There are three good reasons why ranchers pay the high cost of health insurance — to get good medical care if sick or injured, avoid ruinous medical bills, and protect the ranch from medical creditors should medical bills outstrip the ability to pay them.

Even so, some ranchers can't afford health insurance now. And, as insurance premiums continue to rise, the number is likely to grow, adding to the national total of more than 60 million adults who either can't afford health insurance or have insufficient coverage.

There are ways to make such insurance more affordable. Among them is to opt for a higher deductible.

When their annual premium hit $11,000/year, Carol Hamilton, who with her husband operates a 600-mother cow operation in southwest Wyoming, opted to raise the deductible from $1,000 to $5,000. The higher deductible dropped the couple's annual premiums to $7,400.

Some health insurers offer deductibles as high as $20,000 for each person insured in return for low rates, but there's a trade off. The higher the deductible, the higher the potential out-of-pocket expense. Remember, however, that the purpose of health insurance is to avoid catastrophic health expenses that can financially ruin you.

Health savings accounts

One way to prepare for high deductibles is a Health Savings Account, which provides federal income-tax breaks for contributions paid into the account. Such accounts function like a standard Individual Retirement Account. Contributions up to a set limit may be deducted from taxable income.

Money in the account can be invested and grow tax-free. Then it can be withdrawn without tax penalty to meet insurance deductibles or other out-of-pocket medical expenses, such as doctor fees, eye exams or dental care. (Check federal guidelines for details on Health Savings Accounts.)

Even with high deductibles and a Health Savings Account, adequate health insurance is still beyond reach for about a third of U.S. adults. As a result, some people think the day has come for a federal national health insurance plan, similar to those in Canada and Europe.

“I hate to say it, but I think the government is going to have to step in and do something,” says central Wyoming rancher Rob Hendry, who pays $1,200/month to cover himself, his wife and two children. “I'm not one for big government, but this is getting out of hand.”

A large new federal program would be difficult to pull off given the mounting federal deficit. In the meantime, many states have tired of waiting for a federal program and are opting for their own experimental programs to get more residents insured. The most radical is in Massachusetts, which plans to achieve health insurance for every state resident. (Check with state officials for programs that may be available or about to begin in your state.)

No signs of easing

The rising cost of coverage shows no signs of easing. Even with the lower rates Carol Hamilton obtained by raising her family's deductible to $5,000, health premiums are still more than 700% higher than in 1987 when the cost was less than $1,000/year.

“There's no way the average self-employed person can keep up with the cost,” she says. “In another five years, gosh knows what it will be.”

For the present, the Hamiltons are biting the bullet and paying the bill.

“If something serious happened, we wanted insurance to pay the medical bills without having to mortgage the ranch to pay them,” she says.

For others though, the price of insurance is out of reach. In that case, here are some things you can do, according to Jack Thomas, MD, director of the Family Practice Residency Program at Pacific Hospital in Long Beach, CA, and the host of the TV series, “Dr. Jack's House Calls.”

First, if you have an emergency, remember federal law requires hospitals to treat emergencies first and worry about collecting the bill later.

“Neither profit nor non-profit hospitals can turn you away if you think it's an emergency,” Thomas says.

  • If you have an emergency, Thomas suggests you go to the nearest hospital or call 911 for an emergency crew to take you to the nearest facility.

  • Second, if you have children, keep in mind Congress has authorized millions of dollars to assist states in helping families without insurance to pay their children's medical bills.

  • Many hospitals will negotiate a lower fee structure for those who can't pay their bills in full. While such measures can be negotiated after the fact, it's often better to work out a payment plan in advance.

    “Be proactive,” Thomas says. “Go to the hospital's business office and ask what you can work out, such as a reduced price payment plan.”

  • Other avenues for reduced-price care for many procedures include privately-run free clinics. Many areas also have reduced-price teaching facilities where doctors go to meet residency requirements once they've finished medical school, Thomas adds.

Check for reduced-price dental programs, as well. Dental schools are one place to look.

Doug McInnis is a Casper, WY-based business writer.