By Hannah Packman, NFU Communications Coordinator
Access to affordable and effective health care is a fundamental concern for many Americans. However, farmers, ranchers, and rural communities face several unique obstacles to acquiring and paying for coverage. Rural communities experience higher rates of poverty, unemployment, chronic and mental health issues, and risky behaviors than their urban counterparts, all of which increase the need for health insurance and decrease ease of access. To compound the matter, farmers and ranchers face additional hurdles when seeking health care. While almost half of Americans are covered through their employers, food producers are often self-employed, requiring them to pursue health care options independently. These barriers are especially alarming given the dangerous nature of farming; risk of death, injury, and disability are far higher in farming, ranching, and fishing than in most other occupations, making access to health care particularly crucial.
Beyond the regional and occupational issues, beginning farmers and ranchers endure a third level of difficulty. When entering the field, new producers often have high upfront costs, as well as student debt, but do not have substantial savings or ready access to other forms of capital. Beginning farmers also face a great deal of uncertainty, as income can fluctuate significantly from year to year. Adding health insurance to the mix can strain a young farmer’s already tight budget. In many cases, farm families are forced to work off-farm jobs almost exclusively for employee health benefits.
In 2010, the Affordable Care Act (ACA) eased some of the burden by extending dependent coverage until age 26, incorporating premium subsidies based on income, expanding Medicaid, covering essential health benefits, and prohibiting the pricing or exclusion of coverage based on preexisting conditions. Additionally, the Health Insurance Marketplace makes coverage more accessible to many farmers. The current system isn’t without its flaws, however, and the marketplace has been marked by instability. Premiums are consistently higher in rural areas due to a lack of competition, and rural residents tend to have fewer health plan choices than urban residents.
Last week, the U.S. House of Representatives narrowly passed the American Health Care Act (AHCA), a bill that would repeal and replace the ACA. Although the ACA could certainly use some improvements, the AHCA is not the solution beginning farmers and ranchers need. It does not address the aforementioned pitfalls of the current system; indeed, it would erase much of the progress made under the ACA, depriving an estimated 24 million Americans of coverage by 2026, causing older American’s premiums to skyrocket, and jeopardizing access to affordable coverage for those with preexisting conditions.
The AHCA’s proposed limit on Medicaid expansion and cap on federal funding per enrollee would disproportionately affect beginning producers. It often takes several years for an operation to be profitable; in the meantime, beginning farmers might rely on public welfare programs, including Medicaid. Cutting support for low-income individuals could cause young producers to leave farming, a profession already heavily weighted toward older Americans.
Rural communities would suffer as well; rural Americans enroll in Medicaid at higher rates than urban Americans, and the hospitals who serve them are more dependent on Medicaid payments than their urban equivalents. Rural communities are already at an infrastructural disadvantage, with far fewer physicians per capita and greater distances to healthcare facilities. 78 rural hospitals have closed since 2010, most of which were located in states that opted out of Medicaid expansion. Slashing Medicaid funding will exacerbate the issue by starving rural hospitals of funding and forcing them to shutter, thus giving rural patients even sparser options.
This alone would be alarming enough, but the AHCA goes even further to weaken the protections offered by the ACA. Most notably, the MacArthur amendment would allow states allows states to opt not to cover the ten essential health benefits ensured under the ACA, many of which are critical for young producers. As previously mentioned, farming is an extraordinarily dangerous profession. If states opt not to cover ambulatory services, emergency care, hospitalization, and rehabilitative services, injured farmers would have to pay for those benefits out of pocket, whose prohibitive costs could be easily bankrupting. Furthermore, farmers with young families rely on coverage of pregnancy, maternity, and newborn care, all three of which states could choose to opt out of covering.
The amendment would also change the community rating provision, allowing insurers to charge higher premiums to those with preexisting conditions who let their coverage lapse. This would force many farmers into high-risk pools and leave individuals with preexisting conditions to contend with increased premiums, higher deductibles, and longer waiting periods for coverage. By some estimates, 1 in 4 Americans have at least one preexisting condition, meaning tens of millions of people under 65 could face higher healthcare costs.
The United States depends on the food, fiber, and fuel produced by American farmers and ranchers. As such, we need to be fostering the next generation of family farmers and ranchers by eliminating possible barriers to entry. The AHCA would make it even more difficult and expensive for young farmers and ranchers to access health care, and as a result, it could discourage them from choosing careers in agriculture. This flawed legislation would not just violate the basic human right to affordable and effective health care, but also threaten our national food security.
Did you purchase healthcare under ACA? What was your experience like? Share your thoughts in the the comment section below.