Health Insurance Report September 2011

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Farmers Market Coalition

September 2011

Photo courtesy of Lisa Bralts-Kelly

Healthcare Insurance Gaps in Farmers Markets:

A summary of coverage and needs among markets managers and producers in the United States

farmers ● consumers ● communities

P.O. Box 504 ● Charlottesville, VA ● 22902

[email protected] ● 434-984-0175 ● 877-FMC-0553 ● www.farmersmarketcoalition.org

Farmers markets are good for everyone. Join us to make them even better.

Healthcare Insurance Gaps in Farmers Markets: A summary of coverage and needs among market managers and producers in

the United States

By Andrew Love Executive Summary

The Farmers Market Coalition (FMC), with support from the USDA Risk Management Agency, conducted a

survey of farmers market managers and producers selling at farmers markets in the spring of 2011. The results of the survey appear in the following report, and have been gathered by analyzing the answers

provided by the 393 respondents. Instances where fewer than 393 respondents provided an answer are indicated as such for each graph where appropriate.

The survey indicates that people who work in the farmers market community are disproportionately uninsured when compared to the national average. According to the most recent U.S. Census Bureau

statistics from 2009, approximately 16.7% of the U.S. population is uninsured. Of the 393 respondents, 31.9% indicated that they do not have healthcare, and the vast majority of these (92.6%) identified cost

as the primary reason. Those who are currently covered received their coverage through their employer’s plan (28.3%), an individual/family plan (30.1%), or a spouse’s plan (22.5%). A small number

of respondents (8.5%) received their coverage through Medicare, Medicaid, or Tricare.

The financial barriers indicated by the farmers market community are likely due to two factors: 1) the

prevalence of self-employed, small-scale business operators who sell at a farmers market, and 2) the large number of volunteer market managers. According to USDA, more than 60% of farmers markets are

managed by volunteers (Ragland and Tropp, 2009). On the producer side, small businesses do not have

the economies of scale to warrant discounts to either the business owner, or the employees that work with the business owner.

In an effort to assess the degree of need for affordable health coverage among the farmers market

sector, the Farmers Market Coalition sought input on interest in several low-cost alternatives to major medical plans, including supplementary, alternative coverage. In general, farmers market managers and

farmers responding to the survey felt that plausible offerings could include a mini-medical plan, a

discount card, or a nationally sponsored health insurance policy that could be provided to those in the farmers market community.

Introduction

Remarkably, farmers markets thrive despite limited capital on the part of farmers and market

organizations. Limited capital means minimal financial padding which could keep business operational in the event of a physical injury, illness, or even loss of life. Temporary or permanent loss of an operator or

manager can be catastrophic for businesses and market organizations. Farmers themselves, as self-

employed individuals, are often priced out of available insurance plans, or dependent on their own or their spouse’s off-farm employment for health benefits. With one or both spouses often working off-farm

either part-time or full-time, production capacity is limited. By extension, so too is farm income, further creating dependence on off-farm jobs.

mailto:[email protected]


http://www.census.gov/newsroom/releases/archives/income_wealth/cb10-144.html











A study by the Social Responsibility Initiative at The Ohio State University found that health insurance is

identified as a the most serious financial threat for commercial farmers in the Rural-Urban Interface,

more so than the cost of farmland, farm inputs, or product prices. Researchers concluded that ―an affordable and accessible national health care program would free up time and resources farmers at the

Rural-Urban Interface could reinvest in their enterprises, households and local economies‖ (Inwood, S., Sharp J. S., Smith, D-J., and Clark, J. K., 2009).

One of the main reasons for the inadequate coverage typically faced by farmers and their families is the fact that many of them have to buy individual health insurance policies (Center for Rural Affairs, 2009).

While only 8% of the general population has individual policies, about 33% of family farmers and ranchers rely on individual policies, which generally provide less comprehensive coverage with higher

deductibles and co-pays. In a preliminary survey conducted by the Farmers Market Coalition (FMC) in March 2010, 62% of producers with health insurance purchase it themselves. These problems are

exacerbated by limited cash flow and wide variations in annual income from year to year, compounding

the impact that medical debt can have in putting a farm business in jeopardy (Blankenau, Bailey, and Hudson, 2009). Value added vendors, and even market managers, face similar obstacles to health

insurance.

The need for affordable health insurance coverage is not limited to farmers market producers.

According to USDA’s most recent analysis, 60% of farmers markets are operated exclusively by volunteers (Ragland & Tropp, 2009), with still others managed with part-time staff, very few of which are

eligible for benefits. This adds to management turnover and other human resource risks which stunt farmers markets’ ability to maximize return to farmers. In a preliminary survey of FMC members in 2010,

only 13% of responding market managers said they receive health insurance through their market organizations.

Survey

The Farmers Market Coalition’s (FMC) interest in health care coverage began with anecdotal stories about the adversity faced by those in the farmers market community when attempting to find affordable

insurance plans. Conversations with FMC members, as well as discussions on the FMC listserv, indicated

a strong need for further research on health insurance in the farmers market community. Meanwhile, the milestone passage of the Healthcare and Education Affordability Reconciliation Act in 2010 presented a

unique impetus for better understanding the needs of the rapidly growing and volunteer-heavy sector.

One of FMC’s members, the Agricultural Institute of Marin (AIM), conducted a survey of its approximately

500 producers in 2010, with the assistance of the San Francisco Insurance Center. Results from this survey substantiated FMC’s concerns of disproportionate levels of uninsured amongst the farmers market

community.

The survey results indicated that those in the farmers market community are disproportionately

uninsured when compared to the general population. According to the most recent U.S. Census Bureau statistics from 2009, approximately 16.7% of the U.S. population is uninsured. By contrast, 29% of the

AIM survey respondents were uninsured.

After reviewing these results, FMC became increasingly interested in understanding the current healthcare coverage characteristics and needs of those in the farmers market community, particularly

farmers market managers. With the assistance of the San Francisco Insurance Center, FMC began

constructing and then disseminating a survey to determine the prevalence of health care amongst



http://www.googlegroups.com/FMC-list)














farmers market staff, volunteers, and producers.

The importance of this research is underlined by the morbidity rates that are strongly correlated with lack of insurance. Healthcare coverage is vital to ensuring good health. For some, it provides a safety net for

those who find themselves in need of costly medical care. For everyone, it is an important component of preventive care and a long healthy life. Those who have access to healthcare coverage have access to

the regular checkups and doctor’s appointments that ensure early detection, and routine medical advice.

Recent studies, like the one in the American Journal of Public Health, have shown that the uninsured working-age Americans have a 40% higher risk of death than their privately insured counterparts. The

Henry J. Kaiser Family Foundation’s report The Uninsured: A Primer, Key Facts About Americans Without Health Insurance demonstrates a clear correlation between lack of insurance and a host of other medical

problems. To name a few, the uninsured are more likely than their insured counterparts to have no regular source of care, postponed seeking care because of cost, needed care but did not get it, and to

have not filled a prescription, because of cost.

Two other recent developments in the intersection of healthcare and farmers markets have also

compelled FMC to delve into the issue. One, the recent passage of the Patient Protection and Affordable Health Care Act has and will continue to change both the healthcare system and the health insurance

industry. The repercussions are not yet fully known, as the bulk of the changes do not go into effect

until 2014. However, it is already clear that while certain changes such as zero cost preventive care and removal of pre-existing conditions clauses for children under 19 are welcomed by us all, there is a cost

associated with these mandated benefits and those costs have found their way down to the consumer in the form of increased premiums, potentially making health insurance even less affordable for those in the

farmers market community.

Considering that lack –- or undercoverage — of health insurance clearly jeopardizes one’s health, and

that the farmers market community is disproportionately more likely to be uninsured, FMC seeks to understand and communicating those effects to its members and the farmers market community at large.

Two, local food continues to become an increasingly popular topic, generating increased demand for local food, and by extension farmers markets. In 2010, there were 6,132 farmers markets, a 16% increase

from the 2009 figure of 5,274. The USDA Farmers Market Directory for 2011 indicates that there was a

similar 17% increase in the number of farmers markets between 2010 and 2011, to 7,175 farmers markets. Growing sales in farmers markets equate to more produce, more products, and a growth in the

industry as a whole. It is imperative that this growth be safeguarded by providing information and services to workers so that they can purchase adequate health insurance.

Structure of the Survey

The survey was composed of 24 multiple choice questions. Questions were constructed with the intent of determining how many people have health insurance, the types of insurance that have been purchased,

as well as how many people do not have health care and the barriers that prevent people from purchasing insurance.

The survey was disseminated through Farmers Market Coalition networks via email in the beginning of April 2011, and was open for three weeks, closing on April 22, 2011. There were 393 respondents to the

survey, including local and state farmers market organization staff, volunteers, and farmers. The Farmers Market Coalitions wishes to thank all those who responded to the survey to taking the time to provide

their input.



http://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/









http://www.kff.org/uninsured/upload/7451.pdf





















http://www.ams.usda.gov/AMSv1.0/farmersmarkets





Demographics

While the survey itself did not target a specific demographic, certain response trends are evident in the

survey results. Of the 393 respondents, 275 were women, representing 74.9% of the total response poll, while 97 or 25% of respondents were male.

n=272

Respondents did represent a wide variety of age ranges. Divided into ten year cohorts, the survey

indicates 11.6% of respondents in the 20-29 age range, 17.2% were 30-39, 18.9% were 40-49, and

34.7% were 50-59. 17.2% of respondents were of 60 years of age or older.

The majority of the respondents were either married (66.1%) or had a domestic partner (8.1%). About a quarter of respondents (25.5%) were single.

26%

74%

Gender of Respondents

Male

Female

11.6%

17.2% 18.9% 19.1%

15.6% 13.2%

4%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

20-29 30-39 40-49 50-54 55-59 60-64 65+

Current Age of Respondents







n=272

More than one-third of the respondents (33%) indicated that they were a business owner and sole business employee. This population is likely over-represented by producers rather than market

managers.

Rate of Insured

One of the primary goals of the survey was to assess the prevalence of heath care coverage in the farmers market community. Were those in the community less likely, as likely, or more likely to be

insured than citizens in the United States as a whole?

According to the 2009 US census, 16.7% of the American population was uninsured. An article in USA Today noted that ―The percentage with private insurance was the lowest since the government began

keeping data in 1987.‖ Those in the farmers market community are facing even more difficult

circumstances. Of those surveyed, 33.6% said that they have no health insurance, compared to the

66.4% that said they do have coverage.

n=369

Health Care Coverage and Cost

There are likely a variety of reasons behind the apparent under-coverage amongst those in the farmers market community. One factor may be the small scale business models. FMC’s survey indicated that just

over one-third of respondents counted themselves as the only staff member of a self-operated business. Nearly 49% responded that they had 2-10 employees. These numbers corroborate the often held theory

that farmers market vendors are operating smaller scale business models than their industrial

equivalents.

66%

34%

Healthcare Insurance Coverage in the Farmers Market Community

Insured

Not Insured



http://www.usatoday.com/news/nation/2010-09-17-uninsured17_ST_N.htm







n=370

These smaller scale models tend to limit the affordability and availability of health care plans, both for the

owner and the employees. Statistics gathered from Blue Shield’s Healthcare and Technology 2010 Conference Presentation show that while 95% of large group employers offer healthcare to their

employees, less than half of companies with less than ten employees offer healthcare coverage. Considering that 73.9% of those surveyed in the farmers market community worked with an employer

that employed 1-10 employees, it’s not surprising that so many individuals remain uninsured.

As predicted, cost is the most prohibitive factor in preventing individuals from purchasing healthcare. Of

the 31.9% that indicated they do not have healthcare, 92.6% identified cost as the primary reason. One of our respondents summarized some of the frustrations felt by many. ―I can't afford $500/month with

$10,000 deductible for my husband and myself. That's the best deal I could find. We are healthy, don't

visit doctors, and almost moved back to Canada when we had a health crisis last fall. I don't trust that insurance companies would pay a claim even if I had health insurance.‖ A handful of individuals left

comments stating that one member of the family held a part-time job simply for the health insurance benefits offered through the employer.

The farmers market community, far from being alone in feeling the effects of expensive premiums. A

2010 report by the Kaiser Family Foundation reveals that between 2000 and 2010, there was a 114%

increase in premium costs, with a 147% increase in worker contribution. The same report indicates that the average monthly premium cost for a PPO is $905, and that even High Deductible Health Plans

(HDHP) have an average cost of $632. These high costs combined with the limited economies of scale offered by small farmers market businesses create an imposing financial barrier to providing healthcare.

When asked what monthly premium they would be willing to pay, assuming higher monthly costs were associated with a more robust healthcare plan, the respondents indicate a nearly unanimous decision for

lower premiums. Close to 91% of those surveyed said they would prefer to pay $250 or less. Of that 91%, 65% reported that they would like to pay between $10 and $150.

0%

10%

20%

30%

40%

50%

1 2 to 5 6 to 10 11 to 25 26 to 50 51+

35.0% 41.9%

7.0% 4.0% 3% 8.6%

Number of Employees in Responding Farms and Farmers Market

Organizations



http://ehbs.kff.org/pdf/2010/8086.pdf









The preference for less expensive healthcare premiums may be difficult to realize due to the increasing

costs of premiums across the board. An average family plan monthly premium is $814 (Kaiser Report).

Other sources indicate a less expensive average. The report ―Individual Health Insurance 2009: A Comprehensive Survey of Premiums, Availability, and Benefits,‖ listed lower annual premium averages.

The annual premium was $249 for a single person, which is at the high end of what FMC’s uninsured respondents were willing to pay. The average monthly premium for a family was $527. Less than 1% of

FMC’s uninsured respondents said they would be comfortable with this price.

Nationwide, annual premiums averaged $2,985 for single coverage and $6,328 for family plans in mid-

2009. For single policies, annual premiums ranged from $1,350 for persons under age 18 to $5,755 for persons aged 60-64. For family policies, premiums ranged from $2,573 for policies covering children

under age 18 to $9,952 for families headed by persons aged 60-64 (America’s Health Insurance Plan, 2009).

Analyzing FMC’s respondents who currently did have healthcare, reveals that their premiums are closer to the more expensive national averages, than it is to the uninsured population’s preference for a more

modest rate. The most common premium was between $200-$399, with the second most common premium being even slightly more expensive at $400-$599. Granted there are some people paying $199

and under for their healthcare plans, however it’s less common than the more expensive premium rates

which both the farmers market community, and the national population, are typically paying for healthcare.

Those who are currently covered predominantly received their coverage through an employer’s plan

(28.3%), an individual/family plan (30.1%), or a spouse’s plan (22.5%). A small number of respondents (8.5%) received their coverage through Medicare, Medicaid, or Tricare.

If covered, by what plan? % of Total

Employer's Plan 28.30%

Individual/Family Plan 30.10%

Spouse's Plan 22.50%

Medicare, Medicaid, or Tricare 8.50%

Other 16.60% n=222

Medical care was the most popular form of healthcare provided, with 98.6% of those insured currently

being covered by a medical plan. The majority of the insured (67%), only rely on their healthcare coverage for low-cost routine health procedures. The most popular of which include routine checkups,

prescriptions, and/or occasional minor treatment. Dental care was also common with 59% of the population covered under a dental plan.

Slightly over 23% of respondents who currently have health care, indicated that their plan covered themselves, their spouse, and their children. This stands in contrast to the 40% of people whose health

care plans cover only themselves.

Those who do have healthcare primarily use their insurance plans to cover routine medical expenses. In fact, 67% of respondents indicate that they use their plan either for routine checkups (31%) or routine

checkups, prescriptions, and/or occasional minor treatments (36%). A smaller, but still significant

percentage (19%), indicated that they use their coverage plan often for multiple reasons such as



http://healthinsurance.about.com/gi/o.htm?zi=1/XJ&zTi=1&sdn=healthinsurance&cdn=health&tm=74&f=00&tt=2&bt=0&bts=0&st=25&zu=http%3A//www.ahipresearch.org/pdfs/2009IndividualMarketSurveyFinalReport.pdf






prescriptions, labs, x-rays, physical therapy, inpatient/outpatient treatment, etc. Only a small

percentage, 7%, noted that they never use their plan, and 5% indicated that the use their plan for

―other‖ purposes.

Possible Solutions One tactic that might address the financial constraints of the uninsured population is a national

healthcare plan for people who work in the farmers market industry. FMC has been tentatively exploring

the possibility of such a plan by researching both feasibility and consumer interest. When asked if they were interested in a national healthcare plan sponsored by FMC, 80% responded that they were either

somewhat interested (31%) or very interested (49%).

Given that 92.6% of respondents identified ―cost‖ as the barrier that prevents them from purchasing health insurance, it comes as no surprise that 90.5% indicated ―cost‖ as one of the factors that would

have the greatest influence on whether or not they were to enroll in a national healthcare program. Other

significant factors include annual deductible (60.2%) and doctor/provider network (57.2%). Other important factors were also cost related, such as prescription drug coverage and cost (43.9%),

alternative medicine/treatment coverage (39.7%), and discount/savings over current plan (30.2%).

Similar responses were given when those surveyed were asked how much money they would be willing

to spend on a monthly basis if they were offered discounts on medical coverage that were the most relevant to them, including medical, dental, vision, life, disability and alternative health. The majority,

61.4%, replied that they would prefer to spend $200 or less on monthly medical care, which is consistent with previous responses regarding their monthly budget for medical expenses. Respondents were nearly

split in two on whether they preferred to pay between $101-200, or $26-$100, with 27% and 26.7% respectively. The remainder, 7.7%, replied that they would pay between $10-$25.

Unsurprisingly, when asked to rate the importance of insurance types and factors to consider when buying insurance, 78% ranked health\medical coverage as the most important and 16% ranked it as

somewhat important. Respondents were then asked which factors were the most important when choosing a healthcare plan. Answers were very comparable when asked about the importance of

choosing a plan either on cost or benefits. For cost, 56% thought it was somewhat important, whereas

36% thought it was the most important. The importance rankings of choosing medical plan based on benefits were much the same (58% for somewhat important and 33% for most important).

FMC asked the respondents if they were interested in a national healthcare plan sponsored by FMC. While

FMC currently does not offer such a plan, the question was asked in order to gauge industry interest. The

results clearly demonstrate that there is such an interest, with 57% saying they were somewhat or very interested.

Interest in a National Healthcare Plan % of Total

Definitely Not Interested 6%

Not Very Interested 18%

Not Sure 16%

Somewhat Interested 38%

Very Interested 19%

n=338

After consulting with experts in the insurance industry, FMC identified three alternatives to traditional







healthcare coverage and assessed interest in them via this survey. Those three alternatives included

supplemental medical coverage, a mini medical plan, and a discount card. Supplemental medical

coverage, as the survey explained, hypothetically costs $16-$55 per month, filling deductible gaps and covering excess expenses that traditional health insurance policy might not cover.

The mini-medical plan, as described in the survey, would carry a monthly cost of $100 for individuals up

to age 64 and $570 for entire families. It provides reimbursements for a certain percent of services (such

as office visits, lab & X-rays, hospitalization, and surgeries) and access to a large national PPO network of doctors and facilities. Generic and brand prescriptions, under such a plan, would cost $10 or 50% copays.

These details were explained to survey respondents, noting that a "mini-medical" plan can be used to supplement existing coverage or as a low-cost alternative to a traditional major medical insurance policy.

The discount card would cost approximately $15 per month and include family benefits such as free 24/7

access to a doctor via phone/email with prescription-writing capabilities; 10%-60% discounts on

prescriptions, medications, alternative health, chiropractic care, vision/dental through Aetna's PPO network; and free towing/roadside assistance.

On a Scale of 1-5, How Interested are you in the following? % of Total

Supplemental Medical Coverage 3*

Mini Medical Plan 3.5*

Discount Card 3.5*

n=335 1=Least Important

5=Most Important

*Scores indicate the mean response

Reception to both the supplemental medical coverage, and mini medical plan were tepid. Supplemental medical coverage was ranked as somewhat important by 30% and most important by 10%. The mini

medical plan, which was more popular than the supplemental medical coverage, was rated as somewhat

important by 28% of respondents and most important by 25% of respondents. A partial explanation for the lack of interest could be due to a lack of familiarity with these coverage options. This unfamiliarity

could lead to poor comprehension of the plan’s offerings, thereby generating uninformed opinions of just how interested the respondents are to the plan.

The discount card did receive slightly more positive results with 19% indicating that they were very

interested, and 39% indicating they were somewhat interested. The discount card, which does not offer

as comprehensive a coverage plan as the other two options, might very well appeal to the limited budgets of the survey pool considering it’s extremely low, $15 per month, premium.

Limitations

The design of the survey does carry some limitations that need to be mentioned. One, while every individual was asked the name of the organization they work for, there is still some ambiguity as to what

percentage of the people worked for a farmer or small business, were the owner of a farm or small business, or worked for the farmers market itself. This means that one cannot infer the respondents’ role

in the farmers market, nor can one infer if the survey is representative of the variety of different job

types that are present at a farmers market.







The design of Constant Contact, which was the platform utilized to conduct the survey, does not allow

one to identify an individual’s entire list of responses. In other words, one can determine how many

people answered a certain question, and which answer they selected, but it is not possible to then look at the relationships that might exist amongst groups of people who had similar answers. For example, one

can notice how many respondents indicated they would prefer to pay $100-$150 for their premium, but it’s not possible to see how that group responded to questions about the mini medical plan, or if those

people are more likely to be married, have kids, etc.

Conclusion

FMC’s ―Health Insurance Survey‖ validates the previous statistical findings of the Agricultural Institute of

Marin’s survey. Both studies reveal that those employed in the farmers market industry are, when compared to the general population, disproportionately more likely to be uninsured. AIM’s survey pool

revealed a 29% uninsured rate, while FMC’s pool revealed a 34% uninsured rate. Both figures are well

above the national average of 16.7%.

Lack of health care for the farmers market community is primarily due to an absence, or at the very least perceived absence, of affordable health insurance options. The overwhelming majority, 92.6%,

responded that cost was the prohibitive factor. There are at least two major factors that contribute to

the prohibitive insurance costs faced by this community. One is the rising national cost of healthcare that is being experienced by all people regardless of their industry. Secondly, small businesses are the

predominant business scale amongst vendors, and small businesses are at significant disadvantage when it comes to purchasing affordable healthcare. Small businesses are not able to take advantage of the

economies of scale that are achievable by larger businesses, and are left with more expensive monthly premiums, both for the employer and the employee.

This report has shown that lack of healthcare coverage in farmers markets is a real problem, and that problem is created by prohibitive costs. One solution to the predicament is to create a large scale

healthcare plan that would take advantage of the economies of scale offered to organizations that represent a larger number of people. Using a larger pool, premiums for all could most likely be reduced,

thereby lowering, if not eliminating, the financial barrier that prevents so many market managers,

vendors, farmers, and sales associates from accessing affordable healthcare options.

Far from being a special interest issue, healthcare coverage for farmers markets is a national public health issue not only for those who make up the farmers market community, but for all who rely on this

community for their own nourishment, health and income. Without this community, consumers are forced

to get their food from businesses where food quality and sourcing is less transparent and sustainable farming practices, price movement and ethics are questionable. All of which can adversely affect the

health and well being of consumers.

The uninsured, like so many in the farmers market community, face serious threats to their health that include a reduced lifespan, greater likelihood of death, less reliable access to healthcare and an inability

to sustain their businesses should they become ill. This current state of susceptibility that America’s small

businesses and farmers are in must be remedied. The viability of our communities and our nation as a whole are at stake should these farmers continue to have inadequate and unaffordable access to

healthcare, as they will ultimately not be able to produce the food that sustains us all.







References

Bailey, J.M. March 2009. The Top 10 Rural Issues for Health Care Reform. Center for Rural Affairs. Available here.

Blankenau, J., Bailey, J.M., Hudson, J. April 2009. The Causes and Consequences of the Rural Uninsured and Underinsured. Center for Rural Affairs. Available here.

Cecere, D. New Study Finds 45,000 Deaths Annually Linked to Lack of Health Coverage. Cambridge

Health Alliance, September 2009. Available here.

DeNavas-Walt, C., Proctor, B. D., Smith, J.C. September 2010. Income, Poverty, and Health Insurance

Coverage in the United States: 2009. US Census Bureau. Available here.

Kaiser Family Foundation and Health Research & Educational Trust. May 2010. Employer Health Benefits: 2010 Summary of Findings. Available here.

Healthcare Trends in America. Blue Cross Blue Shield, 2010. Available here.

Inwood, S., Sharp J. S., Smith, D-J., and Clark, J. K. October 2009. The Persistence of Agriculture at the Rural-Urban Interface: Does the Cost of Health Insurance Make a Difference? Social Responsibility

Initiative Topical Report 09-05. Available here.

Ragland, E. and Tropp, D. 2009. USDA Farmers Market Manager Survey, 2006. U.S. Department of

Agriculture, Agricultural Marketing Service. Available here.

Tallon, James R., Rowland, Diane. The Uninsured: A Primer, Key Facts About Americans Without Health Insurance. The Henry J. Kaiser Family Foundation, January 2006. Available here.

Wolf, Richard. Number of Uninsured Americans Rises to 50.7 Million. USA Today, September 2010. Available here.

Yoo, Hannah, Carpetner, Lisa, Heath, Karen. ―Individual Health Insurance 2009.‖ America’s Health

Insurance Plans (AHIP), October 2009. Available here.



http://files.cfra.org/pdf/Ten-Rural-Issues-for-Health-Care-Reform.pdf

http://files.cfra.org/pdf/Causes-and-Consequences-of-Rural-Uninsured.pdf


http://www.census.gov/prod/2010pubs/p60-238.pdf


http://www.bcbs.com/blueresources/healthcare-trends-report/pdfs/2010-healthcare-trends-in-america.pdf

http://cffpi.osu.edu/docs/HealthInsurance09.pdf























Pag

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Appendix A

Questions included in the 2011 FMC Health Insurance Survey

1. Date of Birth 2. Home Zip Code

3. Gender

4. Current Age 5. Marital Status

6. Number of Children 7. Employer/Name of Organization or Company

8. Employer Zip Code 9. Number of Employees (owner counts as 1)

10. Name of Your Farmers Market (if Applicable)

11.Do you have health insurance now?

Questions 12-14 are only relevant to those who do NOT have health insurance.

12. If you answered ―NO‖ to question 11, please check all the reasons that apply:

Cost

Carrier Denied Coverage

Lack of Information

Lack of Interest

Other

13. If you don’t have coverage now, what monthly premium would you be most comfortable with paying

(assuming that a higher dollar monthly premium equates to a greater number of benefits)? $10-$150

$151-$250 $251-$500

$501-$750

$751-$1,000 $1,000+

Questions 14-19 are only relevant to those who DO have health insurance.

14. If you answered ―YES‖ to question 11, are you: Covered under your employer’s plan

Covered under an individual/family plan

Covered under your spouse’s plan

Covered under Medicare, Medicaid or Tricare

Other

15. Please check the types of insurance you currently have: Medical

Dental

Vision

Life

Disability

Accident

Critical Illness

Other





16. Under your current health insurance plan, who is covered?

You only

You + Spouse

You + Children

You +Spouse + Children

17. What is your current monthly premium cost?

Less than $100

$100-$199

$200-$399

$400-$599

$600-$799

$800-$999

$1,000 or more

18. What type of plan usage best describes the way you use your plan I never go to the doctor/never use my plan

I get routine checkups, but otherwise have my plan just in case of emergencies

I use my plan for prescriptions and routine checkups and\or occasional minor treatments

I use my plan often for multiple reasons such as prescriptions, lab, x-ray, physical therapy,

inpatient/out patient treatment, etc.

I use my plan all the time to treat a chronic condition

Other

19. Please rate your overall interest in a national health insurance/benefits plan sponsored by the Farmers Market Coalition

Definitely not interested

Probably not interested

Don’t care one way or the other

Somewhat interested

Very interested

20. Please check the areas that would have the greatest influence on whether or not to enroll in a

national health insurance/benefits plan sponsored by the Farmers Market Coalition

21. If a national organization like FMC were to provide you and your family with health-related coverages

and discounts that you see value in, such as medical, dental, vision, life disability and alternative health to name a few, what would be your total monthly budget for any or all such products (which could be

used to enhance your existing coverage or stand-alone coverage) ? $10-$25

$26-$100

$101-$200

$201-$300

$301-$400

$401-$600

22. Please rate how important the following items are to you:

1=Least Important, 2=Not Very Important, 3=Not sure, 4=Somewhat Important, 5=Most Important







Health/Medical Coverage

Choosing a Medical Plan Based on Cost

Choosing a Medical Plan Based on Benefits

Choosing a Medical Plan Based on a Balance Between Cost and Benefits

Access to a Large National Network of Doctors, Hospitals, etc.

Prescription Drug Coverage

Vision Coverage ($6-$12 premium per month)

Dental Coverage ($30-$46 premium per month)

Life Insurance

Short/Long Term Disability

23. Please read about the following two plans and rate them based on how important they might be for you:

*Supplemental Medical Coverage: $16-$55 cost per month. Fills in deductible gaps and covers excess expenses that your traditional health insurance policy might not cover. **Mini Medical plan: Monthly costs are between $100 for individuals up to age 64 and $570 for entire families. It provides reimbursements for a certain percent of services (such as office visits, lab & X-rays, hospitalization, and surgeries) and access to a large national PPO networks of doctors and facilities. Generic and Brand Prescriptions at $10 or 50% copays. Note that a "Mini-Medical" plan can be used to supplement existing coverage or as a low-cost alternative to a traditional major medical insurance policy. For more information about the types of mini-med plans available, click here.

1=Least Important, 2=Not Very Important, 3=Not sure, 4=Somewhat Important, 5=Most Important

24. How interested would you be in an FMC-sponsored Discount Card (approximately $15 per month to include family benefits such as free 24/7 access to a doctor via phone/email with prescription-writing

capabilities; 10%-60% discounts on prescriptions, medications, alternative health, chiropractic care, vision/dental [through Aetna's PPO network]; and free towing/roadside assistance). Click here for more

background information about the 24/7 access to a doctor via phone or email.

1= Definitely Not Interested, 2=Not Very Interested, 3=Not Sure 4=Somewhat Interested, 5=Very

Interested



http://www.homeland4one.com/information/services.cfm?page=1390&id=26608

http://www.newbenefits.com/BenefitMoreInfo.aspx?bid=849

Health Insurance Report September 2011

Economy & Finance

Transcript of Health Insurance Report September 2011