Health care is a real rural issue |

Health care is a real rural issue

Lura Roti
The Kenzy farm family from Gregory area understand the importance of affordable healthcare. Their daughter, Brooklynn, has had Type 1 diabetes since she was 10-months-old. Left to right: Nicholas, George, Shelly, Tyler and Brooklynn. Photo courtesy South Dakota Farmers Union

Until recently, when Shelly and George Kenzy paid their monthly bills, they wrote a check for $2,600 to their health insurance provider. A large expense for the farm family of five who raise cattle and forage crops near Gregory.

“Health insurance is a big deal for our family because our daughter, Brooklynn, has had Type 1 diabetes since she was 10-months-old,” explains Shelly, noting that without insurance, the insulin which literally keeps the otherwise healthy and athletic 13-year-old alive, would cost $600 out-of-pocket each month – not to mention the two monitors she wears at all times costing about $11,500 and then there are testing supplies and three yearly visits to the endocrinologist.

The out-of-pocket insurance expense dropped to just a little over $400 a month when the family signed up for group insurance thanks to Shelly’s position at the local public school.

“This insurance is a huge deal. It means we know we can keep Brooklynn using the latest technology and don’t have to worry about using older ways to treat diabetes,” Shelly explains. “This gives her a healthier future because her numbers are steady. We don’t have to worry as much about future health problems.”

The Kenzys struggle to find affordable healthcare is not unique.

According to a recent survey of 1,000 farm families from seven states (South Dakota was not included in the study), 40 percent say health insurance is a barrier because of out-of-pocket expenses. One in five farmers surveyed said they were carrying medical debt or incurred medical debt due to out-of-pocket expenses not covered by insurance and three out of four farmers surveyed indicated health insurance was important or very important to their farm’s risk management plan.

The study was supported by a grant from the Agricultural and Food Research Initiative Competitive Program of the USDA National Institute of Food and Agriculture.

Like the Kenzy family, 50 percent of farm families surveyed receive their health insurance from a public employer.

“Health insurance is linked to farm quality of life, risk management, farm economics, off-farm employment, the ability to grow the farm enterprise and farmers’ ability to save and invest for long-term planning,” explains Alana Knudson, Public Health Program Area Director at the University of Chicago NORC (formerly National Opinion Research Center).

Knudson addressed more than 300 family farmers and ranchers during a meeting held at the U.S. Department of Agriculture headquarters in D.C. during the September National Farmers Union Fly-In.

Today, Knudson serves as a Principal Research Scientist and is the Co-Director of the Walsh Center for Rural Health Analysis at NORC. She also is the deputy director for the Rural Health Reform Policy Research Center, one of seven rural health research centers funded by the federal Office of Rural Health Policy.

“Studying health insurance among farmers is not new but it has picked up in the last 10 years,” says Knudson, who grew up on farm in rural North Dakota and conducted her first healthcare study of farmers in North Dakota in 2008.

Health insurance ranked among the top three issues which farmers and ranchers discussed when they sat down with policymakers during the National Farmers Union Fly-In. It’s a timely topic explains Doug Sombke, South Dakota Farmers Union President.

“It seems everyone is floundering when it comes to healthcare. Our message is simple – there needs to be an answer in place before we cut the ACA (Affordable Care Act),” Sombke says. “In the last few days I have talked with representatives from rural hospitals and nursing homes. They say they will not be able to keep their doors open if Medicaid is cut. What will happen to their residents?”

Access to healthcare is an issue for South Dakota’s rural citizens, adds Cynthia Painter, who ranches with her husband, Joe, and their two daughters near Buffalo.

“If our local clinic closes, we would have to drive two hours for healthcare,” says Painter, who also volunteers as an EMT.

Distance to providers also came up in Knudson’s study where one in 10 farmers indicated this as a healthcare challenge. It should be noted that of the states where farmers were surveyed, few are as rural as South Dakota. The states surveyed include: Pennsylvania, Massachusetts, Vermont, Nebraska, Michigan, Kentucky, Mississippi, Utah, Washington and California.

Emphasizing the important role healthcare plays in the lives of farmers and ranchers, during her USDA presentation, Knudson outlined research which shows how healthcare costs impact the following:

Succession Planning; “As we know for farmers, land is the most important or valuable asset we have. We asked about the need for care as people age. More than half (surveyed) indicated they will need to farm longer to augment income or if they need to cover excessive healthcare costs, they will need to sell land to the highest bidder and maybe even to off-farm development. If the next generation can’t afford to buy land, who will farm? Clearly health insurance impacts availability and cost of land.”

Risk Management; “One farmer surveyed said, ‘You have to have health insurance. We have a risky job. We don’t want to put our farm at risk if something were to happen to us.’”

Farm Management; Fourteen percent of farmers surveyed, indicated that once they were able to purchase insurance through the Affordable Care Act marketplace they no longer needed to work off the farm.

“It gave them a chance to focus on their farm enterprise and not have to make a decision between a job off the farm and health insurance.”

If farm families did not have to worry about healthcare expenses, those surveyed said they would invest those dollars in retirement, their children’s college education and farm-related investments.

Rural Development; “Rural development is definitely tied to health insurance – we are all interrelated in rural communities. If farmers are not insured and do not go to healthcare providers, we lose hospitals.”

What is Farmers Union’s answer?

When Farmers Union members met with congressional staff and leaders and discussed healthcare, a single-payer system, like Medicare was suggested.

Knudson’s research backed this suggestion. “Medicare stands head and shoulders above the health insurance …the medical industry has come around, a large percentage of my colleagues say a single-payer form of Medicare expansion is where we need to go,” Knudson said.

To learn more about how insurance impacts farmers and ranchers and to view the findings of this report, visit

–South Dakota Farmers Union