We live in a country where the majority rules. From local governments to the very peak of federal power, those who get the most votes win. 

In that same vein, the political party that wins the most seats enjoys the power and privileges that come with being in the governing majority in the legislative branch, and the candidate that garners the most votes lands at the very top of the executive branch. 

But what happens when elected officials controlling the agenda push policies of that most of the public does not favor? 

Unfortunately, that is exactly what is happening in regard to the debate about health care funding. A proposal has been introduced that has not garnered resounding public support. If implemented, cuts to the Medicaid program and ending health care tax credits have the potential to impact millions of Pennsylvanians.

As president of the Pennsylvania State Grange, I work every day with our state’s ag industry.  The state grange is the oldest agricultural and rural advocacy organization of its kind in the United States. Our members face a myriad of challenges and pressures daily as they do the hard work of providing the food and products that keep our country running. They encounter significant overhead and costs (especially when you factor in the price of equipment, land and energy) and operate on a very slim margin. There isn’t a lot of wiggle room in their budgets. 

That’s why the debate over Medicaid and the potential ending of health care tax credits is a very real concern to those in the commonwealth’s agricultural community. 

The data shows that Medicaid cuts will disproportionately hurt rural Americans, who are already facing health disparities and a lack of convenient access to critical services. 

And what is usually the largest industry in rural areas? Agriculture.

Medicaid, which is a joint program between the federal and state governments, provides health care coverage for children, people with disabilities, lower-income adults and older adults. There are approximately 3 million Pennsylvanians (or 23 percent of the state’s population) enrolled in the program. For those Medicaid recipients working in the ag industry, cuts to the program could be devastating. 

These are men and women who are working hard every day to provide for their families. These are our neighbors and friends. 

Interestingly enough, polling shows that there is a lack of appetite for cuts to Medicaid across the board—even from Trump administration supporters. A recent KFF poll shows that a majority of Republican voters (more than 60 percent) classify the federal Medicaid program as “very important.” In the rural communities that would be most impacted by the cuts, support for decreasing funding to the program was low—only 23 percent total in support and 35 percent of Republicans in favor.

At the same time, Congress is discussing whether to extend enhanced tax credits for health insurance. These tax credits have been crucial to make health insurance affordable for farmers.  Ending these tax credits will have a huge impact on our rural and agricultural communities. These credits are currently available for individuals with an income that is below 400 percent of the federal poverty level (FPL) to help them purchase healthcare on the Pennie marketplace—the state’s insurance marketplace. These credits keep their health care premiums to no more than 8.5 percent of their income regardless of the individual’s age.  

In Pennsylvania, the enhanced credits have provided a lifeline for more than 478,000 individuals, many of them farmers or others in rural areas—helping them to afford health insurance. Unfortunately, there is a very real possibility that these credits will expire. If that were to happen, health care premiums would increase by an average of 81 percent for individuals who are 250 to 400 percent below the FPL. 

Simply put: if these tax credits are not extended, it will effectively be a health-care tax increase on the agricultural community and will significantly jeopardize their ability to afford health insurance. 

It’s easy to state a talking point about an issue and speak in generalities. But the fact of the matter is the above-mentioned actions will have real, dire impacts on rural health care and the industries and people who work in these rural regions. 

I encourage our federal elected officials to take a hard look at the data and how these proposed cuts and tax credit rollbacks will affect their constituents—particularly those in rural communities.  

Matthew Espenshade is the president of the Pennsylvania State Grange.