"If anything were to happen to my wife and I, the business is sunk," Larry Harbour, a small business owner in rural Nebraska, told NPR. "It's like playing Russian roulette. Every day, we wonder when it's going to happen — if something's going to happen, are we able to afford it?"

Like millions of other uninsured and underinsured Americans, many of whom live in rural areas and have difficulty obtaining affordable and reliable coverage, Harbour and his family are one serious illness, one accident, away from financial calamity.

In the Harbour family’s case, the only health insurance plans he and his wife could find had premiums ranging from $24,000 to $40,000, on top of a $2,000 deductible. The cost was simply too great.

He said the insurance he and his wife investigated was basic, to the point where the couple would have to pay more for the insurance than they would for the health care they'd receive.

"It's unaffordable for me, especially being a small business owner, because I don't have a certain amount of employees to be able to get a better rate," Harbour said.

The Harbours’ situation is not a unique one in rural America, where half of all jobs are provided by small businesses. Small employers are at a severe disadvantage when it comes to securing affordable rates from insurers, in part because risks can't be pooled in a large group. Workers at small businesses are twice as likely to be uninsured as other workers,  according to Jon Bailey of the Center for Rural Affairs, based in Lyons, Nebraska.

In addition, farmers and ranchers, many of whom are self-employed, make up a sizable block of the rural population. One-third of farmers and ranchers are dependent on individual health insurance policies, four times the national average. Plans from the individual market often provide less coverage at a higher cost, according to Bailey, who co-authored a report released in April entitled, “The Causes and Consequences of the Rural Uninsured and Underinsured.”

Individual insurance policies in rural areas are more expensive for a number of reasons.

The costs are higher because of the nature of individual insurance. There isn't a large group to spread risk. And the rural population trends older and sicker, according to studies quoted by Bailey. There is also less access to health care in rural places, he added. On top of that, farming and ranching are considered risky professions.

The high cost of insurance in rural America puts reliable health care coverage out of the reach of many families like the Harbours.

"We can put people on the moon," said Linus Solberg, an Iowa farmer. "We can go up and fix this Hubble satellite that we have up there. And we can't have health care for all these people. It's ridiculous."