Extension Responds: 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 .
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!