Farmers Face Prospect of Skyrocketing Healthcare Premiums

The expiration of insurance subsidies could hit dairy farmers the hardest. Uninsured rates among this group are significantly higher than in other types of farming operations.

According to a 2015 USDA study, 41 percent of dairy farmers were uninsured, compared to 10.7 percent of all farm households. This is because their work requires milking cows multiple times a day, which makes it challenging to have an off-farm job to supplement income or get access to employer-backed insurance. Dairy products also have tighter profit margins, which could explain the large divide in uninsured rates.

And now that these credits could be expiring, farmers across the spectrum are weighing difficult decisions and less-than-ideal alternatives.

Difficult Choices Ahead

Some farmers could opt to stay on their current plans and absorb the increased premium cost. But this could tighten already thin margins within their operation.

“Farming can be an incredibly taxing job, physically, emotionally, mentally,” said Maddie Kempner, policy and organizing director at the Northeast Organic Farming Association of Vermont. “So, having high quality and affordable healthcare is really critical to farmers and people who work on farms.”

The farming community has been anticipating the blowback from these credits expiring since at least June, Kempner said. Some farmers are considering purchasing high-deductible catastrophic policies. These plans have lower monthly premiums, but participants must pay for care until the higher deductible is met. These are largely beneficial to have in place in case of serious illness or injury, not necessarily preventative care.

Some farmers, like those living in states with abnormally high healthcare costs, are considering moving, Unangst-Rufenacht said.

Other farmers access healthcare through an off-farm job like teaching or construction. Becot found that about 60 percent of farmers have one of these jobs, though most would rather focus on farming full-time.

“We’ve heard a lot about how the way the health insurance system kind of holds back people from focusing on their businesses . . . and how that adds layers of stress as people have to manage a lot of demands,” Becot said.

With the credits potentially expiring, more farmers may consider taking up off-farm jobs to maintain insurance.

Farmers with inadequate coverage could split up pills or take partial doses of medication to expand the length of a prescription, or delay surgeries until they qualify for Medicare, Becot said. This all impacts their quality of life and ability to farm. It also means that the long-term cost of treating an illness or injury could be more expensive down the line, since the condition will likely have worsened, Becot continued.

“We often hear that farmers are a tough crowd, [that] they don’t want to go to the doctor,” Becot said. “The story that I’ve heard is, ‘It’s not that I don’t want to go to the doctor, but it’s not affordable, my health insurance won’t cover it, or there isn’t a doctor available in my area.’ ”

Some are even weighing going without insurance entirely. Farmers looking at an uncertain economic future may not know if they’ll have funds for care, Wertish said. “It’s going to have a huge ripple effect.”

How Farm Communities Will Feel the Effects

If a big chunk of a community drops out of the health insurance marketplace, hospital incomes will also be impacted. This will most affect rural hospitals that are already facing economic pressure and cuts from Congress.

Nationally, about 190 rural hospitals have closed or ended inpatient services since 2010, according to the National Rural Health Association (NRHA). This year alone, another 432 rural hospitals have been marked as vulnerable to closure, Carrie Cochran-McClain, chief policy officer at NRHA, told Civil Eats. That’s based on factors like negative operating margins, cash on hand, and other indicators of long-term financial health.

The Republicans’ One Big Beautiful Bill included changes to Medicaid that are also expected to have a significant impact on rural hospitals. On average, these hospitals are projected to lose about 20 percent of their Medicaid budget due to policy changes—including, for example, shifts in how a state pays for its Medicaid program, Cochran-McClain said.

The expiration of the ACA enhanced premium tax credits are expected to intensify all these issues for rural hospitals. Cochran-McClain said rural areas are more reliant on the subsidies. If farmers or others living in these areas drop their ACA marketplace coverage, this could push up overall insurance costs for everyone else in their community with ACA coverage.