Download with no insurance Income

Underinsurance Among
Iowa Farm Families
Natalie Roy, MPH
Executive Director
AgriSafe Network
Phone: 1-985-845-1116
Email: [email protected]
www.AgriSafe.org
Copyright 2007 AgriSafe Network
Funding provided by the Rural Health Network Project,
Office of Rural Health Policy, DHHS
AgriSafe Network
• The Mission of the Network is to support a
growing network of trained agricultural health
and safety professionals that assure access to
preventive service for farm families and the
agricultural community.
Survey of Farming Community
• Population-based 5265
farm households with a
gross sale of >$25,000
• Random sample of 2000
• In 2001 survey completed
by 717 farms (36%)
• In 2004 survey completed
by 920 farms (46%)
Survey administered by
Iowa Agricultural Statistics
(USDA)
• Written 10 page
questionnaire using
standard questions
Characteristics of
Survey Population
All Iowa
farms,
2002 USDA
Census
Farms
surveyed
in 2004
Farms
surveyed
in 2001
920
717
90,634
Number of people on
these farms
2,477
1,950
246,546
% of population under
18 years of age
26%
26%
% of population over
65 years of age
15%
15%
55
54
54
40,000
40,000
--
Characteristic
Number of farms
Average age of farmer
Median income of
farm household
FINANCIAL SECURITY
• 1/3 of farmers reported the financial wellbeing of their farm to be a moderate to
serious problem.
• 1/5 of families have a person working off
the farm for the primary reason of
obtaining health insurance.
• 1/2 of full time farmers also report
working off the farm part time.
E
Underinsurance
At What Point does the Increasing CostSharing by Consumers Become too
Burdensome?
At What Point Can this Increased Cost
Sharing be Defined as Inadequate
Financial Protection?
*Adapted from the State Health Access Data Assistance Center
Measuring Adequacy of Coverage
(Underinsurance)
Economic
Ability to pay for:
•Out of
Pocket Costs
Structural
Attitudinal
Benefits:
Beliefs of the consumer:
• Preventive Care
• Perception of unmet
healthcare needs
•Premiums
• Prescription
Drugs
•Deductible
• Dental
• Satisfaction
• Understanding
•Co-pay
*Adapted from the State Health Access Data Assistance Center
No Insurance by Income
Income
30,000
% with no
insurance
11%
30,000-50,000
4%
50,000 >
2%
US pop . <65 yrs
(n=238 million)
Source of
Health
Insurance
13%
6%
Public
Self-Purchased
Uninsured
Employer-based
17%
64%
Farm Pop. <65 yrs
(n=1701)
Farm Pop. <65 yrs
(n=2097)
1%
2%
38%
44%
50%
55%
5%
5%
2001
2004
Source of Health Insurance by Income
Employer
SelfPurchased
Public
< 30
20%
74%
6%
30 - 50
37%
59%
3%
> 50
45%
54%
1%
Income
(1000’s)
Median out of pocket costs by insurance type
(2001-2004)
1800
Annual Median Dollar Cost
1800
1600
1400
1400
1300
1400
1200
1200
1000
900
800
Households with
Employer-based
Insurance in
2001 and 2004
Households with
Self-purchased
Insurance in
2001 and 2004
Households with
Medicare in
2001 and 2004
Median premium costs by insurance type
(2001-2004)
5500
Annual Median Dollar Cost
5500
4700
4500
3500
3500
2500
2500
2200
1500
1700
Households with
Employer-based
Insurance in
2001 and 2004
Households with
Self-purchased
Insurance in
2001 and 2004
Households with
Medicare in
2001 and 2004
Percentage of Income Spent on Health
Care by Household Income
Income
<10%
10-19%
2029%
30% or
more
<30,000
14%
13%
36%
37%
3050,000
26%
47%
24%
6%
50,000>
77%
23%
0%
0%
Cost of Health Coverage
• Median Health Care Costs of Farm
Families in Survey is $6000
(Premiums + Out of Pocket cost)
• 3/5 of farm households spend more
than 10% of income on health care
• 1/4 of farm households spend more
25% of income on health care
E
Use of preventive services by
insurance coverage
Employer
Based
Self Purchased
all survey respondents
office visit in past year
blood pressure in past year
cholesterol in past year
83%
83%
52%
77%
78%
47%
women > 50 years
ever bone density
ever mammogram
57%
95%
50%
82%
men > 50 years
ever prostate
83%
78%
women > 19 - 64 years
gynecological exam in past
year
70%
55%
children <11 years
well-child visit in past year
61%
44%
Benefits Covered among those
< 65 years of age
Co-pay Drug
Dental*
Benefit
Employer
S
95%
91%
50%
Self77%
Purchased
68%
14%
*Nationwide, 35% of rural residents lack dental coverage
compared to 76% of farmers who self-purchase
Attitudinal Measures of
Underinsurance
Paying for health care is a burden
Health needs adequately covered
Rating of plan
(0-worst, 10-best)
Experienced problem finding or
understanding info about health
plan
Employer- SelfBased
Purchased
69%
83%
70%
51%
8
6
14%
24%
Availability of Public Health
Insurance for Children
17% Eligible for S-CHIP
– Only 1% enrolled
21% Eligible for Medicaid
– Only 1% enrolled
A
Conclusions
• Health insurance coverage places a
significant financial burden on farm families.
• Fifty percent of farmers purchase in the
individual insurance market which has
limitations in care benefits.
• Utilizing economic, structural and attitudinal
approaches, AgriSafe determined farmers
are at high risk to be underinsured.
Strategies for Improvement
• SCHIP should be designed to account for
fluctuating incomes (hawk-i)
• Small group employer reform
• Insurance Coop (Wisconsin Model-WFC)
• Improved Data Collection
• Expansion Strategies Should Reduce Other
Cost-sharing Requirements (co-pay,
deductibles, etc.)
• Educate Farmers
Additional Resources
• State Health Assistance Center,
www.shadac.org
• The Health Care Crisis Among Dairy Farmers,
Wisconsin Family Farm Facts, Program on
Agricultural Technology Studies
• Wisconsin Federation of Cooperatives (WFC),
www.wfcmac.coop
• Health Insurance Coverage in Rural America,
The Muskie School and the Kaiser Commission
on Medicaid and the Uninsured
www.agrisafe.org