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Stress and Safety
The Health Care Crisis for Farm Families: Finding Options
That Work
By Roger T. Williams
Wisconsin farm families find it increasingly difficult
to obtain affordable and accessible health insurance. This
situation has turned into a crisis, as evidenced by survey
results published by the Program on Agricultural Technology
Studies at the University of Wisconsin-Madison. This survey
of Wisconsin dairy farmers showed the following:
- Nearly 1 in 5 (18 %) dairy farmers surveyed had no insurance
at all. Younger farm families and those with children
under the age of 18 were more likely to be uninsured.
- Nearly 1 in 4 (23 %) dairy farmers were underinsured
(they had at least one family member with no insurance).
These families tended to be older (58 % of farmers over
55 were underinsured).
- More than half (58 %) of dairy farmers with insurance
had major medical policies with a deductible of $500 or
more. This means, in effect, that many dairy farmers in
the state have no preventive care.
- Nearly 3 in 10 (28 %) dairy farm families received
their care through a family member’s off-farm work,
and less than 1 in 10 (6.4%) received their health insurance
through a local farm cooperative.
One farm family member described the situation this way:
“We have gone without health insurance for 12 years
because decent health insurance is just too costly …
This is money that is hard to justify with all the bills
and then living expenses. So, we take the risk of going
without … that’s one more worry on our shoulders,
hoping that nothing serious happens to anyone in our family.”
Going without health insurance is a significant risk. It
raises the question of what options are available for farm
families who are uninsured, underinsured or living without
affordable health care coverage. Here are some of the health
care options and resources available now, as well as options
that are being proposed for the future.
Health Care Options/Resources Available Now
Badger Care Program – Badger Care
is a statewide program designed to provide health care coverage
for working families with children under the age of 19.
This program works for some farm families, but it does have
drawbacks:
- Depreciation on farm assets is treated as income, falsely
inflating the income of farm families and making some
ineligible for the program.
- Families must meet income criteria on an annual basis,
and higher income in any given year can make families
ineligible.
- Only families with children under 19 living in the
household are eligible.
- Some rural physicians do not accept payment through
this program.
Efforts are under way to exclude depreciation from income,
but that is not possible at the present time. Badger Care
can be a helpful program for some farm families but be sure
you understand the limitations before adopting this as your
health care insurance. For further information, call (800)
362-3002 or check the Website at www.dhfs.state.wi.us .
Health Insurance Risk Sharing Program (HIRSP)
-- HIRSP offers health insurance to Wisconsin residents
who, due to difficult medical conditions, cannot find adequate
health insurance coverage in the private market. You must
be a Wisconsin resident under the age of 65 when you apply.
You must demonstrate:
- A rejection or cancellation of coverage by other health
insurers,
- A notice of reduction or limitation in health insurance
coverage by your current carrier, or
- A notice of an increase in health insurance premiums
of 50% or more by your current insurance program.
HIRSP covers a range of services with deductibles of $500,
$1,000 or $2,500, depending on the coverage chosen. Premiums
are expensive, so families usually use the program to provide
coverage for high risk individuals only. For further information
or for quotations on HIRSP premiums, call (800) 828-4777
or write HIRSP, 6406 Bridge Road, Suite 18, Madison, WI
53784-0018.
Community Health Centers –Sixteen
Community Health Centers (CHCs) exist in 31 medically underserved
communities (including rural areas) across Wisconsin. This
network of CHCs is federally-funded and, due to a new President’s
Initiative, is likely to expand to serve new communities
by the end of fiscal year 2006. These CHCs provide primary
care and preventive care. They operate on a sliding fee
scale basis and most accept all kinds of insurance, including
Medicare, Medicaid and Badger Care. This is not a form of
health insurance, but farmers living within the service
area of a CHC may benefit from its services. CHCs’
sliding fee scales and their ability to accept all kinds
of insurance are powerful advantages. The biggest disadvantage
is that CHCs are currently only located in 31 communities
across the state. For further information or to check on
the closest CHC, contact the Wisconsin Primary Health Care
Association, 49 Kessel Court, Madison, WI 53711; call (608)
277-7477 or check the Website www.wphea.org
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Free Health Care Clinics – Approximately
30 free health care clinics exist in Wisconsin, with several
serving rural areas of the state. Most are community clinics,
and some are affiliated with religious organizations. The
services offered differ from clinic to clinic. The St. Clare
Health Mission in La Crosse, for example, is open two nights
a week, making it more accessible for farm families. This
clinic offers primary health care and a pharmacy that provides
medications at reduced cost. Volunteers provide the health
care services, and services are free unless patients are
in a position to pay (on a sliding fee scale basis). Some
clinics do not offer services to persons with health insurance;
so they would only be a resource for uninsured farm families.
For further information, check the attached list of free
clinics or contact Susan Strom, Chippewa Valley Free Clinic,
P. O. Box 231, Eau Claire, WI 54702; call (715) 839-8477.
Parish Nurse Programs – Approximately
400 churches throughout Wisconsin have Parish Nurse Programs
that provide a range of prevention and early intervention
programs including blood pressure screening, bone density
screening, information about nutrition and exercise, weight
loss, smoking cessation, grief counseling and support and
other programs, which vary by location. Parish Nurse Programs
bring a holistic approach to health care, integrating the
physical, emotional, social, occupational, intellectual,
environmental and spiritual aspects of health. Some programs
are run by volunteers and others employ paid Parish Nurses.
While Parish Nurse Programs are not able to provide a full
array of health care services, they can be a wonderful resource
for low cost prevention and early intervention services
in many communities across Wisconsin. Check with churches
in your community or area to see if they have Parish Nurse
Programs that could be helpful to you.
Health Care Options Proposed for The Future
A number of proposals may help uninsured or underinsured
farm families in the future. These include:
- Changes in Badger Care and Medicaid
– Assembly Bill 272 in the 2001-02 Legislature was
aimed at exempting depreciation from calculations of farm
and self-employment income and would have made more farm
families eligible for Badger Care and Medicaid. The bill
did not pass, but it has been reintroduced as Assembly
Bill 129 in this legislative session. Representative Mary
Hubler and Senator Robert Jauch are the lead people in
proposing this legislation.
- Creating Health Insurance Pools –
Two bills that would open the state employee health insurance
pool to farm families are being introduced in the state
Legislature. LRB 2068, being introduced by Representative
Debi Towns and Senator Joe Leibham, would only open the
state employee health insurance pool to farm families.
LRB 1224/1, being introduced by Representative John Ainsworth
and Senator David Hansen, would open the state employee
health insurance pool to anyone who is not otherwise eligible
for health care coverage under a Group Insurance Board
plan. Either plan would make a comprehensive state insurance
plan available to Wisconsin farm families, but families
would be required to pay the full cost of those health
insurance plans.
- Creating a Universal Health Plan –
Representative Mark Miller and Senator Tim Carpenter are
introducing a Wisconsin Universal Health Plan in the Wisconsin
Legislature. Assembly Bill 229 (the companion bill in
the Senate is Senate Bill 90) would create a single-payer
system that has been referred to as a “health care
for all bill” since each state resident would receive
medical services necessary to maintain health and obtain
treatment/rehabilitation for injury, disability or disease.
Representative Miller argues: “It is time for a
comprehensive change. Incremental reform doesn’t
work.” This bill, which faces an uphill battle because
of budget constraints, would certainly benefit farm families
in Wisconsin.
- Creating Rural Health Care Purchasing Alliances
– The Wisconsin Federation of Cooperatives is pursuing
a program implemented in Minnesota in 2002: creating rural
health care purchasing alliances, These alliances bring
cooperatives and small businesses with fewer than 50 employees
together in purchasing alliances to buy competitively-priced
health insurance for their members and staff. The Federation
of Cooperatives proposal would create five purchasing
alliance demonstration projects in rural Wisconsin to
“offer affordable, customized health care to purchasing
alliance members.”
If you support any of these initiatives to improve health
care for Wisconsin farm families, contact your state Representative
and state Senator and urge them to support the initiative(s).
Your voice is critical for improving the health care situation
of farm families in our state!
By Roger Williams, Professional Development and Applied
Studies, (608) 263-4432, rwilliams@dcs.wisc.edu
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