Left Behind: A Political Battle for Affordable Healthcare for Farmers

As COVID-19 cases rise across the country, many rural hospitals are not equipped to handle a surge.

“Unfortunately, I most certainly think that we're at a crisis point right now,” says Alan Morgan, CEO of the National Rural Health Association.

He says rural hospitals are built for primary care and general surgeries, not pandemic surges.

“Standard protocol is once you need a ventilator and ICU treatment, you are transferred to a larger facility,” he says. “We're really uncharted territory now from a rural standpoint.”

With urban hospitals also near capacity, these rural areas have nowhere to send critical patients. It’s another challenge rural America is facing when it comes to healthcare.

“Rural Americans are more likely to be self-insured, or work for small employers that have insurances who have high copays and high deductibles,” says Morgan. “And unfortunately, this crisis–and what we see after it–is really going to push the need for some form of insurance reform as we move forward.”

As healthcare concerns are on the rise among rural Americans, Morgan says it’s a nationwide issue getting worse, not better.

“The most recent surveys I saw from Farm Bureau and National Farmers Union indicate somewhere upwards of 80% of the nation's farmers and ranchers have current concerns about their health care coverage. “

Morgan says climbing insurance rates are creating health insurance many small businesses, including farmers, can’t afford. That’s why he says reform to the current healthcare system is needed.

The Pain of Finding Affordable Health Insurance

Seventh generation dairy farmer Daniel Olson knows the situation all too well.

“Being self-employed, health care is a real challenge,” says Olson who is a dairy farmer in Lena, Wisc. He and his wife have eight children, and he says finding affordable health insurance is a problem.

“Even with really high deductibles of $10,000 plus deductibles for health insurance, I want to say we were paying maybe $2,000 a month, something like that,” he says, “It was not affordable at all.”

Michael Bergen in Nebraska was experiencing something similar. Climbing premiums and rising rates came to a breaking point for his family after their previous health insurance provider upped their costs again. 

“We were seeing anywhere from a 15% to 25% increase every year,” says Bergen. “We were going to go from $2,200 in 2019 to up to a projection of $3,000 a month for 2020. And at that point, we just said we can't do it.“

He says the decision to find new insurance was an emotional one.

“We have a son who's nonverbal,” says Bergen. “And a lot of our cost was because of him. So, what the health insurance company was doing was just passing the cost back onto us for what we were charging.”

Like many farmers, the Bergens knew they had to find a more affordable plan, but what that also would take care of their sons’ doctor and therapy visits. So they started searching businesses geared toward farmers and found a plan that worked.

“We added on dental and vision with Farmers Business Network’s insurance, something that we had not previously felt like we could afford, and we added those on and still - with those add-ons – our premium from the projection was $1,900 dollars a month savings.”

Searching for Solutions

FBN says the insurance division of the company - called FBN Health- was born out of farmer angst expressed in surveys.

“When we started creating a membership base about five years ago, we would always ask our membership, ‘how can we help you? What are the things that you want us to do for you?” says Lucas Strom, VP of business development and head of FBN's insurance division. “Healthcare was always one of the top two or three things. It was always the cost of it, or the availability or I don't understand it.”

Strom says FBN found some members were paying $25,000 to $35,000 a year for a family of four, an out of pocket cost that was hurting the farmers they represent.

“We found a partner for a lifestyle health plan, and it’s a product from Moldova Healthcare,” says Strom. “We negotiated on behalf of all of our membership across the U.S., for really good rates, really good premiums, and it's a really great group insurance product that works for a lot of farmers.”

Strom says when it comes to healthcare, it’s a complex issue and differs state by state.

“Ultimately, what we have here is, [the public option] works for some, but having another private option makes more sense than the government option for others,” he says. “That's not always the case. And the key is competition. The key is options.”

In Tennessee, the state Farm Bureau created a health insurance division in the 1940s, and even that state is seeing increased interest from farmers and ranchers looking for healthcare today. 

“We added nearly 250 new contracts to those plans that we're selling today in the under 65 market last month alone,” says Anthony Kimbrough, CEO of Farm Bureau Health Plans in Tennessee. “You're continuing to see to see growth in that in that market.”

Kimbrough says the increased interest is rooted from one major problem.

“It boiled down to an affordability issue,” he says.

Kimbrough says even with the Affordable Care Act (ACA) today, farmers, ranchers and other small businesses are unique.

“It’s that niche that really has almost been forgotten in all of the discussion surrounding the Affordable Care Act,” he says.

Kimbrough says the niche of small businesses, including farmers and ranchers, who operate under unique circumstances, became even more clear as a result of ACA.

“For self-employed individuals -as the majority of our farmers- if their income levels, which they can fluctuate greatly, but at many times, due to the fluctuation, you’re not eligible for the premium tax credits available through the marketplace.”

A Political Battle for Affordable Healthcare for Farmers

It’s not just Tennessee. Kansas Farm Bureau is close to finishing its first year of offering a healthcare option to members.

“We just heard consistently from producers of any ages, who were saying, ‘look, we can no longer afford to buy coverage for our families; it's too expensive, and we're spending $30,000 to $40,000 a year for high deductible plans that have limited networks that don't meet the needs of our family,’” says Terry Holdren, CEO and general counsel at Kansas Farm Bureau.

The Kansas Farm Bureau leaders says the organization started to turn over rocks and  found  affordable options for farmer and rancher members would take legislative approval, just like any other state Farm Bureau group would need to offer something in addition to what the marketplace has in the state today.

“We put together the concepts and wrote legislative language to give us authority to offer health care products to our membership, that are specifically in the state statute designed as not insurance,” he says. “Those key words take you outside the Affordable Care Act, and let you then use some of the old tools of underwriting and rating the risk to provide coverage or offer coverage to our members.”

While only members can sign up, Holdren says it was a grassroots effort. He says it was an effort that was a heavy lift, as the issue became a contentious political issue within its state legislature.

“Here was significant opposition from the insurance, the health insurance industry in the state who viewed us as competitive,” says Holdren. “We think that's good, being viewed as competition, but it also felt like they were saying we would potentially undercut their market in some way.”

Holdren says the issue of healthcare is political, but one Kansas Farm Bureau was able to navigate.

“We're talking about getting coverage to the 20% that are either on an individual plan through the ACA, or their operating on some other subsidized program, or about 8% of the folks in Kansas, they have no coverage at all.”

For Olsen, a shared healthcare plan through Christian Healthcare Ministries is a plan he found to be the right fit for his large family. 

“The way it works is, it's really family friendly,” says Olson. “Every adult in the family is one unit. So I’m one unit, my wife is a unit, and then all of our children qualify as one unit. In our family, we're paying for three units, and it's really reasonable right now, i think the gold level is $172 a month, and the silver level is like $118.”

The Future of Affordable Healthcare for All

While farmers and ranchers continue to search for solutions to viable healthcare plans, the National Rural Health Association knows it’s a growing problem nationwide.

“You've got people either love the Affordable Care Act or hate the Affordable Care Act, and we're gridlock because of that,” says Morgan.

Moving forward, Morgan thinks revisions to ACA are inevitable, especially with the new Congress.

“We're talking about how you enact legislative measures to make sure that healthcare is affordable for all Americans and that really is the goal on that,” says Morgan. “I think what we're going to see is some movement towards possibly lowering the Medicare eligibility age that will help out somewhat, certainly for our nation's farmers and rancher, which are generally an older population, and I think you're going to see more hopeful compromise as we move forward into the next congress on this.”

Public or private solutions, Kimbrough thinks competition will be healthy for the marketplace.

“We certainly believe that we can coexist with what's out there today in regard to the ACA,” he says. “A lot of folks have tried to make it the ACA or nothing, but we're not taking any options off the table that exists today, we're simply putting another option on the table. “

Morgan says ACA isn’t perfect, but with improvements, he says it’s a vital option moving forward.

“I'll be honest, if you eliminated the Affordable Care Act today, you would have more than 500 rural hospitals close tomorrow,” he says. “So, that is not an option.”

From Washington D.C., to grassroots healthcare efforts taking shape, there are still hurdles to overcome to create affordable healthcare for all.



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