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ACA enrollment, reenrollment available online until Dec. 15



WASHINGTON, D.C. — A study from just a decade ago found that health care was the No. 1 concern of American farmers.

The Affordable Care Act (ACA) opened its enrollment and reenrollment period on Nov. 1. The period is only six weeks long, with the online system expected to be down on several Sundays. In addition to computer problems, budget cuts to the program mean there are fewer health care assistants in each state to help, said Matt Perdue, government relations representative for the National Farmers Union (NFU).

He said it’s difficult to tell where the farm ends and the farm family begins. Farmers consider every dollar they spend an investment – when they invest in seed or fertilizer, they see a return on the investment. Health insurance doesn’t offer an assurance of profit, though, and might be something they are less likely to purchase.

The problem with health insurance hits the farming population from two sides. Older farmers are more likely to have preexisting conditions and be cash-poor, two problems the ACA helped address by eliminating preexisting condition limitations or premiums on insurance rates, and offering stipends to help cover some cost.

The second problem is for new farmers, often young families, which are low on cash and assets. “Last year eight out of 10 individuals who bought were eligible for plans of $75 or less because of financial assistance from the ACA,” Perdue said. “Everyone wants to be covered, but the current instability scares them.”

He said the premiums shown when researching insurance aren’t set figures. Most people get financial incentives to join the ACA.

Shoshanah Inwood, assistant professor at The Ohio State University’s School of Environment and Natural Resources, was the project director for a research program focused specifically on farmers and health care.

“I’ve never done research like this, where farmers and ranchers are on the phone crying,” she said. “They were thanking us for researching this because no one has ever talked about it.”

About 14 percent of farmers surveyed for the HIREDnAg survey transitioned from an employment-based health insurance to different types of insurance, often the ACA, she explained. While the farmers still might have off-farm jobs to bring in extra income, they no longer have to work full-time off the farm, to return and work on the farm.

When considering health insurance, Inwood said the most important thing is researching options. She talked with many farmers who had more than one type of insurance in the household. One family had three types of coverage, with children on the CHIP program, the farmer on ACA and the wife of the farmer covered by an off-farm job’s insurance.

Inwood started the study when she worked at the University of Vermont. In 2007, she was conducting a study about how communities supported farmers. When asked what the biggest concern and cost was, the farmers said it was health insurance.

That answer spurred her to look into the issue. She received USDA funding in 2014. Her survey was conducted in 2016 across 10 states, with more than 1,000 farmers responding.

In 2016, 92 percent of farmers and ranchers reported they and their families had health insurance. About 32 percent had two or more plans within the same household.

About 75 percent of farmers have health insurance through an off-farm job. Nearly 20 percent of those work in the nonprofit sector and about 20 percent work in the private sector. The remaining 59 percent work in the public sector in health, education or government jobs.

The public sector jobs mean any cuts to funding can impact farm families, Inwood said. If a school system loses funding and needs to cut teachers, a farmer might lose their day job – and health insurance.

She said older farmers worry that a serious illness or injury will require them to sell the farm to pay bills. When it comes to retirement and long-term care, most don’t have the money to pay and might have to sell the farm for the highest profit. Selling the land for profit could mean less land is available to young farmers to buy.

Additionally, 82 rural hospitals have closed since 2010. The hospitals are often one of the largest employers in a rural area – a farmer could lose an off-farm job and easy access to health care at the same time.

Perdue said farmers in the NFU have been worried during 2017 as Congress tried to repeal and replace the ACA. Some of the changes discussed would cause the older farmers to pay higher premiums, up to five times current prices.

None of the proposals passed this year, but farmers still worry. Prior to the ACA, most weren’t able to afford health insurance without having an off-farm job, he said. “They’re worried they’ll go back to that,” Perdue said.

The survey results and more information about health insurance, rural economic development and agriculture can be found on the HIREDnAg website at

The NFU is providing information about open enrollment on its website,