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This story was produced in partnership with 

, a collaboration of public media newsrooms in the Midwest and Great Plains. It reports on food systems, agriculture and rural issues.

Ben and Paula Sue Steffen have been farming their whole lives in the small town of Humboldt in southeastern Nebraska. Over 40 years of marriage, they’ve seen good and bad times in the agriculture industry.

“It's always a balancing act,” Ben Steffen said. “There have been years where you could make money falling off a tree in this business. There have been some of those years — just get up and plant it — and you walk home and make money.”

“It hasn’t been like that the last few years,” Paula Sue Steffen added. “I don’t even remember in recent years when that would have been.”

This year is no exception. High diesel prices have added thousands of dollars to the yearly cost of running farm equipment. The Steffens had to cough up an extra $50,000 for fertilizer to treat their fields of corn, soybeans, wheat and hay.

“This is the most expensive crop we've ever put in the ground,” Ben Steffen said. “It's kind of breathtaking when you do this year after year, and you keep seeing those numbers go up.”

Those extra costs have already put a strain on the farm’s checkbook. But this year, a completely unexpected cost was added to the ledger: health insurance.

This year, the Steffens expect to pay $32,000 for health insurance — more than double the about $13,000 they paid in 2025 after the premium tax credit. Steffen said they could get a different income-based tax credit, but at this point they’re unsure how much of their costs it will offset.

Paula Sue Steffen said they’ll have to make space for the extra cost, especially in a potentially dangerous business like farming.

“We don't care about the fact that we may have to go to the doctor a few times a year or need a checkup,” she said. “We just need to be covered, because if something does happen, the numbers are just crazy. You have to be covered or you're going to be in trouble.”

The Steffens use an Affordable Care Act plan bought from the federally regulated marketplace. They’re part of millions of self-employed Americans and part-time workers who are paying more for the insurance after Congress allowed 

 that partially covered premiums to expire.

 58 percent on average for all enrollees this year, according to the health policy organization KFF. However, premiums doubled or tripled for many middle-income Americans who relied on the expired “advanced premium tax credits.”

The ACA plans — often called "Obamacare" — are a common choice for Americans who can't access healthcare through public benefits or employer-sponsored health plans. In 2025, about 22 million people across the U.S. got their coverage from an ACA plan, comparing and buying plans on 

The majority of people who purchase plans through ACA are working, according to Matthew McGough, an ACA policy expert with KFF. He said some may be working for small businesses unable to provide insurance or working fewer hours than needed to qualify to receive health care benefits through an employer.

“It's sort of like the last catch to get people who don't have any other way of receiving health insurance coverage,” McGough said.

The Congressional Research Service estimates there were 1.2 million self-employed agriculture workers in 2022. A KFF 

 found that around 27 percent of agriculture workers are on plans — a high share compared to the general population.

 about 13 percent across all users after premiums spiked this year, and they could rise 

Many enrollees downgraded their plan level, opting for a high deductible to get a lower monthly cost. The Steffens moved to one of the cheapest plans. It has a $7,200 deductible.

“It’s not a gold-plated plan where you get everything paid for,” Steffen said. “It’s the kind of thing that’s not sustainable.”

Health insurance wasn’t always such a concern for the Steffens. Over the past few years, they’ve downsized their operation. As the business changed, so did their healthcare costs.

“When we operated our dairy, we began offering healthcare benefits to our employees,” Ben Steffen said. “It was the right thing to do, and we tried to figure out a way to do it, so that we could help them, help our business and sustain them.”

They paid about $12,600 a year on the group plan. In 2022, the Steffens began selling off their milk cows when costs became too high to sustain their dairy operation. Now, stalls that once held hundreds of cattle are full of hay and the milking barn sits empty – and their health premiums have nearly tripled.

While variable costs and tough years are a part of farming, Nick Levendofsky, executive director of the Kansas Farmers Union, said the sudden shift in healthcare cost is something no one could have planned for.

“It's scary because it's cutting into their bottom line,” Levendofsky said. “They didn't necessarily budget for this. They didn't plan for this, and so therefore they've got to make difficult decisions.’

He said he’s heard stories of people dropping their coverage altogether. Levendofsky’s own premiums tripled this year.

“I was paying an amount that was very reasonable for my budget, and it meant that there was more money in my pocket,” he said. “I could buy more groceries. I could do other things with those dollars, and that's just not the case now.”

Having health insurance also provides a safety net for farmers, protecting them from farm-sinking medical debt.

Dina van der Zalm runs communications and outreach for the 

, a group that advocates for family-owned farms and rural communities. She directed the organization’s health policy efforts in 

 when it was advocating for the Affordable Care Act.

“We found a bunch of [farmers] were sending at least one person off-farm to get jobs to get health insurance, and then we also had a ton of people just not getting care, delaying access to care, and we were really, really alarmed by that,” van der Zalm said.

This year, she said she’s seeing the same patterns as farmers look to offset ACA costs. She said she’s spoken to many farmers who are behind on bills, paying minimums and setting up payment plans for regular primary care doctor visits. Some farmers are putting off important health issues or only paying for emergency care until they turn 65 and can enroll in Medicare.

“There's so much that is on a razor-thin margin right now that going uninsured is something folks are not doing now as much as they were doing in those 2007, pre-ACA days, but it is a kind of constant juggle,” van der Zalm said.

 from the University of Nebraska Medical Center found farming injuries cost about $11,000 on average in medical care and about $5,000 in lost work.

Financial stress can contribute to more health problems, including mental health challenges — especially in an industry like farming, where people are already managing unpredictable variables, like weather or harvest outcomes.

“One of the things that makes working in agriculture so stressful is how many factors are out of the producer's control,” said psychologist Mikela Spooner with Texas A&M University. “That is a chronic worry and concern that any of these things could happen or affect what they're doing at any given time.”

 program, which offers free mental health services. She said money comes up in many of her discussions with farmers.

“It might not always be at the forefront of folks' minds, or it might not be the exact reason that they're coming to see me, but it's always kind of related,” Spooner said.

Spooner said financial stress can be tied to worries about holding onto their farms and maintaining their lifestyle.

“We are a combination of our thoughts, our behaviors, and our emotions,” Spooner said. “When one of those becomes overwhelmed or out of sync to what helps us function at our best, it relates to all the others.”

‘We just keep waiting for something to give’

Affordable health care advocates have called for Congress to bring back the ACA tax credits, expand Medicare or Medicaid to wider populations, or consider system-wide healthcare reforms. Local groups of farmers and ranchers have also tried pooling resources in cooperative health plans, aiming to benefit rural areas.

In the short-term, farmers and ranchers do have some options to access more affordable health care. Some farm bureaus, farm unions and livestock producer associations offer health plans. But they are typically limited, not required to accept all enrollees and only cover dental, vision or minor health costs.

Nick Levendofsky said the Kansas Farmers Union offers some coverage to members, which he uses for dental and vision.

“It's a member benefit that we have, but we're very honest with people that it is not insurance,” he said. “It's just basically a supplemental plan that kind of helps save them some cost.”

Levendofsky said the Kansas Farmers Union supported the ACA from the start, in part because it would give families more flexibility.

“It could allow both spouses the opportunity to stay on the farm, and that's the goal for a lot of farmers,” Levendofsky said. “They can't do it alone, or they don't want to do it alone.”

And for some farmers, sending someone to work off the farm for an employer that offers health insurance is unrealistic.

Becky Potmesil and her family own a ranch in rural northern central Nebraska. Finding a regular 9-to-5 job would mean an hour commute to the nearby town of Alliance.

“We're too far from town for us to do that. It's a long, bumpy drive,” said Potmesil, who’s 60 years old. “We are on the end of a road out here – so it takes us a lot longer to get there – but we have neighbors that are about 10 miles down the road that are a lot closer to the highway.”

Potmesil's husband is on Medicare, so their ACA plan covers her and their son, who is 18. Their premium doubled to $2,050 per month this year. Like the Steffens, the Potmesils are also dealing with high input costs. 

 in the area have also compounded their issues.

“Really, our saving grace right now is that the cattle prices are still high,” she said.

Potmesil said managing costs is still complicated, but she hasn’t considered dropping her ACA insurance.

“We haven't gotten there yet, but if it keeps going the way it is — I mean, we just keep waiting for something to give,” Potmesil said.

The Steffens, who are both 64 and healthy, are holding on until they can enroll in Medicare next year.

Even with the heavy healthcare costs, they still wouldn’t trade their lifelong profession and family business for an employer-sponsored plan.

“The freedom to be self-employed is undervalued and underappreciated,” Ben Steffen said. “To walk out in the morning and sit here and look at a crop that's growing, there isn’t a better time of the year. Our corn’s growing three or four inches every day, and you can just see the landscape changing. It's a hopeful season. It's a hopeful business, really.”

This story is part of "Tough Times," a Harvest Public Media series looking at the economic stress that many American farmers are facing in 2026.

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When Congress allowed Affordable Care Act tax credits to lapse, healthcare premiums spiked for millions of Americans — especially self-employed farmers and ranchers. That added cost is multiplying the stress on their already stretched balance sheets.

Healthcare costs have more than doubled for many farmers this year, on top of soaring expenses

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