Skimpy Health Plans Not a Solution for North Carolina’s Uninsured Farmers and Farm Workers

RALEIGH (July 17, 2018) — A proposal recently debated in the General Assembly would allow groups like the Farm Bureau to offer health plans that are exempt from the Affordable Care Act’s (ACA) benefit standards and consumer protections, as well as state and federal insurance rules. These skimpy plans would be inadequate and unaffordable for North Carolina farmers and farm workers, and would do more harm than good, according to a new report from the Washington DC-based Center on Budget and Policy Priorities.

Supporters have claimed these more limited plans will help farmers who make too much to qualify for federal subsidies to help pay their premiums. However, most North Carolina farmers and farm workers struggling to find health coverage have incomes low enough to qualify for subsidies, the new report finds.

Seventy-five percent of uninsured farmers and farm workers in North Carolina have family incomes less than 200 percent of the federal poverty level (or about $48,000 for a family of four). Many would likely be eligible for subsidies to help them afford good-quality insurance through the state’s marketplace or would be able to access Medicaid coverage if North Carolina would opt to close the “coverage gap.”

In contrast, skimpy plans with premiums farmers and farm workers in this group could afford are likely to offer extremely limited coverage, leaving anyone who buys them exposed to high costs if they experience an illness or injury.

“Skimpy plans won’t meet the needs of most North Carolina farmers and will harm many,” said Brendan Riley, a policy analyst with the NC Justice Center’s Health Advocacy Project. “Folks could end up with junk insurance that doesn’t cover medical emergencies, like a farming accident or serious illness.”

Farm Bureau plans aren’t the only type of skimpy coverage that could harm North Carolina consumers. Proposed federal rule changes would allow so-called short-term health plans to last up to a year, even though they are exempt from a number of consumer protections. Such plans typically exclude people’s pre-existing medical conditions, charge very high deductibles, and often leave out coverage of maternity services, mental health care, and substance-use disorder treatment.

Backers of expanding skimpy plans sometimes mention people in the Medicaid “coverage gap” as being a target population for such coverage. North Carolinians in the coverage gap have incomes below the poverty level and generally are not eligible for ACA marketplace subsidies, yet they can’t enroll in Medicaid because North Carolina has not adopted the ACA’s Medicaid expansion, which extended that program to people with incomes up to 138 percent of the poverty level.

Closing North Carolina’s coverage gap would help low-income farmers and farm workers access affordable health care. Expanding skimpy plans would leave this group exposed to overwhelming costs and financial risks.

“North Carolina lawmakers should consider better policy options to make health coverage more affordable for farmers and farmworkers, including adopting the ACA’s Medicaid expansion and providing more help with enrollment to people who are already eligible for comprehensive coverage,” Riley said. “This would increase access to adequate health coverage for farmers and farmers in North Carolina, without upending the state’s insurance market.”