(Two Amish men listen as U.S. President George W. Bush speaks at a campaign rally in Lititz, in Lancaster County, Pennsylvania, October 27, 2004. REUTERS/Kevin Lamarque)

The debate over U.S. healthcare reform that has gripped the nation and led to a government shutdown is of small concern in rural Pennsylvania’s Amish country for a very simple reason.

Along with eschewing cars and many other modern technologies, the descendants of 18th-Century German immigrants who practice the Amish and Old Order Mennonite religions, have effectively opted out of Obamacare, along with most federal safety net programs.

A little-known provision of the law with its roots in a 1950s battle over Social Security exempts these communities from the individual mandate, an element of the Affordable Care Act that requires most Americans to purchase health insurance in some form.

But it is not the idea of health insurance the Amish reject – the close-knit communities essentially insure themselves.