WASHINGTON — One of the central tenets of the health care legislation under construction on Capitol Hill is a mandate that every American be protected by some kind of medical insurance. There’s one exception to the mandate, though: people opposed to buying health coverage for religious reasons.
The emerging bills in both the House and Senate include language patterned on an existing “religious conscience” exemption to laws requiring workers to pay taxes for Social Security and Medicare. What’s not clear is whether the exemption, originally designed to apply only to the Old Order Amish, might be used by members of other religious groups — or those who just say they are — in order to evade the insurance mandate.
It’s probably not a large group: There are only between 200,000 and 250,000 Old Order Amish and Old Order Mennonites (with similar beliefs) in the United States, for instance. But data is thin. The IRS and the Social Security Administration say they don’t collate records on who files for the tax exemption or what religious affiliations they claim. Christian Scientists, who believe in spiritual healing rather than traditional medicine, might be able to file for exemptions to the taxes and to the health insurance mandate, but church officials and lobbyists declined several requests to discuss the matter.
According to the Web site of the Church of Christ, Scientist, believers do not object to all medical care or to purchasing health insurance: “Every Christian Scientist makes his or her own financial and health decisions,” the site says, including when and how to seek medical treatment and whether to carry health insurance.
In Massachusetts, where the Christian Science church is headquartered, the mandatory state health program offers a religious conscience exclusion, and about 9,700 people applied for it in 2007, the most recent year with complete data. The state program has penalties for those who apply for the exclusion and wind up visiting the doctor or the hospital anyway — and, two years ago, about 700 people who applied for the religious exemption were denied and fined, according to Robert Bliss of the Massachusetts Department of Revenue.
There is no similar penalty in the proposed language of the federal health care mandate. A senior Democratic aide involved in drafting the Senate bill, who declined to be named because he was not authorized to talk to reporters, said no member of Congress has pushed for penalties because the number of religious objectors are few and there has been little history of others improperly claiming the exclusion, at least for Social Security and Medicare taxes.
The tax exemption dates to 1965, when Congress included it in the revised Social Security Act (which also created Medicare) to settle a decade-long dispute with the Amish, who believe in a deep division between church and state. The Amish don’t object to paying taxes, and they routinely pay their income, property and other levies to federal and state authorities. But when the IRS began applying the Social Security self-employment tax to farm income in the 1950s — and confiscating farm animals to pay the arrears — the Amish resisted.
Amish farmers argued that Social Security was a form of public insurance, and their religious beliefs prevent them from taking part in public or commercial insurance. Instead, the Amish effectively self-insure within their own community: When a church member needs medical care, for instance, the family pays out of pocket and the church takes up a collection or reimburses them from a common fund.
“The Amish do not believe in accepting government help, and they believe profoundly in taking care of their own,’’ says the Rev. William C. Lindholm, a Lutheran minister and chairman of the National Committee for Amish Religious Freedom, which advocates on behalf of the Amish, who rarely venture into public debate.
What the Amish wanted to do, in effect, was opt out of the Social Security and Medicare systems entirely, and after a public backlash over the livestock confiscations, Congress decided to permit a narrow exemption for religious sects “opposed to acceptance of the benefits of any private or public insurance.”
To get the exemption, taxpayers must provide evidence they are members of a qualifying sect that has been in existence continuously since 1950. As Roberton Williams, a tax expert at the Urban Institute, put it, “People who try to set up their house as a church, well, that doesn’t fly.”
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