As in the rest of the nation, the rural United States is facing increasingly expensive health care options. With an aging population of farmers and ranchers, those in the agriculture sector are watching premiums rise and, often, making hard choices about preventative treatment.

Seeking to bring attention to what farmers and ranchers are facing, a recent survey — titled “Health Care in the Heartland: 2007 Health Insurance and Survey of Missouri Farm and Ranch Operators” — was released by the Missouri Rural Crisis Center, a farmer advocacy group.

“A big finding is that farm families are being forced to go off-farm to take a job for the health insurance,” says Tim Gibbons, who has been with the MRCC for three years. “In some cases, they don’t even need the job except for the health benefits.”

While current conditions are difficult for many farm families, the future is also a huge concern. Farmers are “really worried about what could happen in the next 10 years. Will health care insurance be even more expensive? Will the farm be under even more pressure? Will farmers be forced to choose between exorbitant health care coverage and a piece of needed equipment or land?”

Richard Williams, a red Angus rancher from Tipton, Mo., says his situation “is standard around here for self-insured farmers.” Shown Williams’ claims, several Mid-South insurance agents say his situation is also not an outlier for the Delta.

“We’ve got darned high deductibles,” says Williams, whose state has 104,000-plus farm operations — second only to Texas. “There are many farmers whose wives have to go out and get a job just for the insurance — maybe a job with the state, or something.”

With both spouses working on the farm, the Williamses spend about 15 percent of their budget on health care. “That’s give-or-take, of course. Being on a farm, it’s difficult to say exactly what you’ll make.”

Williams says it is often frustrating trying to explain the unique position of farmers and ranchers to the general public. A few weeks ago, he spoke with a reporter, “and I couldn’t make her understand” how ranchers make money. “She kept asking what sort of paycheck we have coming in. Well, whenever you’re selling a farm commodity, you take what the market will provide. She kept saying, ‘Just sell it at a higher price. Sell it for a price that you need.’ Of course, all farmers know it doesn’t work that way.”

As for the MRCC-sponsored survey, Williams only participated reluctantly. Gibbons says that isn’t unusual. Farmers prefer to speak in generalities and stay away from the personal. “Many times I’ve heard, ‘I don’t go to the doctor. I’ve been to the emergency room twice in the last 10 years.’ But that’s it. Rarely do farmers go much further with the story. Rural folk are stoics and don’t usually want to talk about their business. They don’t want to be seen as whiners.”

Williams is in the same vein. “I don’t like to provide information, and I just throw away most surveys. Most things just roll off our backs, you know. No one likes a complainer. That’s just how farmers are.

“But this health insurance issue has been bothering me for a while, and so I filled out the survey information. I was uncomfortable with it and wasn’t seeking publicity in any way. But my friends said, ‘Man, if someone doesn’t speak out, then the status quo will remain and no one will know what’s going on here.’ So, based on the hope that it’ll help change things, I’m willing to talk about my situation.”

Health care is barely affordable, says Williams. “My wife has a $5,000 deductible and mine is $5,600. Our premiums rise every time we have a birthday. I started out with a $5,000 deductible, but the policy is written to allow the company to raise it — and they have.”

The couple has held their insurance since 1991 and made only “a couple of small claims for my wife. Personally, I’ve never turned in a claim and, unfortunately, have never been to a doctor.”

Would it take setting a bone to turn in a claim?

“Even then, I don’t think we would. We’re small farmers. We run about 950 acres and own about 90 percent of that. The main reason I keep this health insurance is in case something catastrophic happens.

“I’m 54 years old. If I have a heart attack and need a by-pass, or something, we’d end up having to sell land to pay the bill. Or they’d put a lien on it.”

Asked if his policy is aimed at protecting his farm instead of his health, Williams says, “That’s right, and several doctors have made that point to me. They’re correct.

“This isn’t a nice thing to think about, but I’ve considered even dropping health insurance and buying a $500,000 life insurance policy. Then, I’d use that policy as collateral. If I did have a big hospital debt, I’d just sign the policy over to them. When I die, they’d get their money.”

Gibbons says many farmers — “especially those buying health care coverage individually in the market” — rely on catastrophic insurance coverage. “They see it as more insurance of their farming operation as opposed to insuring their health. The last thing they want is to have their farms taken away because of an unfortunate (accident or illness). The current environment is forcing farmers to not go to the doctor, not get preventative care.”

Williams isn’t optimistic that anything will, or can, be done about health care costs. “It isn’t going to be a perfect world and, with the political landscape today, (the problem) may not even be solved.

“But I’d typically classify farmers as a small business. The state of Missouri needs to have a group plan and every small business person could buy into it.

“When buying individually, the insurance companies can find any excuse not to cover you. And they aren’t regulated for price. In a group, there’d be a bit more leverage to get a better deal from the insurance companies.”

Regardless of the path eventually taken to address rural health care, Williams says farmers in his area are united in their displeasure. “There are many differences in how we approach religion and politics — there are a lot of variables. But on this health care issue, we’re on the same side of the fence. Everyone feels they’re being gouged.

“None of us wants health coverage for free. No one wants a hand-out or welfare. We just don’t want to have to pay 15 percent of our income for an insurance policy that we may never use.”

The high costs keep farmers and ranchers from improving their operations. “A lot of money is being taken off the farm. That $500 a month we pay for insurance depletes any chance we have to improve our operation, to put more money into the local economy. Our newest vehicle is from 1999 and has 150,000 miles on it. We have to buy all used equipment and try to get by.”

No one, says Williams, “likes to look in the mirror and realize the years are speeding past. But a lot of people my age are actually embracing that, in a way. Around here, I hear all the time, ‘If we can hold on until we hit 65, we’ll be on Medicare and have insurance.’ You know, it’s a hell of a thing to wish a good chunk of your life away (for the comfort of health care coverage).”

e-mail: dbennett@farmpress.com