Old McDonald had a farm and on that farm he had health insurance purchased from the non-group market. With a higher premium here and more out-of-pocket spending for care there, he ended up paying twice as a much as those who received their health insurance through employment elsewhere ($11,200 to $5,600). E-I-E-I-Ouch.

Ok so we're mixing our musical metaphors. But for many of the two million plus family farms which account for 85 percent of the U.S. agricultural production, this is more than just a troubling tune. It's a harsh reality, made clear in the latest issue brief on rural health care and financial hardship from RWJF's Access Project.

Here are some of the take home points from the issue brief based on data from the 2007 Health Insurance Survey of Farm and Ranch Operators:

• Nine-in-ten surveyed reported having health insurance. More than a third (36 percent, four-and-a-half times the national average) received their coverage through the non-group market where they faced higher premiums and more out-of-pocket spending.
• Forty-four percent of farmers and ranchers spent more than 10 percent of their income on health care. For comparison, a recent study by the Lewin Group estimated that nationally one-in-four non-elderly Americans will spend more than 10 percent of their income on health care in 2008.
• Close to one-out-of-four surveyed (23 percent) said health care costs contributed to financial problems for themselves or their households. A quarter of those surveyed had to tap other financial resources to pay for care.
• Those respondents who had financial problems because of health spent 42 percent of their income on health care.

Today's farmers are not the Joads or the pre-OK Oil Clampetts. Median household income on family farms is just over $90,000 for 2008. And while most have health care, this report shows a great deal find themselves struggling to pay for it and avoid joining the ranks of America's some 25 million underinsurd in America. See for yourself, with this webcast produced by RWJF to accompany the issue brief.

More broadly, this report reinforces the fact that rising costs of health care affect all Americans. More importantly it illustrates some of the shortcomings of the non-group market, as currently structured, for providing affordable coverage.