Farmers who are already navigating a generally weak farm economy are bracing for something else beyond their control – significant increases in health insurance premiums.
Estimates vary, as experts don’t completely agree on how much more people will pay. However, there is broad agreement that the expiration at year’s end of Affordable Care Act enhanced premium tax credits will drive prices higher for millions of Americans – in some cases, much higher.
The enhanced credits were put in place during COVID but are due to expire Dec. 31 unless Congress decides to retain them. Democrats have demanded that Republicans agree to extend the credits and restore cuts to Medicaid made in the One Big Beautiful Bill Act.
A hypothetical example cited during an American Agricultural Law Association webinar Tuesday calculated the increase for an Iowa farm couple making $87,000 a year who had selected the second-lowest cost silver plan.
Without the tax credit to pay for part of their premium, they would pay $1,803 a month in 2026, nearly three times the amount they paid in 2025, said Kristine Tidgren, who heads the Center for Agricultural Law & Taxation at Iowa State University.
“We're going to get whacked hard,” Montana Farmers Union President Walter Schweitzer said, speaking of his and his wife’s premiums after looking at an analysis prepared by KFF, a think tank that examines healthcare issues.
The KFF numbers show that Montanans who use the ACA individual marketplace to get their insurance could see increases of as much as 400% in premiums. For Schweitzer, that translates to at least another $24,000 out of pocket on top of the $17,000 he and his wife currently pay, though he said Tuesday he's trying to get answers from his provider on the actual increase.
Schweitzer says going without health insurance isn't an option.
"ACA has been a lifesaver for me, because I was diagnosed with leukemia and I have to take a prescription drug to stay alive, and so I have no choice but to do health insurance," he said.
Farmers disproportionately represented in individual marketplace
Although only about 8% of the general population get their health insurance on the individual market – largely made up of the ACA marketplaces – the percentage for certain professions is much higher. For example, KFF estimates that 27% of all farmers use the independent marketplace.
Schweitzer says that number in Montana is likely even larger. “Some are saying over 30%. I think it could even be more than that,” he said.
Walter Schweitzer (MFU photo)He is a rancher and therefore better off right now than his row crop colleagues. “The grain farmers in Montana are losing money,” he says. “They're trying to figure out how they're going to pay interest, how they're going to pay their fuel bill, their fertilizer bill. Many of them, you know, this is the time of year that they go renegotiate their operating line of credit.”
Minnesota farmer Cindy VanDerPol also is preparing for what she believes will be at least a 30% increase in premiums. She and her family operate Pastures a Plenty in Swift County that has a farrow-to-finish hog operation and seasonal cattle grazing business while also raising free-range chickens.
Lack of healthcare is something she’s dealt with her entire life. “My parents were small business owners,” she said. “We never had health insurance as I was growing up.”
She survived breast cancer that was discovered in 2021. Without the state’s insurance program, Minnesota Care, she could have been liable for $250,000 in bills, she said.
She and her husband pay about $1,100 per month in premiums but she says $700 to $800 of that was covered by the ACA tax credits. “We haven't looked to see what that base price will be this year,” she said, adding, “I don't know if I want to.”
A prominent ag accountant says marketplace premiums are going up now because the changes in the law will result in a smaller risk pool.
“Some of these providers are not making money on ACA policies, so they're getting out of the marketplace, or they're raising [their premium] substantially,” which probably will mean fewer providers available in rural areas, says Paul Neiffer of the blog FarmCPAReport.com.
Paul Neiffer (Personal photo)“Yeah, they're gonna see their premiums increase, that's for sure,” he said. “I will say that there's a segment of the population that will definitely see a 30, 40, 50% increase in premiums.”
“People that are going off of the ACA, most of those are voluntary, because they're saying, ‘Hey, I'm healthy, I don't even want to pay for health insurance.’” Neiffer says. “There are also lots of people that are on ACA that aren't even supposed to be on ACA because they have affordable healthcare through their employer, so they'll go back to that.”
Enhanced credits weren't there originally
Neiffer cautioned against “misleading headlines” about premium increases. The loss of the enhanced premium tax credits will affect some people negatively, “but it's not going to make anybody destitute,” he said.
He notes that the tax credits did not exist before COVID. “People are not losing anything that they're originally entitled to,” he said. “They're just losing the enhanced premium subsidy.”
Roger McEowen, a professor of agricultural law and taxation at Washburn University School of Law in Topeka, Kansas, said much the same.
“The COVID enhanced tax credits were not ‘intended’ to continue, as the Dems now want,” he said in an email. “Alternatives to government healthcare are health savings accounts and health sharing arrangements. Those alternatives don't receive enough attention.”
Neiffer also mentioned the savings accounts, which are now being made automatically available to people on the bronze, or lower-cost, policies. “That could be helpful for farmers, especially healthier farmers that really don't need to participate in health coverage as much as maybe less healthy farmers, and they want to save up more for health costs later,” he said.
The always emotional debate over healthcare has extended to the cost estimates being produced by groups such as KFF. A Wall Street Journal op-ed written by Chris Jacobs, founder of Juniper Research Group, maintains that KFF has exaggerated the impact of the problem..
He wrote that “other groups have confirmed that federal dollars will continue to pay the lion’s share of most enrollees’ premiums if the enhanced subsidies expire” and says “given the results from KFF and the Urban Institute, most households will likely face increases of $50 to $100 a month.”
He also acknowledged that “some will face more substantial costs if the enhanced subsidies expire” – in particular, those with incomes four times the poverty level, who will lose enhanced subsidies at the end of the year unless Congress acts.
“If the enhanced subsidies expire, the cap would return, and households with incomes just above it could face thousands of dollars in heightened costs,” he wrote.
KFF defended its analysis and said Jacobs did not dispute that on average, premiums will more than double for marketplace enrollees.
“Our analysis clearly states that consumers’ premium payments – what people actually pay out of pocket after tax credits – would more than double on average if the enhanced tax credits expire, increasing by 114%. The WSJ column does not dispute those numbers,” KFF said in a post on X.
