June 10, 2023

Health insurance access, research crucial for rural communities

PEOSTA, Iowa — Health insurance is an important consideration for every family — including farmers and ranchers in rural areas, where options may be limited.

Insurance coverage and research was discussed during the AgriSafe Talking Total Farmer Health Podcast on Nov. 1.

Florence Becot, National Farm Medicine Center rural sociologist and research scientist, and Maria Pippidis, University of Delaware Cooperative Extension educator, shared their insight during the podcast.

What trends have you seen in rural health care?

Becot: There is research dating back to the early 2000s that the cost of health insurance and access to farmers have been a challenge. To give you an idea, one of our colleagues, Shoshana Inwood, asked farmers about what was the top serious problem for the farm business and, lo and behold, the top one issue wasn’t connected to the cost of production, wasn’t connected to the cost of land, but for 65% of farmers, it was the cost of health insurance.

And also what we need to remember is that before the major health care health insurance reforms of the early 2010s, there were specific rules around preexisting conditions that made it even more challenging for people to get coverage.

So, what we’ve known is that since the changes brought about by the law in the early 2010s is that people can no longer be excluded as a result of their pre-existing conditions.

And what we know, too, is that access to the marketplace, to health insurance plans through private insurance, has been made easier.

But the last thing that I will say is that also for farmers, an important source of health insurance is to their off-farm job or the off-farm job of their partners.

Why is it important to research rural health care?

Becot: There are many reasons why. First, agriculture is one of the most dangerous occupations. And so it should come as no surprise that for farmers, health insurance is very important.

And when we’ve asked them in the past, over three quarters of farmers say that it’s an important risk management strategy.

What we also know is that there are direct connections between the ability to offer health insurance and health care and the farm business.

We actually have some evidence that high healthcare expenses and high health insurance can lead to bankruptcy and can lead to early farm exits.

And so we also know, too, that the cost of health insurance and health care have direct implications on day-to-day decisions for the farm business.

That’s connected to what kind of farm investments can I make on the farm or do I make on the farm, including around income level — which have direct implications not only on the development of the farm business, farm viability, but also in the long term on potential retirement savings.

So, on and on, health insurance is really an issue that not only impacts farmers’ day-to-day ability to go see a doctor, but also that impacts the development of their farm business.

What has some of the research shown?

Becot: So, what we know from research on farmers, is that on average and even before the health insurance reform of 2010, farmers were insured at a higher proportion than the general population.

What we know, both from our own research and from the USDA, is we’re looking at the lower 90s, 92%.

However, what we also know from our research is that having health insurance doesn’t mean that the coverage is adequate and does not mean that people feel well protected in case they need it.

We found that a significant share of farmers were what we call “underinsured.” And by that, we looked at what people said in case of if they felt confident in their ability to pay for major healthcare expenses, to pay for expenses in case of a major health emergency, half of farmers told us that, no, they weren’t confident in their ability to pay — and that is despite having coverage.

And what we found was that the biggest difference was connected to the quality of their coverage. So, the level of out-of-pocket expenses, the level of how where their plan was covering them.

How can farmers sign up for health care, is there a deadline?

Pippidis: So, some of them are getting health insurance because their spouse is working for an employer who offers insurance through that place of employment. And so to answer your question then, when’s enrollment? Well, that will be driven by the employer and that enrollment period.

Then there’s Medicare, right? So, there may be farmers who are older or 65 or older and have access to Medicare. And so that enrollment period is the seven months around the month of their birthday.

And so, for example, if my birthday is in March, I have kind of three months before my 65th birthday month and three months after to enroll in Medicare.

And then at the end of the year, there’s the Medicare open enrollment period where people can identify or change the Medicare plan that they’re on or the supplement that they might choose.

There is a program in every state called the Senior Health Insurance Program, SHIP, for short. And they are trained volunteers who can sit down with you and help you better understand Medicare.

And also Medicare Advantage plans and also the options for supplemental health insurance plans that are available in your community.

For the marketplace for people who are under 65, who want to access the marketplace plans that are offered either through their state or through the federal marketplace. And that enrollment period is Nov. 1 through Jan. 15.

There are also programs like Medicaid and CHIP. So, Medicaid is for really low-income families. And CHIP is to cover the children in low-income families. And, really, that enrollment period is any time.

And having said all of that, if you have an insurance plan and something changes, maybe you lose your job or you get married or you have a baby or there’s some sort of life events — that opens up the window to change your plan.

What advice do you give people?

Pippidis: I really encourage people to look at last year or what you should have done, because there’s so many people who don’t go because of the cost. But you should have gone. So, do the math and compare that with your plans.

And there’s some really great resources on our University of Maryland Extension health insurance literacy page that can help you crunch those numbers.

We’ve got a really great publication called Estimating Your Health Care Costs, and it will allow you to kind of comparison shop. Put in a couple of plans. Let’s crunch the numbers, see which works. And that will help you pick the right plan.

What are some resources to help people with health care?

Pippidis: Healthcare.gov has done a really nice job of helping people understand health care, health insurance and also kind of how to connect in with the marketplace.

Why is it important to continue this type of conversation within the agriculture community?

Becot: I think there are a couple of reasons. First, navigating health insurance landscape is hard and confusing. And we’ve talked to many farmers who explain to us their frustration with even not understanding how it works.

And so it’s important to really continue the conversation around what could be done to make it easier for people to sign up for health insurance.

The other thing, too, is what we found through our research is really the connections between health insurance and farm business.

We’ve talked to countless farmers who tell us the thing that will make the biggest difference is if I don’t have to spend $20,000 on health insurance a year.

And so I think health insurance is one of those things that, as individuals, there’s not much that we can do. But talking with farm organizations, commodity groups — really talking about what kind of solutions could be deployed, but also really connecting with policymakers and talking to them about what will make it easier to have a vibrant and resilient farm business.

Erica Quinlan

Erica Quinlan

Field Editor