ARTHUR — In many ways, Douglas County resembles most of its neighbors in eastern Illinois: a patch of rich Midwest farmland with a small population and an economy that provides comfortable incomes while keeping unemployment relatively low.
It stands out, however, as a county with the second highest percentage of Illinoisans without health insurance, stemming from the jet-black, horse-drawn buggies that roll up and down the county’s roads and the Mexican workers who arrived in recent decades to make brooms.
Douglas County — and the area around Arthur in particular — is the heart of an Amish community that dates to the 1860s. More than 2,300 people here are Amish, almost 12 percent of the population — and the Amish don’t buy health insurance.
Douglas also has a large Hispanic population for rural east-central Illinois, just short of 6 percent. And Hispanics in the U.S. are more likely to be uninsured than the rest of the population — about 31 percent lack health coverage, according to the U.S. Census Bureau.
“We see people come through the door every day that, with insurance, would be able to treat and manage their conditions much better,” said Susan Hays, director of nursing at the Douglas County Health Department.
With the full launch of the nation’s new health care law just weeks away, millions of uninsured Americans are contemplating whether to sign up for coverage. Their numbers vary from one place to the next, even within the same state or region, as do the chances that advocates will succeed in bringing them into the ranks of the insured.
In Illinois, 1.8 million residents are uninsured, or 14 percent of the population, according to Census Bureau estimates from 2012 and 2013. That’s squarely in the middle of U.S. states, with Texas at the top of the list at 24 percent.
Cook County has Illinois’ highest rate of non-elderly uninsured, 18.8 percent, according to census figures from 2011, the last available count at the county level. The lowest rate was in Monroe County, 8.2 percent.
In McLean County, according to the Kaiser Commission on Medicaid and the Uninsured 2013, about 10.4 percent of the population was uninsured before rollout of the Affordable Care Act.
The uninsured tend to be adults younger than 65. Many are immigrants, according to Chicago-based demographer Rob Paral, and many are the working poor. They make too much money to qualify for Medicaid or other government help, but either can’t afford or have chosen not to get insured.
But look closer at places like Douglas and Moultrie County, just to the west, and you find notable exceptions. In Douglas, 17.6 percent of residents did not have coverage according to the 2011 figures, largely because of the Amish. Another 1,200 Amish live in Moultrie, where the uninsured made up 12.4 percent of the population.
The Amish will not be required to sign up for insurance under the Affordable Care Act that provides exemptions for religious reasons. But to say the Amish are uninsured doesn’t tell the whole story.
They have their own system, through their churches, where members pool money to help each other. They negotiate discounts with doctors, clinics and hospitals when they can. And those discounts often allow Amish families to pay bills upfront without ever tapping their safety net.
Richard Otto’s wife recently had surgery that cost more than $10,000. The 40-year-old Amish co-owner of a shoe store and father of five, said it was a debt he chose to pay on his own.
“They offered us a fairly big discount if I paid it all upfront,” he said.
The reasons Amish don’t buy insurance are religious and cultural, according to Ohio State University professor Joseph Donnermeyer, who specializes in rural sociology and Amish communities. The same factors that drove the Amish from Europe to North America, including religious persecution, fuel “their reluctance to be connected to mainstream organizations of any kind, including insurance companies,” he said.
“They latched onto New Testament passages basically from St. Paul that you should not be ‘yoked to the world.’” Donnermeyer said.
Less exposed to mainstream media messages, the Amish are not reminded constantly about health threats. But they also see advantages, both financial and religious, to having their own system.
“It’s Christians helping Christians,” said Oba Herschberger, a 65-year-old Amish farmer. “If the whole world would do this, we wouldn’t need any insurance.”
Fifteen miles east of Arthur is Arcola, a town of 2,700 around which the county’s 1,178 Hispanics are clustered — more than a quarter of the town’s population, according to census figures. By contrast, most surrounding counties have Hispanic populations of less than 1 percent.
Immigrants from northern Mexico started coming in the 1960s to work in factories where a type of sorghum known as broom corn was turned into brooms and mops, said Tim Flavin, director of Mi Raza Community Center. Most of those businesses have closed, but the immigrants stayed and found other jobs.
Immigrants living in the U.S. illegally are not eligible for the health law’s benefits. Despite promotional efforts, others are choosing to go without, too.
Rolando Ambriz came from Mexico in the 1970s. The 54-year-old’s broom factory job helped him put a daughter through the University of Illinois and provides health insurance but he knows many others who won’t buy it.
“It comes down to money,” he said. “As far as I know, not many people have opened up and said, ‘OK, I’m going to get it.” ’