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Health care at the crossroads

CHERYL TEVIS 01/08/2014 @ 11:40am Cheryl has been an editor at Successful Farming since 1979.

After six decades of debate in this country, Americans are deciding which route will lead in the direction of accessible, affordable health care insurance.

Leroy Hodge was devastated when he received a letter notifying him that his health insurance was being cancelled. Six months earlier, the Hamill, South Dakota, farmer had received preapproval for heart surgery. That was in 1991.

Recently, several million Americans received health insurance cancellation notices. On the surface, it may seem that the 2010 Affordable Care Act (ACA) hasn’t improved anything.

Hodge would disagree. Beginning January 1, arbitrary cancellation is against the law. Companies cannot cherry-pick customers.

His prognosis was worse in yet another way. Hodge had nowhere else to turn. “I would gladly have paid a premium if I could have had health insurance,” he says. “I was uninsurable.”

The new round of cancellations is occurring now because insurers chose not to renew policies through 2014 that don’t offer ACA’s minimum health benefits. Today, the approximately 15.2 million Americans in the individual insurance market have other options in the Health Insurance Marketplace, as well as from their current insurance companies. In some cases, higher premiums for expanded coverage may be offset by the ACA’s free preventive screenings and the elimination of co-pays.

After 60 years of debate, health insurance reform has reached a strategic crossroads. Farmers and other self-employed individuals will play a significant role in the success of the final phase-in of the ACA in 2014. That’s because about 33% of farmers are insured in the private individual market, compared with about 8% of all Americans, according to a 2007 Access Project Report.

Farmers without employer-based insurance spend more on health care than other households. Double-digit premium hikes have been common in the individual market. A 2012 survey of Illinois Farm Business Farm Management Association members pegs the average per-farm total health care-related expenses, including insurance, at $10,100 for a family of three to five.

“Premiums have been higher because farmers are in a high-risk occupation and insurance underwriters know it,” says Joyce Lash, a Cooperative Extension family finance specialist serving nine south-central Iowa counties. “Charging a higher rate based on occupation is off-limits now. Insurers can set rates only on geographic region, age, family size, and tobacco use.”

An Agriculture.com poll conducted in early November indicated that farmers had not visited their state Health Insurance Marketplaces or HealthCare.gov. They cited a lack of time, a faulty website, and a distrust of government as barriers. Many were aware they might receive tax credits and subsidies. Most rated their understanding of the Marketplace as very poor, poor, or fair. This mirrors the results of a University of Nebraska-Lincoln poll taken last summer.

However, the 2010 passage of the ACA already has launched a series of fundamental changes. Many families have taken advantage of reforms that allow them to keep a child age 26 and younger on their insurance policy or to eliminate preexisting condition exclusions for children under age 19. In 2014, adults with preexisting conditions (like hypertension, diabetes, or heart disease) no longer can be denied insurance or charged more. Most preventive health care services now are covered.

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