With Big Potential Premium Increases Looming, About a Quarter of Farmers and Ranchers Get Health Insurance Through the ACA Marketplaces
A new KFF analysis finds that 27% of farmers, ranchers, and agricultural managers had health insurance coverage through the individual market in 2023. Many workers rely on the individual market for health insurance, and over 90% of individual market enrollees get their coverage through the Affordable Care Act (ACA) Marketplaces.
Over a quarter of chiropractors, real estate brokers, dentists, and workers in other occupations were also covered through the individual market.
Of those in the Marketplaces, most (93%) rely on ACA tax credits to lower their premiums.
Enhanced premium tax credits, which since 2021 have made Marketplace coverage more affordable and prompted a steep rise in enrollment, are set to expire at the end of this year, which would leave farmers and other workers with Marketplace coverage facing much higher out-of-pocket premium payments.
Also, KFF Vice President Cynthia Cox takes a broader look at the expiring enhanced tax credits, which Congressional Democrats have made central to their government funding demands, and how they lower health costs for many traditionally Republican constituencies, such as people in southern states, small business owners and employees, farmers and ranchers, older adults, and rural Americans.
QUINNSCOMMENTARY 
Let me repeat myself.
Amazing!
All of the D’s and R’s who want the subsidies to continue are suggesting that this is another curtailment of the Patient Protection and Affordable Care Act of 2010 – or Health Reform or ACA.
NOPE! By being opaque, they are lying to you. These “super subsidies” that will soon expire were NEVER part of the ACA.
They were add ons by the Biden Administration. They were intended to buy votes. They were intended to be temporary. They were intended to reduce costs and expand subsidies for Americans enrolled in public exchange coverage as part of the response to COVID.
Bue they were NEVER necessary!
COVID has long been over – pretty much since 2021, once the vaccines were commonplace. These enhanced subsidies took effect in 2022. They were NEVER part of Health Reform and THEY NEVER SHOULD HAVE BECOME LAW AS WE HAD ALREADY BLOWN THROUGH A FEW TRILLIONS IN EXTRA COVID EXPENDITURES.
The Robert Wood Johnson has released a report that says:
“… Enhanced premium tax credits were approved by Congress in 2021 and are set to expire at the end of 2025. If they are not renewed, approximately 7.3 million people will lose subsidized ACA health coverage, and 4.8 million people will become uninsured. …”
Yes, many will lose the subsidy that Health Reform DID NOT provide. And, yes many will become uninsured – NOT because they can’t afford it, but because they have different priorities – as the subsidy eligibility and percentages will return to the same levels that were approved as part of Health Reform, percentages and amounts in place from 2014 – 2021!
What the expiration of the subsidies confirms, however, is that ACA was NEVER about reducing the cost of health coverage for those who are covered by plans where the government does not set prices (employer-sponsored plans, marketplace/exchange coverage, individual insurance, etc.) No, the ACA was solely focused on increasing the number of people who were covered under Medicaid and taxpayer-subsidized coverage, even moving millions from what would have been employer-sponsored coverage to taxpayer financed coverage, while reducing the number of uninsured.
It was and it remains intentional – a drift towards single payer where taxpayers fund an ever increasing amount of health coverage for an ever increasing number of individuals.
ACA is the primary reason why America added $26 Trillion to the national debt over the past 15 years since March 23, 2010, the date PPACA became law with President Obama’s signature.
That is, we’ve reduced the cost of coverage today and sent the bill to generations too young to vote and those yet unborn.
Health Reform and to a much lesser level, President George W. Bush’s creation of Medicare Part D (Rx) coverage are the two main reasons why we are consistently running $1 – $2 Trillion in annual deficits – because, while President Obama guaranteed that health reform would not add one thin dime to the deficits and debts, all of the revenue gamesmanship failed.
Long past time to stop the farce. Long past time to stop adding to the massive burden we are passing to future generations.
Let the enhanced, vote buying subsidies lapse as approved when it was signed into law by Congress and President Biden.
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Jack, much of what you say is accurate, but I fear you are also out of touch with the real world of affording premiums and health care.
Many people cannot afford the regular ACA premiums. Many people will choose to give up insurance for other expenses and take the risk. ACA never could meet the political promises, but you know as well as I do the system does not work for nearly anyone.
As long as we have Americans in different systems, it will never work.
The day before I retired my premium deduction was $167 a month for a couple. Today for two of us all combined premiums are $2,000 per month. Yes, some of that is income based, but even without that it would be around $800 per month which is not easy for many retirees.
We can rant all we want about politics, but what we need is a system of insurance for every American on the same playing field and then we need to better coordinate all health care services provided to an individual.
We are in the process of navigating the system now from one doctor and facility to another and none talking to the other. We just had to pick up and deliver a CT scan disk to a doctor because he can’t access data where the CT was performed. That’s nonsense and wasteful. I can handle the system, but most people can’t.
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No, I am not out of touch.
Tell me why our children and grandchildren should pay more in taxes, someday, so that the cost of coverage for people who are in the public exchanges today should pay less than what Health Reform (the Patient Protection and Affordable Care Act of 2010 requires)!?
The problem is that Americans, including families of four with incomes in excess of 4x the poverty level ($128,600), which is nearly 50% more than the median household income ($83,730, 2024), are receiving Biden Administration subsidies that aren’t being paid for by current taxpayers, but that add to the annual deficit and national debt. We are adding $1 – $2 Trillion a year to our annual debt – spending money we don’t have must stop, and it must stop now!
Yes, American households who pay income taxes and who have incomes below the median household amount have been and will continue to pay more in taxes, today and tomorrow, to fund subsidies for people in households whose income has exceeded $128,600 in each of the past four years 2022 – 2025.
That is simply stupid. That is nothing more than vote buying.
Part of the problem is defining the word “affordable”. Under Health Reform, “affordable” premium for health coverage is defined as 9.96% of modified adjusted gross income in 2026 … in effect 10% of income.
However, American health care spending is about 18% of Gross Domestic Product, which is likely in excess of 25% of net after-tax personal income.
Remember that those covered under Medicaid generally pay no premium and have modest out of pocket costs. Remember that those covered under Medicare generally paid FICA-Med taxes while working and taxpayers, via general revenues (income taxes), pay 75% of the cost of Medicare Part B and Part D.
Do you have a deduction from your paycheck of 18%, or 25%? No, most employers who offer coverage don’t spend 10% of wages on health coverage, and they typically pay a super majority of the cost of coverage. In fact, most workers pay on average (and averages can be deceiving) 2% – 3% of income for single coverage, and 5% – 10% of income for family coverage – where the impact on take home pay is less than those ranges because most employee contributions are on a pre-tax basis via cafeteria plans.
Those who can’t afford the taxpayer subsidized coverage in the public exchange (as established by Health Reform, and as in effect from 2014 – 2021), should take the same steps 160+MM Americans have, and join an employer who offers health coverage.
American want the best health care coverage YOUR money will buy.
The existing super dollop of subsidies that were temporarily implemented during the Biden Administration have nothing to do with Health Reform “affordability” – they were simply ploys to buy votes, and to move Americans closer to single payer.
Stop! Stop I say!
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No doubt there is room for debate on the appropriate level of subsidies and for whom, but the bottom line is cuts will hurt people.
In NJ a silver plan for a family is over $1400 a month. So, what income level can afford that?
I want to know why a couple earning up to $300,000 a year can receive $25,000 in tax free tip income.
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First, those are not cuts. These were, are and continue to be temporary added dollops of wealth transfer from those too young to vote and generations yet unborn – monies far in excess of what was approved as part of Health Reform.
Second, why do you ignore the hurt that is assigned to taxpayers? Why do you solely focus on those who will no longer get extra subsidies? Individuals with incomes as low as $11,600 (single filers) or $23,201 (married filing jointly) are paying income taxes in 2025. Tell me why anyone earning that level (which isn’t even the federal poverty level for the single filer, where the joint filer’s income is slightly over the federal poverty level in the lower 48), who has coverage through an employer-sponsored plan, should have to pay even a dime in additional income taxes to fund someone else’s exchange based health coverage? That is stupid! It is totally arbitrary. It is nothing more than vote buying. And, worst of all, Presidents Obama, Trump, and Biden allow it to continue, ever increasing the national deficits and debt, adding $1 – $2 Trillion a year, ever increasing the transfers of wealth from generations too young to vote and those yet unborn in order to buy votes today.
Third, you note that in NJ a silver plan for a family is over $1400 a month. My understanding of exchange based coverage is tha tthe taxpayer subsidy is the amount that will keep the cost of coverage at 10% of the family’s Modified Adjusted Gross Income. So, if that is the individual’s cost of coverage, net of the taxpayer subsidy, they have an income of $140,000 a year, right?
Else, if that is the total cost of coverage before the taxpayer subsidy, $16,800 is a decent price for family coverage in most any state. But, you have to know the MAGI in order to identify what part is funded by taxpayers and what part is funded by the family, right?
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Al Lindquist
great work Jack–love reading a fact based analysis–same issues we face with all these social programs –brother Quinn wants us all under one system and like most of what he suggests it will be an invitation to more debt and more crises.
Again, thanks –it makes for an interesting read.
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Not just that but those who don’t have health insurance will be forced to use emergency rooms. That will cause those of us who do have health insurance to have our premiums go up. ACA is good for everyone. Not just the people who are on it.
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Al Lindquist:
Oh well another Christmas tree with goodies attached to hook the taxpayer and the insured–how much does it add to the deficit? Who cares because the left likes this deficit creator.
Wasn’t this “subsidy” supposed to help folks during the pandemic but then disappear as folks get back on their feet? Now that they have gotten used to this “subsidy” we should act as if this is just a normal cost and one party is trying to reduce this cost and pass on the difference to the user.
How serious is this? Some folks want to shut down the government if the “subsidy” disappears as it is supposed to.
Another lie promulgated by those who bought so many of the Biden falsehoods.
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I have often wondered if the MAGA Cult will survive without President Trump. The president’s policies that harm his supporters will likely make it difficult, if not impossible, for eventual pretenders to assume MAGA leadership. How ironic if the Cult withers away because of The Art of one too many disastrous Deals
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