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GOP Health Care Bill Could Hit Rural America Hard

Screenshot/Department of Health and Human Services
Darvin Bentlage, a cattle farmer in Barton County, Mo., was uninusred before the ACA and worries he could be again under the GOP replacement plan.

Darvin Bentlage says his health insurance plan used to be the same as all the other cattle farmers in Barton County, Mo.: stay healthy until he turned 65, then get on Medicare. But when he turned 50, things did not go according to plan.

“Well, I had a couple issues,” he says.

He’s putting it mildly.

Over two years time he had Hepatitis C and diverticulitis, and that’s on top of his diabetes, persistent kidney stones and other problems.

“I had to go back and refinance the farm,” he says, “because by the time the two years was up I had run up between 70 and 100-thousand dollars hospital bills.”

He racked up those bills in 2007. Bentlage says all those pre-existing conditions made buying health insurance became impossibly expensive, which was a problem, because he needed more health care. So when the Affordable Care Act exchanges opened up in 2013, he says, “I was probably one of the first ones to get online with it and walk through it.”

Bentlage was so vocal about how well it worked out, the Obama administration made a video about him.

Farmers, on the whole, are a pretty conservative bunch, politically, but there’s a key part of the ACA that works well for them. That part is also exactly what they stand to lose under the GOP replacement plan: subsidies that are responsive to income fluctuations.

Back in 2013 when Bentlage first purchased insurance through the ACA, he had an average crop year and got about $4,000 in subsidies to help pay his insurance premiums. But then last year there was a lot of rain in Barton County and he had trouble getting his crop planted.

His income went down, but as it did, he qualified for more health insurance subsidies, up to about $10,000 worth. That’s how he was able to keep his health insurance.

Under the GOP replacement plan, those subsidies will vary based solely on age and will be capped at about $4,000. That’s not enough for Bentlage to afford health insurance if he has another down crop year.

“I’d just have to go back to plan A and hope I make it to 65,” he chuckles.

Insurance premiumstend to be higher in rural areas, where patients tend to be older, poorer and sicker most; but that’s just part of the healthcare challenge in places like Barton County. Maggie Elehwany of the National Rural Health Association says there’s another issue: 80 rural hospitals have closed across the country since 2010.  

"We've got an access crisis going on," she says. "What this House bill does is nothing — nothing to address the rural hospital closure crisis.”

And hospital closures, she says, affect  “not only the health, but to the economic vitality of the community.”

“If a hospital closes in a rural area, it closes for good," she says.

One reason for these hospital closures is that 19 states, including Missouri, chose not to expand Medicaid under the ACA, which left many rural patients uninsured and unable to pay their bills. The GOP proposal would cut Medicaid even more over time.

Darvin Bentlage has experience with this problem too. He says his county recently increased property taxes to keep its hospital open.

“It falls on the farmers,” he says. “My property tax on the hospital went from about 80 dollars to about 400 dollars.”

Missouri’s Republican congressional delegation has said the ACA has failed. And Bentlage says it does need work.

“There’s problems with it,” he says, “but I don’t think it’s not worth scrapping.” All you need to do, he says, is look how it’s helped him.

This story was a collaboration between Side Effects Public Media and Harvest Public Media