Threat of medical debt is a top worry for most farming families, says study about household-level farming stressors

Farming families are famously tough and resilient, but they face a host of challenges and fears. One of their top worries is that one of them might suffer an illness or injury that leads to significant medical debt, a recent study found after surveying 900 farm households in 10 states. 

According to the study, recently published in Agriculture and Human Values, more than 90% of farming households had health insurance in 2016, but 55% said they weren't confident they could cope with a major illness or injury without going into debt. That wasn't an unfounded concern, since 20% of farming households surveyed had medical debt of at least $1,000. That indicates that inadequate insurance is a problem for many farming families, according to study co-author Florence Becot. 

"The Affordable Care Act, or ACA, helped make medical coverage available to more Americans and benefitted farmers," Scott Heiberger reports for the Marshfield Clinic Research Institute in Wisconsin. "A provision of the ACA uses income and not assets to determine Medicaid and Marketplace subsidy eligibility, which decouples the family from the assets of the enterprise and addresses the 'land rich, cash poor' conundrum farmers often face. This provision allowed farm families a wider array of health-insurance choices via public health insurance and marketplace options. However, choices in the insurance marketplace can be limited, and health-insurance plans are often confusing. So-called 'skinny' plans – those with lower premiums but very high deductibles and out-of-pocket expenses – offer a weak safety net as people might avoid going to the doctor to limit costs, and a major illness or injury can result in medical debt."

The study matters, Becot and co-author Shoshanah Inwood write, because research on resiliency among farmers mostly focuses on problems such as fires, droughts, or economic trends. Little has focused on family-level concerns such as major illness, divorce, or off-farm employment. It's important to understand those things too, the authors write, because those stressors can lead farmers to sell their land and quit farming, further depopulating rural communities.