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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Organizations working to fight food insecurity across Arkansas support two bills before state legislators.

The Grocery Tax Relief Act would repeal the state grocery tax and the Good Neighbor Act would expand protections for food donors and food banks.

Brian Burton, CEO of Arkansas Foodbank, said several recent bills passed by lawmakers have helped Arkansans who cannot afford food.

"Expanding school lunch programs and raising the asset limit on SNAP Benefits," Burton outlined. "And in the current session they passed the universal Free School Breakfast bill."

Arkansas is one of only 10 states in the country with a grocery tax. It generates approximately $10 million a year.

The U.S. Department of Agriculture has ranked Arkansas number one for food insecurity for the last two years. If the bills are passed, they will go into effect in January 2026.

Burton noted they are monitoring possible changes in federal funding because of cuts by the Trump Administration.

"When they talk about cutting the federal budget, they are hurting low-resource states like Arkansas because we are very dependent on all the myriads of federal government programs," Burton pointed out. "Some of which have been funded for decades."

Nearly 11,000 more Arkansans are struggling to make ends meet than in 2022. It's estimated nearly 47% of Arkansas households are living paycheck to paycheck. Burton stressed those residents will be affected the most by any changes.

"Programs like SNAP and WIC, the Farm bill, these are mission-critical and central to the fight against food insecurity," Burton contended. "In fact, 80% of food insecurity is solved through some form of federal nutrition program."


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Gov. Bill Lee has opted Tennessee out of the federal Summer EBT program and nonprofit groups in the state said they will work to fill the gap for families in need.

Summer EBT provides $40 a month per child for food assistance when kids are out of school.

Ella Clay, executive director of the nonprofit Healing Minds and Souls, said losing $75 million in federal aid is disappointing. Her organization serves 500 meals a week and provides resources to families in the 37208 ZIP code, an area with high food insecurity and significant challenges for residents.

"We have food," Clay pointed out. "We have produce, vegetables, fruits, personal hygiene products, products for your household, and various products even for children. And so, those are the ways that we're here to serve our community."

Nearly 700,000 children benefited from the Summer EBT program last year in Tennessee. Gov. Lee has instead announced a state-funded alternative to provide a one-time, $120 payment to eligible families in underserved counties.

C.J. Sentell, CEO of the Nashville Food Project, said despite the proposed federal budget cuts, his organization vows to keep providing summer meals for kids and continue participating in the Child and Adult Care Food Program and the Summer Food Service Program.

Sentell noted they are working with 50 partners to deliver nearly 7,000 meals weekly from two kitchens.

"We work with those organizations to enhance their programming with food," Sentell explained. "All of our work is done in partnership with other organizations and 65% of our meals are going to children and seniors, so, think after-school programs, senior adult programs."

He added they work with partners and use federal programs to reduce costs, providing food to child care centers like Saint Luke's Community House and have expanded partnerships in the past year to reach more people with food and curb costs.


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Food-bank organizations teamed up in four states, including Wyoming, to launch the 104° West Collaborative in 2021 to better serve their Indigenous community members.

Early research has helped them understand how to serve these rural communities in culturally informed ways.

There are 23 federally recognized Native Nations across North Dakota, South Dakota, Montana, and Wyoming - each with unique food access, security, and sovereignty issues.

President and CEO of the Montana Food Bank Network Gayle Carlson said the collaborative spent its first year interviewing key tribal leaders, to make a cultural learning series for food-bank staff and board members.

"It goes the gamut from the historical perspective of how food was used as a weapon," said Carlson, "all the way to who's the point of contact we should first be working with, so that we had that full spectrum of understanding."

The Food Bank of Wyoming's Totes of Hope program provides food for 150 Fort Washakie kids - about a third of its student population - when school isn't in session.

The organization is looking to expand its mobile food pantry deliveries on the Wind River Reservation this year.

Carlson said in cases of extremely long traveling distances, it can make more sense to use food bank resources to support agencies on or near the reservations to help serve people living there, rather than food banks delivering food themselves.

She added that the four-state area is almost 400,000 square miles.

"That was something that really struck home to me is the rural nature of these reservations," said Carlson. "They are a long way away from any services. They do not have public transportation. So for them to go a hundred miles to go to the Walmart is really, really difficult."

The Wyoming Food Bank distributed more than 615,000 pounds of food across the state's reservations in 2024.




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