For years, Indiana farmer Corina Brant found herself squeezed on health care. Unable to qualify for Affordable Care Act subsidies, she worked an extra job that took her away from her farm duties.
That all changed in 2021, when she bought a policy for herself and her family under the Indiana Farm Bureau. It’s one of the growing number of states that allow these agencies — which lobby on behalf of farmers — to sell policies underwritten by large insurers such as UnitedHealthcare. The laws are modeled after a decades-old Tennessee statute that allows a state farm bureau to sell health coverage to farmers.
The catch: While these policies are inexpensive, they come with major restrictions. The plans cover checkups and most medical procedures, but they aren’t required to cover applicants with preexisting conditions or maintain coverage for someone who becomes seriously ill. In that sense, they resemble the cheap short-term plans that the Trump administration has pushed as a private-market alternative to the ACA. Critics call them “junk plans,” while proponents say they expand affordable options to an underserved group.
For Brant, who grows corn and soybeans near Frankfort, it’s still worth it. “With us not having to worry about coverage, I was able to be a full-time employee” on the farm, she said.
The latest state to embrace these plans is Ohio, which passed legislation last summer with broad bipartisan support letting its farm bureau participate. It joins nearly a dozen other states — Arkansas, Indiana, Iowa, Kansas, Missouri, Mississippi, Nebraska, North Dakota, South Dakota, Tennessee and Texas — that have enacted similar measures. Wisconsin may also join that group, although prospects there are less certain.
Farm bureaus in those states now collectively insure hundreds of thousands of people, although precise data is hard to come by. (Some farm bureaus declined to comment or provide numbers.) Tennessee’s farm bureau covers about 200,000individuals. The Indiana Farm Bureau’s plans enroll about 11,000 farmers and family members, up from 5,000 in 2021, said Steven Allen, the group’s health plans manager.
Even so, Allen says, sign-ups for ACA plans in states like Tennessee, Arkansas and Indiana have all surged in recent years. Indiana, for example, saw 359,240 ACA sign-ups in 2025, up from 185,354 in 2023 — numbers that dwarf the farm bureau’s enrollees.
Feast or famine
Farmers have long struggled to find affordable health coverage because of their operation’s fluctuating profits. In that respect, the broader ongoing political battle over extending ACA subsidies — which Congress will try to take up before year-end — may not make a big difference to many farmers regardless of the outcome.
The problem: While insurance premiums are fixed, farm income is volatile because it depends on the size of a year’s harvest weighed against input costs such as fertilizer. And only some of those expenses can be written off — which means calculating income to find a health plan can be a moving target.
“If you don’t know if your monthly income is going to be $3,000 or $3,500, then you don’t know what percentage of income will be eaten up by a premium,” said Amit Batabyal, a professor of economics at the Rochester Institute of Technology.
Under this bookkeeping, many farmers are classified as self-employed or small business owners who are too wealthy on paper to qualify for subsidies — but are in fact cash strapped. And since the federal government has to be reimbursed if someone underpaid their ACA premiums the previous year, the calculus for farmers can be fraught.
“You might have one year where you lose your shirt, and then next year have a really great year and now you have to pay back some of these subsidies,” Batabyal said.
That said, a relatively large share of farmers, ranchers and other agricultural managers — 27 percent— still find coverage through the ACA, according to the nonpartisan health policy research group KFF. And many more have coverage through an outside job (or a family member with an outside job) that offers insurance. The Agriculture Department’s 2022 Census of Agriculture found that around 62 percent of farmers work off the farm at least part-time, although that estimate didn’t break down how many were insured through those jobs. An earlier study from the Agriculture and Applied Economics Association in 2018 concluded that 72 percent of farmers had insurance through an off-farm job held by themselves or a spouse.
Those jobs are generally at a school district or local government agency, which “tend to offer the highest wages and most generous benefits,” said Shoshanah Inwood, a rural sociologist for Ohio State’s agricultural school.
Health care on the cheap?
Farmers and agriculture associations have generally backed the spread of the farm bureau plans, arguing they extend affordable coverage to more people.
But a direct comparison between farm bureau coverage and standard health insurance (ACA or not) is difficult. The agriculture groups aren’t required to submit any data to regulators, while the cost of health insurance on the open market is highly variable.
Furthermore, farm bureaus don’t publish the monthly costs for their plans. But they do advertise annual deductibles between $1,500 and $3,750.
Jason Mugnaini, the Wisconsin Farm Bureau’s executive director of government relations, says he estimates bureau health plans are 30 percent to 60 percent cheaper than unsubsidized insurance through the ACA. But they “will never be able to compete with subsidized health care plans,” he acknowledged.
For now, these plans hold bipartisan appeal. In the case of the Ohio legislation, which came into effect in September, nearly all Ohio Democrats voted with Republicans in a rare example of cross-party agreement. While Democrats expressed some misgivings about the law, most saw it as a way to extend affordable coverage to more people.
Hearcel Craig, a Democrat representing the east side of Columbus, said he voted “yes” only after Republican colleagues included transparency requirements about the policies the bureau sells, such as disclaimers that the plans don’t offer the same protections as traditional insurance.
Democrat Nickie Antonio, whose district encompasses most of Cleveland, said she would have preferred universal health coverage, “but that’s not the world we live in.” Farm bureau plans at least cover some people now, she said.
However, the unregulated nature of farm bureau coverage gives pause to Ohio farmer Scott Myers, who has several employees working on his 2,500-acre farm in the northeastern portion of the state.
“I don’t want to hire somebody and find out that one of my employees can’t work for me” because a health plan won’t cover their preexisting conditions, he said. “I try to pay well, offer a lot of time off and offer health insurance benefits.”
Kendyl Meadows, who runs an organic vegetable farm in Columbus, is unsure if she would qualify for a farm bureau plan because she has two preexisting conditions.
“I’m nervous about anything that’s trying to chisel away at valuable consumer protections,” she said. “Even though the plan might look good now, without federal guidelines enforcing it, it could change at any moment.”
The American Cancer Society and the American Heart Association cited the exclusion for preexisting conditions as one of the main reasons they opposed the expansion of these policies.
And while farm bureaus say they won’t cancel a health plan following a serious diagnosis, nothing stops them from doing so, notes Anna Howard, policy principal for the American Cancer Society’s Cancer Action Network.
Farm bureaus also face no disclosure requirements, leaving potential applicants in a state of uncertainty, according to a 2023 Government Accountability Office report. Policymakers “lack a clear understanding of how these plans and memberships operate, their role in the insurance market, and the scope of their potential effects on individual consumers and workforces,” it warned.
These plans, critics say, also unravel a basic principle underpinning strong insurance markets — the concept of pooled risk. “Segmenting the market, taking the healthy people who can pass medical underwriting and enrolling them in the farm bureau plan … hurts comprehensive coverage because you’re left with older and sicker people [on traditional insurance],” Howard said.
The business relationship between farm bureaus, which are nonprofits, and the plans they sell on behalf of insurance companies remains unclear. Ryan Matthews, a spokesperson for the Ohio Farm Bureau, said in an email that the organization doesn’t charge “additional fees on these plans,” but added that “a very small portion of the total premiums collected does help support the many administrative costs.” Other farm bureaus didn’t respond for comment.
To supporters, the plans remain an important option to cover farmers’ specific needs — needs that were not addressed by the ACA.
That was the case for Wisconsin farmer Sydney Flick, who recalls looking for insurance on the ACA marketplace four years ago as a “healthy 27-year-old.” The best she could find was a plan costing $500 a month.
Flick, who runs a dairy farm near Lodi, is now insured through her husband’s job, but she supports efforts to expand farm bureau health coverage in her state given the sometimes-dangerous nature of the work and the toll of manual labor.
“We have a higher risk job, making health coverage more important,” she said.
The post More states are offering cheap health plans to farmers, with a catch appeared first on Washington Post.
