Jonas Stoltzfus wanted to have cervical spine surgery to relieve the extreme pain he suffered as a result of an accident.

In the U.S., the operation would cost about $75,000.

So the New Holland Amish man had the surgery done in Tijuana, Mexico, for about $20,000.

Many Plain people here travel to Mexico and sometimes Canada for cheaper or alternative health care treatment and medicine.

A new law requiring travelers to carry a passport no matter where they're going outside the United States will force some Plain people to make a tough choice: Follow their religious directive and not be photographed, or get the medical care they want.

America's latest measure to protect the country from terrorism clashes with one of its most revered rights: religious freedom.

"I appreciate the country is taking all these efforts to avoid terrorism," Stoltzfus, 41, said on Tuesday, "but to do a photo would be against my religion."

Area Amish leaders have recruited the help of U.S. Rep. Joseph Pitts, but he says changing the requirement will be an uphill battle.

"If you use religious exemption on photographs, there are Islamic groups with women who don't want their faces shown as well," Pitts said. "You have to be very careful about this."

The new regulations that include the passport requirement were adopted by Congress in 2004 to secure the borders against terrorists.

Last month, the rules went into effect for air travelers. Land and sea travelers will have to show passports starting in January 2008.

The only valid substitutes for a passport will be an Air NEXUS card, used by some American and Canadian frequent fliers; a U.S. Coast Guard Merchant Mariner document; and an Alien Registration Card, for legal permanent residents who are not U.S. citizens.

Active members of the U.S. military are exempt.

Pitts said the law is "pretty rigid" and would be difficult to amend.

New legislation likely would be required, he said.

Pitts is exploring whether a fingerprint or retinal scan could be used instead of a passport photo.

If such technology could be made available at a location along the Mexican and the Canadian borders, he said, the issue might be resolved.

"I've raised the issue among some of my colleagues," Pitts said. "I don't know if it has the votes yet.

"Amish certainly aren't a threat to our national security, so there should be a law so you can accommodate them," he said.

A few Amish said some may choose to pay the higher price for medical care here instead of getting their picture taken.

But they said others may just decide not to get necessary health care because of the financial burden it would cause their family.

"If you cannot pay your bills, it is a big stress on the family," said Stoltzfus, father of 11 children.

Would he have his photo taken for a passport?

"Definitely not," he said. "If nothing else is available, it will keep us from getting our health taken care of the way we're used to."

Stoltzfus, like many Plain people, does not have health insurance.

Many pool their resources in their community to help with extreme medical costs, however.

In Mexico, health-care treatment and drugs are often less expensive than in the U.S. Also, some drugs not approved by the Food and Drug Administration are available.

Plain people are often very open to alternative medicines, Stoltzfus said.

He said he and several others have had good results from health care received in Mexico.

Dr. D. Holmes Morton of the Clinic for Special Children outside of Strasburg warned that patients should be cautious about choosing alternative medicines and what sometimes turn out to be illegitimate health clinics in Mexico.

Morton knows that some elderly go outside the U.S. for cheaper knee transplants, and he knows of three children who went to Montreal for surgery related to seizures.

Often, cancer patients who have been told there is nothing more that can be done here go abroad seeking alternatives, he said.

Morton said he thinks some Amish will choose to have a photograph taken, since it already is allowed for some official and medicinal purposes.

"I guess if it comes to pass, we'll just stay home or follow the law," said an Amish businessman.

Another Amish man who did not want to be identified said some patients come from Canada to this area for mental health and other treatment, and he said they also will be affected by the new passport requirement.

Previously, only a form of identification such as a driver's license or birth certificate was required, he said.

Amish taxi driver Cletus Ressler, of Leola, said he will have to get a passport, too, since he sometimes drives Amish people to Canada for a variety of reasons, including vacations at Niagara Falls.

Stoltzfus said some Amish have traveled by train to Mexico for years. They've received treatment for everything from serious ailments to dental work.

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