As the U.S. farming population continues to age and shrink in numbers, many farmers face the painful and costly reality of being unable to secure affordable health care. A 2015 multi-state case study revealed 65 percent of farmers identified health care costs as the most serious threat to the economic viability of their operations.

Through recent farm bills, Congress has attempted to stimulate ag sector growth by funding new farmer/rancher programs designed to attract a new generation of farmers through training and education. Despite their good intentions, they did not consider how healthcare is critically needed to support rural economic development.

One negative impact of the Affordable Care Act (Obamacare) has been the consolidation of health care facilities and a reduction in health insurance options. The law prohibits affordable catastrophic policies for people over the age of 29.

“The fact that farmers placed cost of health care as a more serious economic risk than land costs, inputs, market conditions, or pressure to expand, speaks volumes about this issue and how it’s framing the national debate surrounding it,” says Twila Brase, RN, PHN, president and co-founder of Citizens’ Council for Health Freedom (http://www.cchfreedom.org/), whose “Health Freedom Minute” is heard on over 800 radio stations in 47 states.

A national organization based in St. Paul, Minn., CCHF supports health care choices, individualized patient care, and medical and genetic privacy.

If you are reading this and you farm, there is a 72 percent chance you or someone in your family brings in off-farm income to maintain health insurance. That can be not only stressful, but takes time and energy away from the farm and the family.

“Some farmers have suggested the need for a national health insurance policy, but that won’t improve access to care or open closed hospitals,” adds Brase, who was raised on a farm. “It’s a costly security blanket without security.”

For uninsured farmers, a health care crisis is a cost crisis. “Many farmers don’t have the money to cover the cost,” says Brase. Most farming assets are not liquid and the only way to acquire financing is to sell the operation, or parts of it.

“Deductibles and payments have escalated over the years as the entire healthcare industry continues to consolidate under the ACA.”

The Health Maintenance Organization (HMO) Act, enacted in 1973, promoted and encouraged the proliferation of health maintenance organizations. With $375 million of funding to develop HMOs around the country, it gave them a competitive advantage over catastrophic coverage. Then the ACA prohibited catastrophic coverage with few exceptions, while mandating managed care health plans for all. “This made coverage unaffordable for much of the population, including many farmers,” says Brase.

The much-talked-about mandate and penalty portion of Obamacare has not been repealed. Now, instead of $695 or 2.5 percent of your income as the penalty for not being covered, it is zero dollars and zero percent of your income. “Nothing else has changed,” reminds Brase.

 Hardships and Coverage

There are nine primary exemptions under the ACA. The ninth category is entitled Hardship Waivers. To date, the U.S. Department of Health and Human Services allows 14 exemptions under this category. “From an exemption based on premiums exceeding a specific level of income, to an employer discontinuing to offer health insurance, being qualified through an exemption is one possible path to obtaining a catastrophic insurance policy,” says Brase. “Having no income is another exemption.”

Once an exemption is met, applicants may then seek catastrophic coverage through one or more private companies that can be found by logging on to www.ehealthinsurance.com. It is important to remember, health care/insurance exchanges can only sell Obamacare-compliant policies. “If a catastrophic policy isn’t offered in your state, you’re simply out of luck,” adds Brase.

Unfortunately for a great number of farmers, even if their assets are tied up in the operation, their overall income can put them outside of the exemptions and the subsidies that are available on the government exchange.

“The study also found over 50 percent of surveyed farmers were concerned they would have to sell assets to fund long-term, nursing home, or in-home health care,” says Brase. “That could potentially mean the only way they could solve that problem would be to sell their farm, which would mean the farm couldn’t be handed down to the next generation.”

 Burdensome Laws, Options

The American Recover and Reinvestment Act (Recovery Act) mandated government-certified electronic health records for all clinics and small hospitals. The high costs associated with electronic health records have forced the consolidation of many rural hospitals and clinics across the country. “The problem is this unfunded mandate has, consequently, taken away ready access to these facilities for many farmers and their families,” adds Brase. “Those impacted must now travel long distances to see a health care provider, and we all know farming is an all-day work venture.”

Telehealth Networks are one option farmers and other rural citizens might consider. Services like Vertuwell (https://www.virtuwell.com/), that treat a variety of common conditions, provide 24/7 on-line diagnostic services where, for a fee, patients converse with either a physician or nurse practitioner and receive a diagnosis. These telehealth services allow live conversations with a health care provider via audio or video technologies. For either option, the health care provider and patient are in two completely different locations.

One telehealth-based program in Arkansas, AR SAVES (Stroke Assistance through Virtual Emergency Support) has treated over 1,000 patients since it was launched in 2008. It has grown to 48 partnering sites across the state.

Another option expanding across the U.S., cash, check, or charge, direct-pay practices, can be found at The Wedge Health of Freedom (www.jointhewedge.com). “All of the participating doctors don’t sign contracts with insurance companies or the government, so they don’t have third-party overhead costs, which some doctors have told me comprise as much as 50 percent of the price of health care,” concludes Brase, whose organization launched the Wedge in 2016.