It was a cold day in March when Joseph Keim got hurt.
He was out in the woods of his father’s Borden Road property with his brother when the two-foot circular blade of the brush saw they were using bound in a log, tuned sideways and spun at high speed into Joseph’s stomach.
“When I got there, he was lying on the ground holding his guts in with his hands,” said Atlee Keim, Joseph’s dad.
Joseph was rushed to Albany Medical Center Hospital, where doctors stitched up a more-than-12-inch gash all the way through the skin and muscle of his stomach and repaired a second long cut through the tendons and main arteries of his right forearm.
He lived to make a full recovery, but shortly after the accident, the family got a collection of bills from the ambulance service and Albany Med totaling $150,000.
The Keim family is Amish. Their religion forbids health insurance, so there was a moment of trepidation.
This was nearly two years ago, before the bulk of the Affordable Care Act took effect.
Six-figure bills charged to an uninsured family may seem like a good argument for mandatory health insurance, but in fact, the Amish are exempt from the law’s individual mandate. The Keims and thousands of other Amish people across the state are allowed to go without health insurance as they always have, even as most other Americans will face fines for going without starting next year.
Karen Johnson-Weiner, a professor of anthropology at SUNY Potsdam and expert in Amish studies, explained why the Amish fall into that religious exemption category while, say, a group of Baptists might not. That’s because tucked into the federal legislation is an exemption that allows certain religious sects to opt out of the system without incurring penalties.
Church might seem to be unrelated to health insurance, but Johnson-Weiner said Amish people are allowed to opt out because of the integral part church plays in their lives. “Churches are a much bigger deal to Amish people,” she said. “If you’re Amish, you are always in church.
“When someone gets hurt and has to go to the hospital,” she said, “a deacon in the church will go around to all the church families and just collect the money to pay the bill. They’re not required to get health insurance because the government feels they already have a form of health insurance.”
Most Amish feel that formal insurance would cheapen the willingness of their aid, she said.
Her words played out in the Keims’ situation. Less than two years after the accident, their medical bills are paid. On Tuesday, Atlee was working with some friends and family moving straw bales in a cold barn on his property. Joseph, a highly resilient late teen at the time of the accident, is fine — strong enough to be out working with another crew miles away.
“That’s the saw right there,” Atlee said, pointing to a big steel-framed machine. Imagine a wheelbarrow with a small engine instead of a bucket and a roughly two-foot circular saw in place of the front wheel. “I don’t let people get all that close anymore.”
Aside from that new caution, the accident changed almost nothing for them. They never had any sort of insurance and always paid for medical bills out of pocket or with help from the church. They handled the $150,000 charge in the same way.
“You know insurance companies negotiate the cost of medical bills,” he said. “We do the same thing.”
They were able to haggle down the cost of the operation to such a small fraction of the original charge that Atlee just paid it himself. In a worse circumstance, though, he said his church would have pitched in.
New York state has the fastest-growing Amish population in the country, with more than 12,000 at the last estimate. In Montgomery County, there are two large settlements, in Fort Plain and Glen, where the Keims live. Between the two towns, Johnson-Weiner said there are seven church districts, each with 20 to 30 families. All of those families, she said, would be prepared to help in an emergency.
“Every Amish person in that area, between church and extended family, has 200 people they could go to for help,” she said.
A few miles away on Logtown Road, Albert Mast, the 18-year-old son of Aden Mast, heard about Joseph’s accident shortly after it happened and kept in touch through his recovery.
“He’s a tough guy,” Mast said.
At the time, he said his family and everyone in the Amish community was ready to help pay the medical bills. It’s a system that has functioned for many years.
Even so, Diane Dewar, an associate professor of health policy at the University at Albany, is concerned about the uninsured Amish population — not so much for the Amish themselves but for everyone else.
“People who don’t have health insurance are less likely to get preventative care,” she said.
That includes early treatment of contagious diseases that could spread to the population at large.
“Amish people don’t usually vaccinate their children,” she said. “I understand there are some religious and cultural forces at play, but what if we all did that? Polio might come back.”
The Affordable Care Act put another issue on the table. Now the population as a whole is bound together, as Dewar explained it, so that very healthy people subsidize the care of more illness-prone individuals.
“We need a lot of healthy people in the pool,” she said. “They pay premiums and never go to the doctor. They’re great.”
By that measure, Amish people are ideal candidates for the new health insurance system. While they might occasionally get rushed to Albany Med with major injuries, she said, most of the time, they deal with their health problems on their own.
The last time Mast went to the hospital, he thought he had a broken leg. That, he said, is the threshold for most Amish people.
“We take care of most things at home,” he said.