Does repealing or fixing the ACA benefit rural and agricultural people more?

The U.S. Congress is debating whether to repeal the Affordable Care Act (ACA) and start over with new legislation, or to fix the shortcomings while continuing its useful parts. When the ACA was implemented in 2010, it was meant to reduce disparit...

Michael R. Rosmann, Ph.D., FarmersÕ Forum columnist
Michael R. Rosmann, Ph.D., FarmersÕ Forum columnist

The U.S. Congress is debating whether to repeal the Affordable Care Act (ACA) and start over with new legislation, or to fix the shortcomings while continuing its useful parts. When the ACA was implemented in 2010, it was meant to reduce disparities in access to healthcare between rural and urban America, among its many provisions.

At that time, about 7.8 million people living in areas of the country defined as rural had no health insurance, out of a total rural population of about 60 million. Available statistics indicate that people who live in rural America tend to be poorer, less educated, have lower incomes and have more health issues than their metropolitan counterparts.

Most people involved in agriculture live in rural America. While most farming families have health insurance, they were-and some still are-paying more for their insurance than other occupational groups. Most farm laborers do not have health insurance coverage.

Recently, Janelle Ali-Dimar, who is affiliated with the Nebraska Department of Health and Human Services, wrote that health disparities increased since 2010 in rural areas. "Not only do rural residents suffer from higher incidence of chronic illness, they also have limited access to primary care services and are more likely to be uninsured or under-insured".

Ali-Dimar noted that 70 hospitals have closed since 2010 and that these were mostly in rural areas of the country. Of 673 hospitals identified as vulnerable to closure, 355 are in rural communities.


Ali-Dimar also noted that rural areas that have lost their hospitals and have seen the largest increases in loss of access to healthcare are in states that decided to not accept federally-funded Medicaid expansion offered through the ACA. Moreover, during the past several years, Congress cut Medicare reimbursements for many healthcare services, which further hampered those hospitals and providers in rural areas that did not accept the ACA.

In states that accepted the ACA, there were gains in healthcare insurance coverage.

Insurance companies in these states, however, do not necessarily like the federal stipulations that accompany the ACA. Sometimes these companies have left the ACA marketplace entirely.

Proponents of the ACA like that there are caps on administrative costs charged to insurance premiums. To make their point, they cite that the costs of administering the large and complex Medicare system comprise a much smaller portion (about 3 percent) of the overall Medicare budget than private insurance companies spend on administrative activities.

Most surveyed Americans favor keeping provisions of the ACA if it 1) retains insurance coverage for pre-existing conditions, chronic diseases and illnesses and has no lifetime caps on care, and 2) lowers costs of medications by bargained contracts and/or purchases of the drugs from Canada or manufacturers in other countries and 3) allows children to remain on their parents' health insurance coverage until age 26.

The independent polling organization, Hart Research Associates, reported on March 6 that 68 percent of 1,057 Americans they interviewed and who had voted last fall (42 percent Republican and 42 percent Democrats) do not approve of repealing and replacing the ACA and instead want to fix its shortcomings.

Among Republicans, 49 percent favored "repeal and replace." Among voters registered as independents, 32 percent favored "repeal and replace," while just 20 percent of registered Democratic voters favored "repeal and replace." Three of every five survey respondents opposed turning over Medicaid block grants to states for underwriting Medicaid recipients for their healthcare services.

There is much misinformation circulating about the ACA. To be sure, there are many individuals and families who have seen significant increases in their insurance costs since the ACA was implemented in their states.


Implementation of the ACA has cost more for some farm producers' healthcare insurance premiums. People involved in agriculture have some of the highest rates of health perils because farming is a high-risk occupation.

Overall, the ACA has helped more than harmed rural and agricultural people since it was implemented in 2010. A larger portion of rural residents, farm operators, and farm workers now obtain health insurance than before the ACA was implemented. ACA-covered farm families no longer worry about having to sell their farms to pay for treatment of catastrophic healthcare conditions.

Proponents of fixing the ACA say that if Congress were to amend current health insurance, they would do well to figure out a way to require all legal residents to have coverage, so as to increase the pool of payers into a national system. Another feature that is attractive about such a mandatory system of "healthcare for all" is that a fully national program would process all claims similarly, thereby avoiding the many hassles billing agents incur when settling with some insurers.

The problems with the current ACA can be fixed if fully and openly debated by Congress. Feel free to share your opinions with your federal and state officials.

Mike Rosmann is a Harlan, Iowa, psychologist and farmer. To contact Rosmann go online to: .

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