, and the elders allowed the family to go on Medicaid toward the end of John David's life.

Ervin and Betsy Miller, who are related to Toby and Laura, had different experiences when it came to health care costs for their girls, Carolyn and Martha Anne. Both daughters died before their first birthday. 

When Carolyn was sick in 1997, all the hospital medical expenses were covered by the Nemours Fund for Children's Health, says Ervin, a dairy farmer. The fund, created by Alfred I. duPont, who died in 1935, covers medical bills for Delaware’s sickest children.

By 2005, the hospital had changed its policy and did not fully cover Martha Ann’s bills.

Twenty years ago, the hospital provided charity care to Amish families because their beliefs exempted them from benefiting from programs such as Medicaid, said Bill Britton, Nemours' vice president of finance, in a statement.

Martha's Ann's family chose not to go on Medicaid. 

After she died, the Amish set up a system in which families donated a day’s wages to a health care fund every month. The auction for hospital bills was created shortly after.

“That actually made a huge difference,” Ervin said.

Nemours continues to look at families income and expenses when deciding if they are eligible for charity care, Britton said. It offers a discount on medical and hospital bills to Amish families. Some doctors say it can be up to 80 percent.

This discount is reasonable, Britton said, compared to what's charged by competitors such as the Children’s Hospital of Philadelphia, Penn State Children's Hospital and UPMC Children’s Hospital of Pittsburgh. 

But sometimes the Nemours discount and community funds are not enough.

Felicia Bracken, a pediatric care coordinator at Highmark Health Options, says a handful of Dover Amish families temporarily use Medicaid, often when the cost of a child’s care is “astronomical,” she said.

Brackin, who previously worked at Nemours, said every family she’s worked with has consulted community leadership before signing up.

In many cases, families will still insist on paying for certain services, she says. A common example is the family allowing Medicaid to cover the costs of a feeding pump, but paying for the child’s formula themselves.

Brackin and other Nemours doctors have heard of families paying Medicaid back.

In her work with the Amish, the social worker has found that community members “genuinely want to take care of each other.”

“How beautiful would that be if we all modeled that?” she says. “In whatever aspect of our lives, we just took care of each other. That would be amazing.

“Think about how different our world would be.”

Contact Meredith Newman at (302) 324-2386 or mnewman@delawareonline.com and on Twitter @MereNewman.