As health care insurance costs continue to climb, farm bureau health plans offer a lower cost alternative

Farm Bill health care plans have been offered in Tennessee
for over 75 years. (Tennessee Farm Bureau photo)

Affordable Care Act subsidies from the pandemic years made purchasing health insurance affordable for many Americans, but those tax credits expired at the end of 2025, leaving many individuals and families "confronting difficult choices because of rising Affordable Care Act premiums and other affordability issues," reports Michelle Andrews of KFF Health News. Farm bureau health care plans often offer a more budget-friendly alternative.

Farm bureau health plans tend to offer less comprehensive coverage and require physical exams to qualify; however, they can still provide substantial savings. Andrews explains, "Plan details vary by state, but they typically share many features of marketplace plans, including coverage of a wide range of services, a broad practitioner network, and a way to file complaints."

Fourteen states "allow health coverage through state farm bureaus, grassroots membership organizations that advocate for the agricultural industry and rural interests," Andrews explains. In general, anyone can join their state farm bureau, which typically costs $30 to $50. "With membership comes the option of buying into the health plan."

To help keep premium costs low, farm bureau health care plans screen their applicants through an underwriting process and will often deny coverage to sicker people. ACA plans have to take anyone who applies. Andrews writes, "In 2026, average ACA premium payments were estimated to increase by 114% for subsidized enrollees."

Because farm bureau plans can turn down people or exempt coverage for expensive or pre-existing conditions, their plans "may be 30% to 50% cheaper than unsubsidized marketplace plans," Andrews reports. For a healthier Americans, a farm bureau health plan presents a viable solutions to spiking premium prices.

Despite their stricter rules, farm bureau health plans are becoming more popular. Andrews adds, "Last year, Missouri was one of four states that passed laws permitting farm bureau health plans." Currently, farm bureau health plan coverage is allowed in Arizona, Arkansas, Indiana, Iowa, Kansas, Mississippi, Missouri, Nebraska, North Dakota, South Dakota, Tennessee, Texas, Ohio and Wisconsin.

Small businesses and their employees could lose health care coverage if ACA subsidies are cut

Farmers and their employees are among those who stand to 
'lose the most' if ACA subsidies are cut. (KFF Health photo)

As the debate over federal Affordable Care Act subsidies stalls efforts to reopen the government, small business owners worry that their employees won't be able to afford health insurance if the subsidies are cut. 

For lawmakers grappling with ACA decisions, any cuts could impact the 2026 Congressional elections.

Small-business owners such as farmers, dentists and barbers are among those "who stand to lose the most should Congress let the additional, generous federal subsidies put in place during the Covid-19 pandemic lapse," reports Amanda Seitz of KFF Health News. 

ACA subsidies cover nearly 24 million Americans -- and almost half of all those enrollees either own a small business or work for one. Collectively, the group "is more likely to vote Republican and overwhelmingly backed President Donald Trump in last year’s election," Seitz writes. But "even Trump’s own pollsters found deep support for the Obamacare subsidies."

According to Seitz, "Nearly 6 in 10 Obamacare enrollees live in a Republican-held congressional district."

U.S. Rep. Marjorie Taylor Greene, a Georgia Republican who is up for reelection in 2026, "broke with her party last month, calling on the GOP to extend the subsidies," Seitz adds. "Greene said in an interview that rising health care costs are the 'No. 1 issue' she hears about from people living in her district."

Coalfields increasingly rely on federal health programs, but top coal producer, Wyoming, won't expand Medicaid

Coalfield communities increasingly rely on federal health programs as the industry shrivels, Mason Adams and Dustin Bleizeffer report in the third installment of their "Transition in Coal Country" series for the Energy News Network and WyoFile, a Wyoming news nonprofit.

"Coal states that initially rejected Medicaid expansion now see it as a way to help stem some financial losses in healthcare and provide care to residents. Increasingly, the argument that expansion is vital to aiding coal communities’ transition to a sustainable post-coal economy is gaining traction," Adams and Bleizeffer write.

Kaiser Family Foundation map, relabeled  

Some coal states, including No. 1 Wyoming, haven't used the Patient Protection and Affordable Care Act to expand Medicaid, the federal-state program for lower-income people. "Still, shrinking tax revenues, jobs and resources in the industry are forcing the issue in many parts of coal country, and communities are becoming more reliant on — and even warming to — federal health programs like Medicaid," the reporters write.

Wyoming legislative leaders asked members in May to consider Medicaid expansion "in light of the coronavirus pandemic and historic losses in coal," they report, but there was no action. “I’ve been very surprised at the continued resistance to Medicaid expansion,” said Adam Searing, a research professor at Georgetown University’s Center for Children and Families. “I thought surely this would be the catalyst. But it’s still an uphill battle to overcome this ideological resistance.”

Roanoke-based Adams reports, "Medicaid expansion has remained popular in Kentucky and West Virginia, to the point that no one’s talking about repeal any more. In 2018, incumbent U.S. Sen. Joe Manchin, D-West Virginia, who had famously shot the cap-and-trade bill in a campaign spot eight years earlier, reprised the ad — only now he was shooting a lawsuit to repeal the Affordable Care Act. The message helped carry the Democrat to victory in what had been Donald Trump’s second-best state just two years prior."

The same day, in referendums, voters in Idaho, Nebraska and Utah approved Medicaid expansion. The next year, a newly Democratic legislature in Virginia did likewise, and in June, do did Oklahoma voters. Missouri has a referendum Aug. 4, with business interests supportive.

Searing said, “One thing that’s struck me is how Medicaid in the last five years or so has become much more popular than it ever was. People are seeing it more like Social Security or Medicare — not so much welfare but a safety-net program.” In Kentucky, the pandemic prompted the state to enact "presumptive eligibility," which waives the usual screening process for two months. “Basically, if you’re uninsured and you’re under age 65, it will get you coverage,” Dustin Pugel, senior policy analyst at the Kentucky Center for Economic Policy, told the Lexington Herald-Leader.

Read more here: https://www.kentucky.com/news/coronavirus/article244050667.html#storylink=cpy

Medicaid expansion kept hundreds of rural hospitals afloat; ACA repeal could put them at risk

Medicaid expansion brought a windfall to many rural hospitals, as millions of Americans gained coverage and were able to pay for care, but the looming threat of repealing the Patient Protection and Affordable Care Act puts "670 rural hospitals across the country at risk of shutting their doors," Jeff Lagasse reports for Healthcare Finance, citing findings from iVantage Health Analytics.

According to iVantage, which "examined rural hospital performance across a variety of measures," the expansion of Medicaid benefited rural hospitals the most, Lagasse writes. "Rural hospitals in expansion states, running on extremely tight margins, saw a significant improvement to their bottom lines, and provided a benefit to the estimated 62 million Americans living in rural areas, many of whom received health coverage under the ACA for the first time."

How does pulling the plug on ACA threaten rural hospitals? For starters, Lagasse notes, "many are not part of larger health systems, which gives them decreased leverage when dealing with insurance companies; they also don't have as much capital to invest in amenities such as facilities and electronic health records."

"There's a statistically significant impact on the rural median operating margins in states that expanded Medicaid," Michael Topchik, national leader of the Chartis Center for Rural Health and member of the iVantage leadership team, told Lagasse. Topchik implicitly touched on the politics of repealing and replacing the ACA: Many states President Trump carried, "like West Virginia, Iowa, Kentucky, Louisiana . . . saw a lot of people gain coverage either directly through Medicaid expansion or secondarily through the exchanges" for tax-subsidized insurance policies.

iVantage "estimated that that loss of Medicaid expansion would contribute to 137,000 fewer jobs in the broader community, with 99,000 of those jobs lost in the health-care sector," Lagasse writes. "The ACA used only federal funds from 2014 through 2016 to pay for the expanded benefits, and while that reduces to 90 percent by 2020, it's more than the 50- to 75-percent match that existed before ACA implementation" for traditional Medicaid. "Preliminary replacement plans from the GOP-led House would eliminate Medicaid expansion by 2020."

House health-care draft suggests a plan that could leave rural areas short of coverage

Photo from The Atlantic

A 100-page draft of a House Republican plan to repeal the Patient Protection and Affordable Care Act suggests that "millions of people in rural areas where it’s already hardest to find doctors might no longer be able to afford health insurance in a few years," Van R. Newkirk II writes for The Atlantic.

"The basics of that plan, which was unveiled by House Speaker Paul Ryan two weeks ago, and the rough shape of which has the support of new health secretary Tom Price and the Trump administration, are known," Newkirk reports. "The plan removes the individual and employer mandates to purchase and provide insurance, respectively, and it would also repeal most of the taxes that fund Obamacare. It would roll back funding for the Affordable Care Act’s Medicaid expansion and dramatically restructure the Medicaid program’s funding. Further, the plan would replace the Affordable Care Act’s cost-sharing subsidies and premium tax credits with an age-rated tax credit, all while keeping Obamacare’s popular pre-existing conditions ban."

The draft was leaked to Politico last week. It "specifies that Obamacare’s Medicaid expansion for low-income able-bodied adults won’t be completely eliminated, but the eligibility and funding will be rolled back after 2020. The draft also contains a provision changing federal funding for Medicaid in 2020 onward from an open-ended obligation to a system where the per-person spending every year is capped based on spending levels in 2019 and increased annually to correspond with medical inflation," Newkirk says.

The draft plan repeals the tax-based individual mandate and replaces it with an incentive to maintain continuous health-insurance coverage. "For people not covered by employers or public insurance who have to purchase insurance on individual, small group, or exchange markets, this proposal would allow insurers to charge up to 30 percent more in premiums to people who go without coverage at any point for more than two months, and also for young adults who don’t enroll in coverage as soon as they age out of their parents’ plans, a surcharge that would not be remitted as taxes to sustain the system, but would be paid as profits to insurers. The effects of this potential measure on individuals’ pockets are potentially limited by a reduction of federal oversight over what can be considered health-insurance coverage, which would allow people to avoid penalties by purchasing barebones coverage," Newkirk explains. (Read more)

Insurers exiting Obamacare exchanges will leave many rural counties with limited plan options

Americans throughout the country — especially those in rural counties — have growing concerns that they will have limited choices when selecting an individual health plan when open enrollment on the Obamacare exchanges begins Nov, 1, Deborah Dorman-Rodriguez and David Kaufman report for the Legal Solutions Blog. Concerns heightened after Aetna announced "that it will exit the Affordable Care Act marketplaces, commonly known as the 'exchanges,' in 11 states for the benefit year beginning in 2017."

As many as 19 percent of all exchange or "marketplace" enrollees across the United States could have only one insurer to choose from going into 2017, according to an analysis by the Kaiser Family Foundation. "In rural counties, the numbers increase: 41 percent of all marketplace enrollees will have only one carrier to choose from for marketplace policies in 2017, compared with 7 percent in 2016," writes Dorman-Rodrigues and Kaufman.

Wyoming was the only state in 2016 to have only one marketplace insurer. Next year, five states — Alabama, Alaska, Oklahoma, South Carolina and Wyoming — are likely to have only one marketplace insurer available in all counties, Dorman-Rodrigues and Kaufman report.

"Insurers have been vocal regarding ACA marketplace-related losses, and carriers losing money have either actively sought premium increases for 2017 plans or withdrawn from markets entirely where they have determined losses are unsustainable," the reporters write. "Losses are attributed to several factors. These include the complex interaction between the sicker, higher-risk population covered by marketplace plans; the relative lack of healthy individuals in the marketplace risk pools; and the failure of the market stabilization programs to adequately address the overall goal of providing certainty to insurers, protecting against adverse selection and stabilizing premiums in the individual market. This analysis explores the possible regulatory implications of insurers’ exits from the rural marketplace and the potential regulatory responses to the issue." 

National Rural Health Day is Thursday; webinars available on a variety of health issues

The fourth annual National Rural Health Day is scheduled for Thursday. The yearly event is "an opportunity to 'Celebrate the Power of Rural' by honoring the selfless, community-minded, 'can do' spirit of that prevails in rural America," says the organization's website. "But it also gives us a chance to bring to light the unique healthcare challenges that rural citizens face–and showcase the efforts of rural healthcare providers, State Offices of Rural Health and other rural stakeholders to address those challenges."

"Today more than ever, rural communities must address accessibility issues, a lack of healthcare providers, the needs of an aging population suffering from a greater number of chronic conditions and larger percentages of un- and underinsured citizens," says National Rural Health Day. "And rural hospitals–which are often the economic foundation of their communities in addition to being the primary providers of care–struggle daily as declining reimbursement rates and disproportionate funding levels make it challenging to serve their residents."

National Rural Health Day consists of a series of webinars on: AgriSafe—Growing Families Strong: Protecting the People who Feed America, ORHP Quality Showcase, Rural Health 101: States & Communities at Work, ACA and You, Rural Policy and Advocacy Issues, and Collaborative Rural Success Stories. (Read more)

Journalists' guide to covering the second open enrollment under the federal health reform law

The Patient Protection and Affordable Care Act's second annual open enrollment period has started and brings with it many changes. Journalists play a critical role in the process because "Obamacare" remains controversial and there are many nuances that can be obscured, especially because this year's enrollment period is shorter. For a journalists' guide to covering the topic, click here.

If a state doesn’t operate its own exchange for health-care benefits, citizens who want to get covered should visit the federally-run exchange, HealthCare.gov. For the 2015 plan year, 27 states with federally facilitated exchanges, seven states in partnership with the federal goverment and three state-based exchanges will use this site. Click here to check the status of specific states.

Whether they buy a plan through the federal marketplace or an exchange in their state—or qualify for Medicaid—everyone must enroll in a plan or pay a penalty. Even those who purchased plans in the marketplace last year must re-enroll and purchase or select another plan this year because plans have changed and premiums are determined by age and other factors that can change.

Two types of subsidies are available to marketplace enrollees. The premium tax credit reduces enrollees’ monthly payments for insurance coverage. The cost-sharing subsidy is designed to minimize enrollees’ out-of-pocket costs when they go to the doctor or have a hospital stay. Here is a useful Kaiser Family Foundation brief that explains the subsidies.

Here is the foundation's embeddable Health Insurance Marketplace Calculator:

Obamacare has passed the first big hurdle, but many more remain; impact differs from state to state

Monday was the deadline for starting open enrollment for policies offered through the health-insurance exchanges created under the federal health-reform law, and there were signs that final-day rush of signups pushed the total close to the Obama administration's goal of 7 million. But it remains to be seen how many of those people actually pay their premiums and how many of them are young people whose participation is considered essential to the law's success.

"With millions of people signing up, the law has cleared one long, difficult set of hurdles and has defied the darkest predictions of its critics. But that doesn't mean it's out of the woods entirely—it's just on to the next long, difficult set of hurdles," writes Sam Baker of the National Journal. "The national total doesn't say much about of the law's sustainability or what happens to premiums next year. Premiums will go up, because premiums go up every year. The size of next year's premium increases depends on enrollment and demographics in each state, and even within specific regions of each state. Some states are faring better than others," as the Kaiser Family Foundation map below shows.

"Generally, if the risk pool in a particular market turns out older and sicker than expected, insurers are more likely to raise their premiums," Baker writes. "We don't know precisely what insurers expected—they all priced their plans independently, and the law includes several programs designed to absorb any surprises and keep premiums as steady as possible. In competitive markets, insurers likely will try to keep increases to a minimum, but industry insiders caution that hikes are looking likely, at least in some parts of the country."

"The biggest question by far," said Drew Altman, president of the Kaiser Family Foundation, is how people will like their plans, and the proportion of winners (those who couldn't get affordable coverage) to losers (those who had to get more expensive policies that may not include their doctor or preferred facility). But even the winners might "sour on their coverage" as they have to pay thousands of dollars in deductibles before full coverage kicks in, Baker writes.

Charles Ornstein of ProPublica has a good look at how the success or failure of Obamacare can be judged. Chris Cilliza of The Washington Post has a good set of charts illustrating the politics of the law. For a look at how Obamacare was embraced by ruling Democrats in Kentucky, a state with a large rural population, and how it may backfire on them in upcoming elections, read this story by Louisville native and former Post political reporter Perry Bacon Jr. of Yahoo News.

Those in Ky. with enough info on how Obamacare affects them support it; those who lack info don't

Kentucky Health News: Obamacare in Kentucky

Rural obstacles to Obamacare: few providers, lack of broadband, negative talk and misinformation

Enroll America booth (NPR photo: Eric Whitney)

Residents of some rural areas are not buying into federal health reform. They have expressed doubt and fear about Obamacare because of a lack of primary care physicians, a lack of insurance providers and hospitals, or because they don't qualify for benefits in states not expanding Medicaid. Also, Melissa Nelson-Gabriel reports for The Associated Press, many residents in conservative rural areas are being bombarded with negative viewpoints from friends, neighbors and conservative media, and fear the law based on those opinions.

That has caused problems for people like Christopher Mitchell, a marketing director for a network of nonprofit health clinics in Florida. He told Nelson-Gabriel, "I tell people that I am not here to advocate for the law, I am here to support the law and empower people to be able to use and understand the law. But when people are hearing over and over and over that is bankrupting America, it is hard to break through." The Congressional Budget Office has estimated that the law will save money by reducing health-care costs in the long run.

But it's easy for rural residents to be wary of the act, with all the hurdles they face -- long drives to doctor's offices, lack of broadband to enroll online, and the many stories about people having trouble signing up, Nelson-Gabriel writes. Kathy Bannister, a self-employed beautician, "secured a plan from Blue Cross Blue Shield of Michigan with a monthly payment of $215 after subsidies. She now pays $500 for a comparable plan from the same insurer," thanks to some outside help after several failed attempts to do it herself online, Nelson-Gabriel writes. Bannister told her "The whole idea was to make it easier for people. I'd been calling and calling and calling, and a lot of people would have given up. It's discouraging." (Read more)

UPDATE, Jan. 7: Understanding how Obamacare is working, or not working, is difficult because "We have no central clearing house" for information, writes The Washington Post's Sarah Kliff, who is doing the most consistent and comprehensive tracking of the question. She says that creates "what I like to think of as the battle of the anecdotes," which can illustrate how the law is affecting individual Americans, "but they can also be a really terrible way to gauge whether Obamacare is going great -- or is a complete disaster." (Read more)

Farm-paper editor identifies self-employed folks' problems with Obamacare, and hers with Congress

Farmers and other self-employed people may have special trouble maneuvering through the process of obtaining health insurance on HealthCare.gov or a state-run exchange, writes Sharon Burton, editor and publisher of The Farmer's Pride, Kentucky's statewide agricultural newspaper.

Sharon Burton

"The first thing I realized is the system doesn’t know how to deal with people who are self-employed," Burton writes. "I figure that’s just about every farmer in the commonwealth" of Kentucky, which is operating its own exchange, Kynect.

"My husband is a owner/operator commercial truck driver, so his income can fluctuate from year to year. When I adjusted our income based on that fluctuation, the system was not happy with me because I estimated our 2014 income to be different than our 2012," Burton writes, adding that her kynector, a state-paid adviser who helps people use the exchange about it, "She said she too had problems signing up anyone who was self-employed. She also warned me that we should notify Kynect if our income varied even within $1,000 or could face serious ramifications at the end of the year."

Kynect spokeswoman Gwenda Bond told Kentucky Health News, "If self-employed individuals have variable incomes there might be an extra step for them to accurately verify income. They would have to submit additional information, in some cases, because the income verification system accepts the amount reported only if it is within 10 percent of what the IRS has on file for the most recent year."

Burton adds, "There are a lot of bugs in the system. For one, if your spouse’s employer offers family coverage – even if they don’t pay any portion of it – you are not eligible for any subsidies. We all know insurance offered through companies often provides family coverage but it isn’t affordable.
Now you will be disqualified from Obamacare because that unaffordable plan is out there."

Burton has also lost patience with Congress. "The ones who voted for it spend all their time defending it, and the ones who voted against it spend their time trying to make sure it fails," she writes. "Just fix it people. Get on with it. It’s like starting a business. You have a plan, but where you end up often looks a lot different than where you start because you make changes as needed. This is a starting point; let’s move on to the next stage and stop bellyaching." (Read more)

National Rural Health Day set Nov. 21 in Michigan; webinars available for those unable to attend

The third annual National Rural Health Day, which brings awareness to rural health issues and current efforts in addressing these issues, will be observed with events nationwide and special presentations in Sterling Heights, Mich., Nov. 21.

The National Organization of State Offices of Rural Health and all 50 state offices of rural health said in a news release that health concerns of the 60 million rural Americans include: a lack of health care providers; accessibility issues, particularly transportation and technology; and affordability, as the result of higher out-of-pocket costs and other factors.

"Meanwhile, rural hospitals and health systems face declining reimbursement rates and disproportionate funding levels that make it challenging to meet the physical, social and economic needs of their communities," organizers say.

The observance also focuses attention on state rural-health offices, which foster relationships, disseminate information and provide technical assistance that improves access to quality health care for rural citizens, according to the news release.

National Rural Health Day events include several free webinars. To learn more about the observance, visit http://celebratepowerofrural.org. Contacts: Bill Hessert at 814-360-1964, billh@nosorh.org; Teryl Eisinger at 586-850-5257, teryle@nosorh.org.

Mississippi pastor bans fried chicken at church, promotes Obamacare in a state hostile to it

The Rev. Michael Minor, pastor of Oak Hill Missionary Baptist Church in Hernando, Miss., started encouraging his community to be healthy when he banned friend chicken at pot-luck dinners and installed a walking track around the church. Now he's volunteered for a much more daunting undertaking: trying to get "the state's nearly 275,000 uninsured people to sign up for health insurance coverage under the Affordable Care Act," Julie Steenhuysen reports for Reuters.

When Minor became Oak Hill's pastor in 1996, he found that many in the community were obese, and people were dying young as a result. Since he took action, people have become healthier. "You can see the difference," Minor told Steenhuysen. "People are much better sized, way better. And once they get it off, they want to keep it off."

Minor and his church are one of two organizations that received a federal "navigator" grant challenge with the task of helping people sign up for coverage under Obamacare. "That man is essentially heading up outreach enrollment of the ACA for Mississippi. It's staggering," Roy Mitchell, executive director of the Mississippi Health Advocacy Program, told Steenhuysen.

People like Minor will be key in determining whether the law will succeed or fail, Steenhuysen writes, citing a 2012 study about the health of the states revealed that Mississippi is tied for last with Louisiana and suffers from high rates of obesity and diabetes. Minor said, "I'm a firm believer that people are limited because someone tells them they are limited. I tell my members we can do whatever we want to do. Let's just go for it."

Republican-led Mississippi has one of the governments most opposed to Obamacare. It refused federal funds for an expansion of the Medicaid program for the poor, and it was left to use the faulty federal exchange when Washington rejected its application for a state-based exchange, Steenhuysen reports.

Lack of insurance providers and hospitals in rural areas lead to higher premiums under Obamacare

The Patient Protection and Affordable Care Act was designed to make it easier for uninsured Americans to buy insurance at an affordable rate. But the exact opposite is happening in rural areas, where a lack of insurance providers has eliminated competition between insurance companies, leading to higher prices, Reed Abelson, Katie Thomas and Jo Craven McGinty report for The New York Times. In the roughly 2,500 rural counties served by the federal exchange, 58 percent have plans offered by only one or two providers, and people in 530 counties only have one choice for a provider. A state-by-state interactive map is available by clicking here.

"In rural regions, several factors combine to create a landscape that is inhospitable to newcomers," the Times writes. "Developing relationships with doctors and hospitals can be costly where cities and towns are widely scattered and the pool of potential customers is small." States such as Wyoming, with a population of 600,000, are in a difficult situation. Tom Hirsig, Wyoming’s insurance commissioner, told the Times, “I think the problem was that the Affordable Care Act was designed for where the majority of the people live, in the big cities where there’s a lot of competition among health care providers. You’ve got to have some bargaining chips, and we don’t have that much."

Many rural areas only have one hospital, "giving insurers little leverage when negotiating reimbursement rates," the Times writes. "Only one Wyoming county is served by more than one hospital, said Stephen K. Goldstone, the chief executive of WINHealth. In southwest Georgia, another rural region, Blue Cross and Blue Shield of Georgia is the dominant carrier, and it is the only insurer operating in 54 of the state’s 159 counties. Only one carrier, Highmark Blue Cross, is offering coverage in West Virginia, which has high rates of obesity and chronic diseases like diabetes." (Read more; NYT chart shows states on federal exchange)