RALEIGH, N.C. - As North Carolina farmers work to put food on the tables of the state's residents, many are doing so without health insurance or preventive care.

According to the Agromedicine Institute, at least 30 percent of farmers and more than 90 percent of farmworkers do not have health coverage. Francesca Hyatt, Come to the Table director for Rural Advancement Foundation International, said the data points to a cultural practice among farmers.

"They just tend to really be outside of the system," she said, "and so it's been a problem for a long time that farmers have had insufficient access to health care, and farmers will be focusing on everything but their own well-being."

The Affordable Care Act could provide health coverage for some farmers, but because North Carolina did not authorize a Medicaid expansion, Hyatt said many could fall into a coverage gap based on their income and not qualify for help.

Along with a lack of access to medical care, workers in the agricultural industry in North Carolina have a 7 1/2-times greater chance of dying on the job than people in other professions. That figure also is from the Agromedicine Institute, where director Robin Tutor-Marcom noted that it's hard for farmers to make time for medical care, with many of them working during office hours.

"Traditional hours for obtaining medical care are not conducive necessarily to farmers getting care," she said.

Because the system created under the Affordable Care Act involves reporting information to the government, Hyatt said, some farmers may be hesitant to take part.

"Farmers, they tend to be suspicious of enrolling in something through the government," Hyatt said. "So, there's partly, I think, just sort of a cultural barrier, that there's a lot of mistrust about what this is."

Hyatt said it's important to note that the government considers income and not assets for deciding whether a person qualifies for federal assistance in getting health insurance.

The Agromedicine Institute serves all 100 counties in the state and is providing help to farmers as well as people in the fishing and timber industries who want information about the ACA.


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California's program helping low-income families buy fresh fruit and vegetables is on the chopping block and health care advocates are asking legislators to save the Market Match program.

Gov. Gavin Newsom has proposed cutting most of the program's $35 million budget to help close the state's budget shortfall.

Sophia Vaccaro, a participant in Market Match from Echo Park, said she depends on Market Match in more ways than one.

"It helps people being able to stretch their budget further," Vaccaro explained. "Then, I think it helps the community, in that it creates a sense of camaraderie at the farmers' market and makes people more invested in the community itself."

The program matches every dollar CalFresh customers spend on fresh fruits and vegetables at a farmer's market up to between $10 and $20 per day. It is active at 294 sites across the state and is partially paid for through federal matching funds.

Dr. John Maa, surgeon at Marin Health Medical Center and board member of the San Francisco Bay Area chapter of the American Heart Association, said Market Match promotes healthy eating and boosts the local farm economy.

"An improved diet really will have long-term meaningful impacts on health, and also reduce health care costs," Maa explained. "It really helps to sustain the growers and the merchants. I guess it's a win-win-win."

Siu Han Cheung, outreach coordinator for the Tenderloin Neighborhood Development Corporation and board member of the Heart of the City Farmers' Market, argued the program is vital to residents across the state.

"If the Market Match will be cut, that is terrible," Cheung stressed. "That means they have less money to buy their food. So, Market Match is very important for the low-income families and the seniors."

Legislators and the governor are working toward the May budget revisions, and must pass a balanced budget by June 15.

South Dakotans face high prices at the grocery store and some are working to ease the burden.

A new report from the Federal Trade Commission finds some grocery retailers used the supply-chain disruptions of the pandemic to raise prices and collect bigger profits, even after supply chains regulated.

One South Dakota group is trying to reduce sticker shock by targeting the state sales tax on groceries. Dakotans for Health is sponsoring a citizens ballot initiative to repeal the 4.2 % tax.

Rick Weiland, co-founder of the group, said lower food bills would make a meaningful difference for some.

"People of modest means, or low income hardworking families, disproportionately spend upwards of 30% on food," Weiland pointed out. "This is going to be helpful."

South Dakota is one of only two states in the country to apply its full state sales tax rate to groceries with no exemptions, Mississippi being the other. More than 9% of South Dakotans are considered food insecure, meaning they do not always have access to enough healthy food.

The grocery tax has been a popular topic among state legislators in recent years. Republican Gov. Kristi Noem even campaigned on the promise to repeal it. Critics have said proposing a tax cut without a way to finance it is irresponsible.

Weiland pointed out Gov. Noem had a formula spelled out when she brought forward her bill in 2023, which was voted down.

"She had no problem defending her position in front of the Legislature, in terms of how much revenue the state was going to lose and where they could make it up," Weiland recounted.

The initiative needs about 17,500 signatures by next month to appear on the November ballot.

Colorado families must sign up before the end of April to receive $120 per child to buy food through the new Summer EBT program approved by Congress. Families with incomes that qualify for free and reduced-price school lunches - up to around $49,000 a year for a family of three - must enroll through their school.

Anya Rose, public policy director with Hunger Free Colorado, said as school cafeterias close their doors for summer, EBT cards can help kids get the nutrition they need to return to school in the fall ready to learn.

"A lot of families will be automatically enrolled, if they are enrolled in programs like TANF, SNAP, Medicaid. If you are unsure, then talk to your school about filling out the household income form to make sure you can qualify this year if you're income eligible," she said.

EBT grocery cards can be used to buy fruits and vegetables, milk, cheese, eggs, breads, meat, fish and other food at all grocery stores that accept SNAP, the Supplemental Nutrition Assistance Program formerly known as food stamps.

Rose noted grocery cards will be sent by mail, so it's important to make sure schools have your correct address.

Some 337,000 Colorado children are eligible for the program that is expected to generate up to $72 million in economic activity across the state. Grocery cards are available to all income-qualifying households regardless of their immigration status.

"There are no immigration eligibility requirements. And accessing Summer EBT and school meals do not impact immigration status in any way," she explained.

Filling out your school's household income application, sometimes called a school meal or benefit form, will also bring critical federal dollars into Colorado's Healthy School Meals for All initiative. It's currently running $24 million over budget. Rose adds there are other benefits for families who participate in Summer EBT.

"That same form can also qualify students to get discounts on school-related fees for things like SAT or ACT testing, or athletics or band or field trips or other activities," she said.