Farmers now owe a lot more for health insurance

Last year was a tough one for farmers. Amid falling prices for commodity crops such as corn and soybeans, rising input costs for supplies like fertilizer and seeds, as well as the Trump tariffs and the dismantling of USAID, many farms weren't profitable last year.

And now, the enhanced Affordable Care Act subsidies that many Americans, including farmers, relied on to purchase health insurance are gone, having expired at the end of December.

James Davis, 55, who grows cotton, soybeans, and corn in northern Louisiana, said he didn't know how he and his wife would afford coverage. Their share of their insurance premium quadrupled for 2026, jumping to about $2,700 a month.

"You can't afford it," Davis said. "Bottom line. There's nothing to discuss. You can't afford it without the subsidies."

More than a quarter of the agricultural workforce purchases health insurance through the individual marketplace, according to an analysis from KFF, a health information nonprofit that includes KFF Health News.

That 27% rate is much higher than the overall population's — only 6% of U.S. adults have non-group coverage.

Farmers are used to facing challenges such as unpredictable weather and fluctuating commodity prices. But the loss of the enhanced subsidies, coupled with challenging economic conditions, will make coverage unaffordable for many.

Without major intervention from Washington, farmers say they’ll have to choose between being uninsured or leaving the farm work behind for a job that offers health insurance.

A gamble for farmers

Farming is dangerous work. Agricultural workers spend much of their time outside and exposed to the elements. Many of their duties can lead to injury or illness. They drive and operate heavy machinery, work with toxic chemicals, and handle large animals.

The rate of work-related deaths for farmers is seven times the national average.

The financial toll of non-fatal farm injuries is also significant. A study from the University of Nebraska Medical Center found that the average cost of a farming injury was $10,878 in medical care and $4,735 in lost work.

It's essential that farmers can purchase comprehensive insurance, said Florence Becot, a rural sociologist and associate professor of agricultural health and safety at Pennsylvania State University, where she studies the social and economic needs of farm households.

In a 2022 study, Becot found that more than 20% of U.S. farm households had medical debt exceeding $1,000 and that more than half were not confident they could cover the costs of a major illness or injury.

"That shows you the level of vulnerability and concerns that farmers are facing," she said.

Mental health is also a concern. Farmers are roughly twice as likely to die by suicide compared with the general population. Mental health hotlines that serve rural communities have seen an uptick in calls.

These concerns around farmers' increased emotional distress, coupled with a rise in bankruptcies, conjures memories of the farm crisis of the 1980s, said Michael Klein, a vice president at the industry group USA Rice. During that decade, there was a raft of foreclosures, and hundreds of farmers took their own lives.

"We're really afraid of what's going to happen," Klein said.

Farmers can be reluctant to acknowledge that they rely on government-subsidized insurance, said Meghan Palmer, 43, who runs a dairy farm in northeastern Iowa with her husband, John, 45.

"We're not handout-takers," Palmer said.

More than 40% of dairy farmers lack health insurance — one of the highest rates among all agricultural sectors.

But going uninsured is not an option for the Palmers.

During their first year of marriage, the couple recalled, they were uninsured and had to pay out-of-pocket for two unexpected health crises: Palmer had an appendectomy, and her husband needed stitches after getting kicked in the face by one of his cows.

"It was stupid of us," Palmer said of the decision to forgo coverage.

But this year, the combined out-of-pocket monthly cost of their plans is increasing by more than 90%, to $368.18. Their total 2026 deductible is $7,200.

Palmer is a registered nurse who picks up shifts on an as-needed basis, allowing her the flexibility to prioritize her work on the farm. She's now searching for a job with health benefits. But she worries a job that doesn't allow her to keep up with the farm work will create a greater burden for her husband.

"John is working exhausted most of the time," she said. "That's when mistakes get made and you end up in the ER."

Political consequences

Even after the enhanced subsidies expired at the end of 2025, the Palmers estimate their income will still be low enough that they'll qualify for some tax credits to purchase coverage.

However, under the GOP's One Big Beautiful Bill Act, repayment limits are being eliminated, so if the Palmers have a surprisingly profitable 2026, they'll be forced to pay some, or even all, of that subsidy back at tax time.

A farmer’s income can vary drastically year to year, Becot said, partly because commodity prices can fluctuate rapidly.

Some farmers might deliberately choose to not expand their businesses, because too much profit might mean they lose access to health care subsidies.

Farmers who are insured through Medicaid have similar concerns, Becot said. But prioritizing health care affordability by suppressing operational growth can have long-term consequences for a farm's success.

Palmer, in Iowa, and Davis, in Louisiana, are both upset that lawmakers aren’t more sensitive to the economic demands of farming and how those have coincided with rising health costs.

President Donald Trump recently pledged $12 billion in one-time bridge payments to row crop farmers, but that's not going to stop health care costs from ballooning.

Republicans are aware that health care affordability is a problem and have put forth proposals, said Donna Hoffman, a political scientist at the University of Northern Iowa. But most don't support extending the enhanced ACA subsidies, because they don't see them as a good solution to the problem of rising health care costs.

This article is from a partnership that includes the Gulf States Newsroom, NPR, and KFF Health News.