The latest attempt to repeal the Affordable Care Act (ACA), the Graham-Cassidy Health Care Repeal Plan, is a prescription for harm to rural America. The legislation is anticipated to be brought before the Senate early next week, and if passed, will be quickly picked up by the House.
If passed, Graham-Cassidy would:
Completely eliminate the ACA’s marketplace subsidies, which currently help 10 million people afford health care coverage. They would no longer be guaranteed any assistance to buy plans.
Gut Medicaid through deep, permanent cuts that would grow over time and threaten care for millions of low-income seniors, children, and people living with disabilities, and shift massive costs and risks to states through a system of per capita caps and block grants.
Allow states to waive the pre-existing conditions and essential health benefits requirement. That means a previous cancer diagnosis or treatment for diabetes could leave you ineligible for coverage, even under your insurance through work.
End the expansion of Medicaid, which has extended coverage to close to 12 million low-income adults. The plan offers no guarantee of alternative affordable coverage for these beneficiaries. Medicaid enrollment is higher in rural communities than in urban areas, and rural hospitals are more dependent on Medicaid payments than their urban counterparts.
This bill would mean fewer people covered, weaker protections, and higher costs for consumers.
This plan stands to worsen access to affordable and quality health care for American family farmers and ranchers, according to the nation’s second largest general farm organization.
“National Farmers Union’s (NFU) member-driven policy affirms the right of all Americans to have access to affordable, quality health care,’” said NFU President Roger Johnson. “The Graham-Cassidy bill does not address the barriers that farmers and ranchers face in accessing health coverage, and it would only make matters worse. We urge (Senators) to vote no on the legislation.”
A number of provisions within the Graham-Cassidy bill would make health care less affordable for family farmers and ranchers, including the elimination of the current structure for tax credits, cost-sharing reductions, and subsidies for out of pocket costs.
“NFU is extremely concerned about the bill’s effects on the non-group marketplace,” Johnson said. “Insurance companies continually point to marketplace uncertainty as the reason they’re being forced to increase rates. Graham-Cassidy eliminates marketplace subsidies in 2020, leaving the marketplace far more unstable than it is currently. States would then be left with the challenge of devising their own market-stabilizing plans in the face of annual budget decreases.”
Since its launch in 2013, the ACA health insurance marketplace has already improved the prospects for health insurance in rural Wisconsin. According to a June 2015 analysis by the Wisconsin Council of Children and Families, “the health insurance marketplace is especially important in rural areas of the state, where the percentage of people with marketplace plans is typically about twice the participation rate in urban parts of Wisconsin.”
It’s hard to over-estimate the peace of mind that comes with having health insurance. One of the farmers who knows this first-hand is Tina Hinchley, a dairy farmer from Dane County. “Before the Affordable Care Act, we went without health insurance for over 8 years because of preexisting medical conditions. We would apply for insurance, but were continually denied. We have insurance today because of the ACA marketplace,” Hinchley said.
Stevens Point area farmer and Wood-Portage-Waupaca County Farmers Union President Alicia Razvi, told her family’s health care story during NFU’s recent Legislative Fly-In, held Sept. 11-13 in Washington, D.C., and began with this quote: “We are producers, and we are historically under-insured or uninsured. It conveys the idea that food is essential, but the person growing the food is not.”
When Razvi shared her story with members of Congress and Senators during NFU’s Fly-In, others in the room chimed in with their experiences. The reality is, a major health event like her husband’s cancer diagnosis does not need to occur to have a pre-existing condition, or to be deemed uninsurable. It can be as simple as a need for glasses, a premature birth, bad back, broken hand, or even the career choice of farmer.
“Like other self-employed individuals, many farmers find it difficult to obtain affordable health insurance,” Wisconsin Farmers Union (WFU) President Darin Von Ruden said. “In addition, farmers are sometimes excluded from private health insurance plans entirely because of the risks inherent in farming. A lack of affordable health insurance options can also be a roadblock to new prospective farmers getting into farming.”
Patty and Gary Edelburg and their twins own and operate a 130-cow dairy and 450 acres of corn and alfalfa in central Wisconsin. The Edelburgs get their health insurance through the Affordable Care Act, and previously were unable to get health insurance. They didn't qualify for Badger Care, and were denied by traditional private health insurance companies because of very minor pre-existing conditions. When they could, they applied for ACA coverage. Without it, they would not have health insurance.
"My husband and I are equal partners and work equally as hard on the farm,” Patty says. “If one of us were to get a job off farm, just for health insurance, we would have to find someone to replace that person on the farm. That said, I know there are flaws, but it still needs to be affordable.” The Edelburgs pay $542 a month and have a $14,000 deductible for a family of four. They would have to sell cows in order to come up with that $14,000. “If we were to fully need to use our health insurance in the course of a year, we would pay over $20,000,” Edelburg said.
When Linda Ceylor, her husband, and their two small children started dairy farming in 1990, they were unable to afford health insurance. Each spouse worked off the farm, her husband full time, while Linda worked two-part time jobs. None of the jobs offered health insurance.
“All went well until my husband developed a protruding hernia, and needed surgery. After a 10-month wait for Washington State to set up a program for state Medicaid, we were able to enroll and have the hernia repaired. We were very lucky he did not require emergency surgery, which would have ended our dairy farm, as we were still incurring many debts of business startup,” Ceylor said.
Urban sprawl forced the Ceylors out of their farm in Washington State, which led them to relocate to rural Wisconsin, where they again had no health insurance. After several years, they were eligible for Badger Care, which enabled them to avoid financial instability. After the children aged out of Badger Care, the Catawba couple were on their own for insurance. “The affordable plan I was able to purchase through my employer was only catastrophe coverage, and the plan stated only one covered heart attack or stroke in a 30-day period would be covered,” Ceylor said.
“Through all of the health care uncertainty, my part time job became full time,” she said. “We now have both a fiscally sound dairy operation and excellent health coverage. We were helped by a hand up, but still hold a dream that one day we can both be home together to operate our family business.”
Stacey and Tenzin Botsford and their two young daughters farm near Athens. When Stacey was pregnant with their
second daughter, the obstetrics department at their local clinic was eliminated due to budget cuts. The next closest hospital to them was an hour away, and when it came time for the baby to be born, it was too late to get to the hospital, so their child was born at home. “It’s like they don’t want young people to come back to rural communities. Why would you cut these essential services if you want young people and their children to live and work there?” Botsford asked.
Along with the previously listed concerns, Farmers Union is concerned with the lack of transparency in the legislating process to date, highlighting the far-reaching impacts the bill would have on farmers, ranchers, and all Americans.
“There have been no hearings on this bill, and there will be no opportunity for a mark-up,” Johnson said. “This highly partisan process has robbed farmers and ranchers of the opportunity to make their voices heard.”
The U.S. Senate is expected to take up Graham-Cassidy for a vote on Wednesday, September 27. Republicans only need a simple majority to pass the bill, which would send it back to the House, where it is almost guaranteed passage.
Wisconsin Farmers Union is a member-driven organization committed to enhancing the quality of life for family farmers, rural communities, and all people through educational opportunities, cooperative endeavors, and civic engagement. Learn more at www.wisconsinfarmersunion.com.