RACHEL MARTIN, HOST:
Now, to Indiana, where members of the Amish community are trying to figure out what the Affordable Care Act means for them, specifically the law's requirement that every person have health insurance. The Amish are religiously opposed to commercial insurance and they pride themselves on taking care of their own. Here's Dennis Lehman. He is the president of an Amish community health clinic in Topeka, Indiana.
DENNIS LEHMAN: We've always shared each other's burdens, so to speak. We help each other with free-will donations.
MARTIN: Lehman explains how the free-will donation system works when a member of the community gets sick.
LEHMAN: They would travel to their local hospital. They seek treatment just like any private payer would do. And then when they are billed, the bill would go to the individual. If the individual cannot pay for the care, he can turn it over to the church and the church will help him with this.
MARTIN: They also have someone called a bill negotiator to bargain for lower prices, much like an insurance company does. And if the local church still can't cover the bill, the deacons reach out to neighboring Amish churches. Sometimes they'll hold auctions to raise the money.
CHRIS ROBERSON: Community members will donate livestock, furniture, quilts, baked goods, and they can raise a hundred, two hundred, three hundred thousand dollars in one evening.
MARTIN: That's Chris Roberson. He's an attorney based in Indianapolis and he's working with the Amish community to figure out how to integrate a centuries-old tradition with a modern health care law. While the Amish are opposed to the very notion of insurance, in part because of their beliefs in self-sufficiency, they are not opposed to modern medicine.
ROBERSON: The Amish community is, I think, a very misunderstood community. They do have many reservations when it comes to modern society but those reservations, in my experience, seem to be predicated on what about modern society might separate them from their ultimate objective of finding a way to heaven essentially. So, when aspects of our modern culture don't seem to interfere, they are very open - albeit cautiously - to aspects of modern society, including medicine.
MARTIN: We should point out here that there is a religious exemption to the new health care law, specifically intended for communities like the Amish. The problem is that some of the Amish in Indiana work for businesses that are not owned and operated by Amish members. Because of this, they don't have the tax status needed for that exemption. Roberson has helped the Amish figure out another way to comply with the insurance mandate. There's a provision in the health care that allows for what's called health care sharing ministries. These are sort of health care co-ops for people of a common faith. But Roberson says that exception wasn't written with the Amish in mind.
ROBERSON: Historically, there have been three or four large national health care sharing ministries associated with very conservative Christian churches. And it was the sort of lobbying or advocacy efforts of those entities that led to this language being put into the Affordable Care Act. So, I'm not sure that Health and Human Services has really contemplated any additional health care sharing ministries stepping forward and seeking exemption.
MARTIN: So, the Amish in Indiana have been working with the IRS and the Department of Health and Human Services to make sure their program complies. But there are substantial hurdles.
ROBERSON: This system of paying bills in the Amish community that has existed for decades has existed very informally, so to somehow establish membership is going to be a little tricky. Fortunately, the Amish community recognizes what an important issue this is and we're hopeful that we'll be successful.
MARTIN: Roberson is now trying to formalize the traditional Amish system with annual fees, membership cards and careful recordkeeping. So, there will be red tape to cut through, and the changes will be more cumbersome than, say, auctioning off handmade furniture and quilts. But if it works, it will help the Amish navigate between their faith and modern medicine.
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MARTIN: Coming up later this hour, family secrets. For the first 18 years of his life, Steve Lickteig thought he was adopted, but his personal history turned out to be far more complicated than that. So, he turned the camera on his family to try to understand why they kept his true identity a secret for so long.
STEVE LICKTEIG: She looked at me, my mother, and said I have no idea what you're talking about. And I said, you know, well, I know everything. I know what the truth is. And she kept denying and denying. And finally my dad slammed his hand down on his Lay-Z-Boy and said dammit, will you just tell him?
MARTIN: Stay with us for a conversation with Steve Lickteig about his film "Open Secret." Transcript provided by NPR, Copyright NPR.