Excessive health care costs, limited high-speed internet service and long-delayed road and bridge projects are some of the top problems that frustrate those who live in smaller communities, and many do not believe that their voices are being heard by policymakers.

The concerns are identified in a new report by the Minnesota Farmers Union, a grass-roots family farm organization that held 14 discussion sessions across the state in 2017 and another seven this year that drew more than 800 farmers and other members of the public.

Of all the issues, the price of health care dominated the list, with farmers and small business owners reporting costs of $25,000 to $45,000 per year in health insurance premiums and deductibles.

"People want options," said Minnesota Farmers Union President Gary Wertish. "They're tired of politicians playing politics with their health care costs."

High costs are difficult for everyone buying health insurance in the individual markets, said Wertish, and especially for farmers who are starting a fifth consecutive year of depressed crop prices and are struggling to make ends meet.

Wertish said those at the meetings voiced almost universal support for some kind of public health care option to be implemented, such as a buy-in option to MinnesotaCare or even a single-payer program. Other ideas have included more support for programs such as health care cooperatives, or reinstatement of a high-risk health care pool funded by insurance companies.

"Nothing's happening at the federal level, and nothing's happening at the state level," Wertish said. "We're ignoring a huge problem."

Officials from the administration of Gov. Mark Dayton attended the listening sessions, including Nathan Moracco, an assistant commissioner of human services, who said Dayton's proposed buy-in to MinnesotaCare would drop insurance rates by 28 percent for many people without affecting their choice of provider.

Opponents have repeatedly voted down the proposal on the grounds that Minnesotans don't want more government involvement in health care, and that less regulation will lead to more private competition and lower premium costs.

The report also highlighted the need to upgrade rural roads and bridges, and support for a higher gasoline tax or other dedicated funds to make that happen. The current road funding system is based on an outdated model that falls far short of road and highway costs of the 21st century, Wertish said.

Also on people's minds was access to internet service.

"Lots of rural areas don't have broadband," said Wertish. "It should be viewed as a public utility because it's important for farmers or public schools or small businesses if they're going to compete."

University of Minnesota Extension Dean Bev Durgan said that the problems presented in the report are valid for most rural residents, not just farmers — and in some cases for urban Minnesotans as well.

"We like to talk in extension that rural communities aren't dying, but they're changing, and that they're different than what they used to be," she said.

One difference is that the rural population is aging, she said, so it's no surprise that health care costs and access are a growing issue in farm country. A related change is a more diverse population and workforce, she said, and what that means for large farming operations and manufacturers that want to locate or expand in rural Minnesota.

Another issue not highlighted in the report, said Durgan, is the other end of the age spectrum: how rural communities can expect to attract younger people to take over small businesses and retail when they lack adequate housing, child care centers and women's and pediatric health specialists.

Farmers and others at the listening sessions also expressed concerns about rural hunger, and wanted more state support for local food programs, food shelves and local groceries. And they felt strongly about the need for a strong federal farm bill that provides an adequate safety net for farmers, including crop insurance.

Steve Robinson, city administrator for Worthington in southwestern Minnesota, said much of the report rings true for his community, although it represents "big picture" issues while the city is focused more narrowly on specific solutions.

A recent survey of the city's major employers revealed that one of their biggest problems was attracting and retaining employees, Robinson said. "We determined that our role in economic development is going to be not to create jobs but to create employees," he said.

To do that, Worthington has allocated $3 million for new housing, Robinson said, and plans to spend $4 million on parks, trails and other amenities to make the city more inviting to new residents.

The need for solutions is also emphasized in the Farmers Union report. Underlying many of the discussions was a sentiment that rural Minnesotans need more respect and communication, and that farmers feel that they are often not consulted about environmental and other regulations that affect their farms and families.

"There is also a concern that the news media continues to portray rural people in an unfavorable light, and that rural people are looked down upon and blamed for problems unfairly," the report said.

Top representatives from the state's human services, agriculture and transportation agencies attended most of the discussion sessions. Wertish said the report will be presented to legislative leaders of both parties.

Tom Meersman • 612-673-7388