Minding Ag's Business

OMAHA (DTN) -- Farmers and other rural Americans who buy health insurance through the Affordable Care Act (ACA) marketplace face another year of double-digit premium increases and continued concerns about the "ACA cliff."

Premiums, on average, are set to rise 13% for 2027 after increasing 26% for 2026, according to an analysis by KFF, a health policy research organization. At the same time, premium increases vary widely by state as well.

Premiums vary based on factors including age and location as well as the number of people on the policy.

Iowa, for instance, has one of the smallest average premium increases in the country at 5.7%. Only Vermont, at 3%, is lower. In Nebraska, the average premium increase is 13.6% compared with 12.3% in Missouri and 18.7% in Kansas. The highest average premium increases nationally are in Arizona (27.9%), New Mexico (24.4%) and Montana (23.3%).

Rural Americans left the health care exchanges at a higher rate than urban residents after enhanced premium tax credits expired at the end of 2025. In its report on open enrollment, the Centers for Medicare & Medicaid Services stated rural Americans enrolling in ACA plans fell by 10% for 2026, compared to a 4% decline in urban areas. Nationally, about 20.5 million people were covered by ACA plans in June 2026 compared to 25.2 million people a year earlier, KFF reported.

KFF estimates that 27% of farmers, ranchers and other agricultural managers rely on the ACA for insurance, but KFF's most current data was from 2023.

THE ACA CLIFF

The premium increase will also fall harder on people with incomes above 400% of the federal poverty level because they no longer receive premium tax credits to help offset the costs. This leads to the risk of hitting the ACA cliff.

The premium subsidy doesn't taper off any longer, but the subsidy ends abruptly when people top that 400% poverty level by as little as $1.

For 2027 plans, the 400% federal poverty level for an individual and family breaks down like this in the 48 contiguous states:

1 person -- $63,840

2 people -- $86,560

3 people -- $109,280

4 people -- $132,000

As an Iowa farmer told DTN, he and his spouse are spending a lot of energy just planning ways to ensure they don't breach the $86,560 income level for a two-person household. That includes looking at late contributions to IRAs and sometimes turning down work that would risk their premium assistance. Losing the premium subsidy would essentially spike their insurance costs by $23,000 a year, essentially making it impossible to pay the premiums.

PREMIUM CHANGES ACROSS STATE LINES

The Washington Post published interactive maps in an article showing premium increases for benchmark plans by county based on ages and the number of people in the family.

Looking at policies in Iowa, a 40-year-old policyholder with a family of three could see premiums increase $38 to $134 a month, depending on the county. For a 50-year-old policyholder with a family of four, the premiums could increase anywhere from $92 to $332 a month.

In neighboring Nebraska, that same 40-year-old with a family of three faces a premium increase ranging from $138 to $165, while the family of four led by a 50-year-old in Nebraska will see a premium increase ranging from $346 to $423.

Reflecting that contrast, the 50-year-old with a family of four living in Sioux City, Iowa, would see an average premium increase of $144 a month. Living across the Missouri River in South Sioux City, Neb., the average premium increase is $387 a month.

In Kansas, a cluster of counties in the northeastern part of the state shows the premium increases for that family of four could jump by as much as $804 per month. Yet, in adjacent counties in Missouri and Nebraska, the same family's premium increases are closer to $300 a month.

ACA ENROLLMENT

Enrollment under healthcare.gov began on Nov. 1 and runs through Jan. 15, 2027. For people who enroll by Dec. 15, their coverage starts on Jan. 1. For those who enroll from Dec. 16 through Jan. 15, their coverage starts on Feb. 1.

Chris Clayton can be reached at Chris.Clayton@dtn.com

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