DES MOINES &#8212 The cost of health care in the United States is putting a pinch on many family farmers and ranchers who are struggling to pay high premiums and out-of-pocket expenses, according to a report released Thursday.

About 90 percent of the more than 2,000 farmers and ranchers who were surveyed said they had some sort of health coverage. However, many complained of high premiums, and more than one-quarter said high out-of-pocket insurance costs were creating financial problems.

The money problems included using up savings, being forced to take off-farm employment, delaying investments in their operation, and difficulty paying rent, mortgage and other bills.

Most of the 10 percent of respondents who reported that all, or at least one family member was not insured at some point in 2006, said they didn’t have coverage because it was too expensive.

“Medical costs are way out of line,” one respondent said. “Insurance company costs have gone way beyond affordable when income has stayed the same.”

Alana Knudsen, a co-author of the study, said the survey shows that policy solutions are needed “to ensure that farm and ranch operators and other small business owners are able to pay for health care services in their rural communities.”

The study found that about 20 percent of farmers and ranchers had outstanding medical debt.

The report was based on telephone surveys this year in Iowa, Minnesota, Missouri, Montana, Nebraska, North Dakota and South Dakota.

Researchers at the University of North Dakota’s Center for Rural Health, Brandeis University and The Access Project analyzed the results.

“For farmers and ranchers, health care expenses have the potential to affect not only their families’ economic security, but the financial viability of their businesses, which in turn may impact the larger economy,” the report said.