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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