Vermont Business Magazine Accessing health care and health insurance are significant challenges for farmers in Vermont and nationwide, creating obstacles for farm viability, health and well-being, job creation, business expansion and the ability to farm full-time. A day-long summit at the University of Vermont on Thursday brought together key stakeholders in Vermont’s health, agriculture, tax, government, and Extension sectors to share perspectives and discuss opportunities for collaboration and integration of the spheres of health and agriculture to better serve Vermont’s farmers.
The intended outcome is to develop a statewide coordinated approach to addressing health and health insurance in the Vermont farm sector. This event is part of the ongoing USDA Health Insurance, Rural Economic Development and Agriculture research project (HIREDnAg).
In opening remarks, lead author University of Vermont Professor Shoshanah Inwood said Vermont farmers face a magnified version of the same issues and obstacles as small business owners everywhere face in regards to health insurance, the Affordable Care Act, cost of health care, time it takes to understand and deal with health insurance, and child care.
“Agriculture is the least likely industry to offer health insurance,” Inwood told summit attendees.
University of Vermont Professor Shoshanah Inwood. VBM photo.
For labor-intensive Vermont dairy farms, which represents 77 percent of all agricultural sales in the state, there is little time to wrestle with forms or negotiate the Vermont Health Connect Website.
Cash flow for health insurance also creates a barrier, Inwood said. Farmers will typically have unsteady income streams from month to month and year to year.
Farmers also worry most about catastrophic injury. While catastrophic-only health insurance plans have low premiums, they have high deductibles. They also frequently lack dental and optometric coverage.
Given that, the Platinum health insurance plans might present the best option, but the staggering monthly premiums bump into the cash flow problem. The 2017 monthly premium for a Platinum plan (Blue Cross Blue Shield of Vermont) is $686.76/month for an individual or triple that for a family plan.
An Health Savings Account allows for pre-tax savings to pay for out-of-pocket expenses like dental and deductibles, but HSAs also have higher deductibles that would be quickly eaten away by a hospital stay, and still have a significant premium.
Those who attended the summit included UVM researchers, research partners from University of Maryland, nonprofit service providers, health insurance providers, technical assistance providers, Extension employees, VT State Agency employees from Dept of Labor, Agency of Agriculture, Dept of Health, Dept of Taxes, and Vermont Health Connect, as well as representatives from the office of Senators Leahy and Sanders and the USDA.
Study Background and Purpose
The project “Health Insurance Economic Development and Agriculture” (HIREDnAg) is a project lead by researchers at The University of Vermont and the Walsh Center for Rural Health Policy, NORC at the University of Chicago. The goal of this national study is to understand how health insurance influences farm family decision making, quality of life, and economic development.
Farming ranks among the most dangerous occupations in the US (Bureau of Labor Statistics, 2011; Centers for Disease Control and Prevention (CDC), 2013). Health and safety risks inherent in agricultural work include sun and heat exposure, heavy lifting and bending that lead to chronic back and joint pain, operating farm machinery, exhaustion, exposure to disease from farm animals, handling chemicals and dangerous materials. Mental health issues can be exacerbated by economic hardships, chronic pain, stress, long hours, and solitude.
Health insurance is one way to access and pay for needed health care. Having health insurance increases the likelihood of accessing preventive care and treatment in a timely manner, improving health outcomes, and reducing medical debt (Dorn, 2008). Farming families who are uninsured or underinsured can accrue crushing medical debt which can increase financial risk, lead to farm foreclosure, and reduce overall quality of life. While most farmers had health insurance from off-farm jobs, 20% had outstanding debt from medical bills with 25% reporting health care expenses contributed to their financial problems (Lottero, Pryor, Rukavina, Prottas, & Knudson, 2009).
In addition to the occupational farmer health and safety concerns, studies have consistently found that longtime farmers, beginning farmers, and hired workers identify the high cost of health insurance as a major barrier to job creation and the ability to farm full-time (Inwood, 2015; Mishra, El‐Osta, & Ahearn, 2012; Ohio Rural Development Partnership, 2006;Vermont Sustainable Jobs Fund, 2011; Young Farmers Coalition, 2011).
Farmers and ranchers make health insurance decisions from two perspectives:
1) “Farmer and Family” health insurance decisions are made for themselves and their families, and;
2) “Farmers as employers” producers decide if and how to offer health insurance to employees.
The Patient Protection and Affordable Care Act (ACA) has introduced federal and state health care policy changes and has implications for how farmers and ranchers source health insurance, need for off-farm jobs, and requirements for employee-mandated health insurance (Ahearn, Williamson, & Black, 2014). Differences in how ACA markets are being implemented across states may lead to variation in adoption by agricultural enterprises, with implications for farm family and farmworker health. Little is known how ACA reforms will influence the way farm and ranch families’ structure and grow their enterprises, manage risk, and balance labor resources.
Utilizing interviews and surveys in ten study states, the core objectives of the HIREDnAg Project are to:
- Understand how health insurance influences he way operators’ structure their enterprise; manage family and business resources; impact farm labor supply, and; operator and farm worker health, vitality, and quality of life.
- Conduct a needs assessment of farm and ranch technical assistance providers (farm viability and business planning professionals and tax accountants). Develop outreach and educational tools that can assist farmers and ranchers understand health insurance options.
- Communicate the results of the study to national and state policy makers to inform them about how health insurance impacts the vitality of the farm sector and the overall rural American economy.
The ten case study states were selected based on several criteria:
- Active agricultural base, regional, and production variation;
- Medicaid expansion policy;
- State receptivity to participating in the study
In this HIREDnAg case study profile series, we examine the health insurance and agriculture sector in each of the ten case study states. The health insurance policy landscape shifts rapidly; these reports are based on data accurate as of July 2016. Additionally, all agricultural data reported in this series are from the 2012 Census of Agriculture (United States Department of Agriculture, 2012).
Vermont is the second least populated state in the U.S. with a population of 620,453 residents in 2014 (United States Census Bureau, 2014). Vermont expanded Medicaid and is operating a State-Based Marketplace with two participating insurers. (Centers for Medicare and Medicaid Services, 2016; The Henry J. Kaiser Family Foundation, 2016). Between 2009 and 2014 the rate of uninsured residents dropped by 42.3% from 53,192 to 30,716. In 2014, 5.0% of the population remained uninsured , the lowest rate of uninsured beyond Massachusetts (Redmond, 2015). Overall, 45.5% of the population has health insurance through employment alone, while 19.0% reported health insurance coverage through Medicaid or other means-tested programs alone (United States Census Bureau, 2009, 2014). Vermont is one of the states with the highest number of Medicaid recipients per capita (O’Gorman, 2015) with a Medicaid enrollment increase of 38.0% between 2006 and 2016 (Redmond, 2015).
Farm Size and Type
The majority of agricultural sales in Vermont are from dairy product and livestock. Out of $776.1 million in sales, over $598 million (or 77.19%) were related to livestock including $504 million in milk. Maple syrup and hay represented the largest sales in crops with over $88 million (11.4%) in sales.
Between 2007 and 2012, the number of farms increased by 5.1% (from 6,984 farms to 7,338 farms) while farm sales increased by 15.2% (from $673 million to $776 million). Of the 7,338 farms, the majority (84.9%) are considered hobby or small farms with sales under $1,000 and $100,000 respectively, 6.6% are considered medium with sales between $100,000 and $250,000 and 8.5% are considered large with sales over $250,000. However, the majority of the sales come from the large farms (66.6% of the sales) (Figure 3). In Vermont, 7.5% of farms are certified organic.
Marketing Orientation Twenty eight percent of the Vermont farms reported direct sales to consumers, 13.8% engaged in value adding activities while 4.5% of farms reported selling through a CSA (Figure 4). A very small minority of farms 2.1% reported any tourism activity.
There are 12,257 farm operators in Vermont including 7,338 principal operators. The average age of the principal operator in Vermont is 57.3 years old, 54.9% of the principal operators were 65 years and older while 11.1% of the principal operators where under the age of 35. Farming was the primary occupation for 51.5% of the principal operators while 69.5% of households reported that farming accounts for less than 25% of their total household income. Women farm operators (including first, second, and third) account for 38.4% of operators compared to the national average (30.5%). Minorities account for 4.7% of the general population in Vermont, but only 1.7% of farm operators (Figure 5) (United States Census Bureau, 2014). Minorities counted in this figure include Hispanic, Black, Native American and Asian farmers. Beginning farmers in this area represent 22.3% of the principal operators compared to 18.1% at the national level.
Health Insurance Information and Programs for the Agricultural Sector
Nationally, USDA refers farmers and ranchers to the national website healthcare.gov. Given state health insurance policy variations we examined if states have specific health insurance programs or outreach efforts directed towards farmers by consulting the websites of the state agencies of agriculture, state extension services, and state exchange (when applicable). The Vermont Agency of Agriculture and University of Vermont do not currently provide health insurance information for the agricultural sector. Vermont Health Connect, the State-Based Marketplace, provides resources for small business owners through the SHOP Employer Guide, as well as a fact sheet to help legal migrant farm workers obtain health insurance.
About the Authors
Florence Becot is a research specialist at the University of Vermont Center for Rural Studies and a PhD student in the University of Vermont Food Systems Program.
Shoshanah Inwood is an assistant professor in the Department of Community Development and Applied Economics at the University of Vermont.
Lucy McDermott is a community manager at the Collaborative Health Network in Maine. She graduated from the University of Vermont with a bachelors’ degree in economics and minors in community development and political science in 2016.
Source: UVM. 11.3.2016. 1 The rate of uninsured residents does not include the institutionalized population. The U.S. Census Bureau defines the institutionalized population as “people who are primarily ineligible, unable, or unlikely to participate in the labor force while residents of institutional group quarters” (https://ask.census.gov/f faq.php?id=5000&faqId=6669).