by Deena Shanker 

From doctors' and hospitals' groups to the AARP, the opposition to Republican bills to repeal and replace the Affordable Care Act has been widespread. One group of Americans who have been watching the campaign against Obamacare closely: farmers.

In a recent survey led by the University of Vermont, three out of four U.S. farmers and ranchers said health insurance was an important or very important risk management strategy for their businesses. The vast majority—92%—said they had health insurance in 2016. That’s about the same as the general population, at 91%. But insurance plays a special role in farming, one of the most dangerous industries in the country, and one that plays a vital, if often distant, role in every American’s life.

About 100 agricultural workers a day are injured on the job. When Taylor Hutchinson of Footprint Farm in Starkville, Vt., was cutting lumber for the farm’s first greenhouse, she got a piece of pressure-treated wood sawdust in her eye, sending her to the emergency room. Thanks to her Medicaid coverage, she didn’t have to pay out of pocket.

Young farmers such as the 30-year-old Hutchinson, a group that is already precariously small, have benefited from Obamacare in several ways. One out of four farmers and ranchers 18 to 64 years old had bought an insurance plan on a marketplace it created, and 41% of young farm and ranch families (18 to 34 years old) were enrolled in a public insurance program such as Medicaid or the Children’s Health Insurance Program.

Many farmers are taking advantage of Medicaid for the first time because the ACA, which greatly expanded the health-care program for the poor and disabled, allowed for a separation of income and assets, helping farmers who are “land-rich and cash-poor.” Under Obamacare, “because salaries from farming are often so low, many farmers were eligible for Medicaid or got subsidized,” said Shoshana Inwood, lead researcher on the survey and an assistant professor in the Department of Community Development and Applied Economics at the University of Vermont. Not all states participated in the Medicaid expansion, so the benefits haven't been felt equally nationwide. 

Sixty-four percent of farmers and ranchers report having a preexisting condition, and with the average age of principal farm operators at 58, this population could have been at particular risk of higher insurance premiums under the legislation.

Tina Hinchley, a 51-year-old dairy farmer in Wisconsin, was without insurance in 2006 when she was diagnosed with brain cancer. While her family had had catastrophic-coverage plans in the past, they found the plans covered very little, so she was uninsured when she got her diagnosis. That was before Obamacare required insurance plans to meet certain basic needs. 

“You thought you had coverage, but you really didn’t,” Hinchley said. The brain cancer left her with a $187,000 medical bill. “We considered selling land.”

The need to sell off pieces of the farm, or all of it, to pay off medical costs is a common fear among farmers. Forty-five percent of survey respondents worry they’ll have to shed farm or ranch assets to cover health costs such as nursing homes or long-term care, and 52% aren’t confident they could cover the costs of a major illness without landing in debt.

The campaign against the ACA may not be over, having appeared to fail before, only to be resuscitated. And the lack of a bipartisan effort over the years to repair Obamacare's serious flaws, including sharply rising premiums and insurance markets with diminishing choices, is itself a problem. The turmoil caused by the repeal effort has made insurers skittish and contributed to the markets’ loss of stability. 

“The price jumps that we see every year, we can’t sustain it,” said Shelly Kelly, a cattle rancher in Nebraska. Right now, only one insurer is set to offer insurance in her state in 2018, and Kelly said that even though the majority of Nebraskans purchasing insurance on the exchange qualify for subsidies, her family doesn’t. Nebraska is also one of the states that chose not to expand Medicaid under the ACA. That decision has been linked to higher premium increases.

“We would like to have the choice on how much coverage we have,” Kelly said. “We would like to have the option to get cheaper policies.”

Hinchley said she eventually paid off her bill with the help of Catholic charities. Her family now has health insurance, and she goes in for annual routine checkups to guard against the cancer’s return. She worries about what could happen to her under any new legislation as someone with a preexisting condition.

Nearly three-quarters of farmers 18 to 64 had off-farm jobs in 2016 for extra income and insurance, taking time away from farming. “I’d have to leave the farm to pay household expenses,” said Hutchinson, who runs the small Vermont farm with her fiancé. She also worries that if the ACA’s subsidies disappeared, they would lose their two employees, who have helped them double the farm’s income this year and might have to look for better-paying jobs. 

As Congress has hashed it all out, farmers and ranchers, like many Americans, have been concerned their voices wouldn't be heard. Three out of four farmers and ranchers said the Department of Agriculture should represent their needs in these policy discussions, even those that generally prefer less government intrusion into their lives. (The USDA didn’t respond to a request for comment on its role in the health-care debate.)

“Many farmers say, ‘I don’t want the government telling me to put a seat belt on,’ ” Inwood of the University of Vermont says. “But you say, ‘Do you want the USDA involved in this?’ and they say, ‘Yes.’ ”

To contact the author of this story: Deena Shanker in New York at [email protected]

To contact the editor responsible for this story: Peter Jeffrey at [email protected]

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