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Health Insurance on the Farm

June 2000

2000 Health Insurance Survey of North Dakota Farm and Ranch Operators

What is the current health insurance situation for North Dakota's farmers and ranchers? How do farm families compare with the general population in terms of health insurance?

A recently completed survey on health insurance coverage for North Dakota's farm population attempts to answer these and other important questions. The 2000 Health Insurance Survey of North Dakota Farm and Ranch Operators was a cooperative effort by the North Dakota Department of Health, the Community HealthCare Association and USDA's North Dakota Agricultural Statistics Service (NDASS).

The response and volume of respondent comments on the survey was extraordinary. This brochure provides a summary of comments as well as the results of the survey and details on how the survey was conducted.

HEALTH INSURANCE SURVEY, NORTH DAKOTA, MAY 2000
Health Insurance Coverage
Item Total Regions
1 2 3 4 5 6 7 8
Households (Number) 1,374 87 239 145 116 170 239 245 133
Households With No Health Insurance 78 2 16 4 4 10 17 14 11
6% 2% 7% 3% 3% 6% 7% 6% 8%
Households With Health Insurance 1/ 1,296 85 223 141 112 160 222 231 122
94% 98% 93% 97% 97% 94% 93% 94% 92%
Private Health Insurance Coverage 1/ 1,240 80 214 136 109 158 215 219 109
90% 92% 90% 94% 94% 93% 90% 89% 82%
Public Health Insurance Coverage 1/ 357 29 67 38 30 31 54 67 41
26% 33% 28% 26% 26% 18% 23% 27% 31%
Individuals (Number) 4,080 228 715 426 349 546 708 729 379
Uninsured 246 8 47 15 15 23 53 48 37
6% 4% 7% 4% 4% 4% 7% 7% 10%
Insured 3,834 220 668 411 334 523 655 681 342
94% 96% 93% 96% 96% 96% 93% 93% 90%
1/ Coverage may not extend to all household members.

Findings

Findings indicate that 6 percent of the state's farm households had no health insurance. This number is slightly below the 8.6 percent for the state's 1998 general population study. Twenty-six percent of all farm households with insurance had some form of public health insurance, and 90 percent had private health insurance. Only 6 percent of households declined to answer and 6.6 percent were not accessible. On a regional basis, there tended to be more households in the southwestern region (region 8) of the state without health insurance (8 percent).

Regions

Health Insurance

Of all households with private insurance, 69 percent were self-insured and 41 percent were insured through an employer or union (group) membership.

Of those in the latter group, 87 percent had insurance policies that covered all household members. Of these, 76 percent paid some or all of the cost of premiums and almost half of these paid 50 percent or more of
premium costs. Twenty-four percent paid no insurance premiums. Medicare was by far the leading form of public health insurance, providing coverage in 22 percent of surveyed households.
    
Totals often do not add to 100 because multiple coverages exist in many households.


HEALTH INSURANCE SURVEY, NORTH DAKOTA, MAY 2000
Households With Private Health Insurance

Item Total Regions
1 2 3 4 5 6 7 8
Self Insured 858 59 140 98 77 106 150 148 80
69%
74% 65% 72% 71% 67% 70% 68% 73%
Insured Through Employer/Union 505 30 96 53 43 64 89 87 43
41% 38% 45% 39% 39% 41% 41% 40% 39%
All Household Members Covered 441 24 83 46 41 57 76 77 37
87% 80% 86% 87% 95% 89% 85% 89% 86%
Some Household Members Covered 34 3 7 5 1 5 5 6 2
7% 10% 7% 9% 2% 8% 6% 7% 5%
Single Household Member Covered 30 3 6 2 1 2 8 4 4
6% 10% 6% 4% 2% 3% 9% 5% 9%
Pay 1 - 49% of Premium 200 11 42 25 19 22 35 28 18
40% 37% 45% 47% 44% 34% 39% 33% 43%
Pay > 50% of Premium 180 13 33 13 13 27 35 30 16
36% 43% 35% 25% 30% 42% 39% 36% 38%
No Premium Contribution 119 6 19 15 11 15 19 26 8
24% 20% 20% 28% 26% 23% 21% 31% 19%
Households with Private Health Insu rance 1,240 80 214 136 109 158 215 219 109

HEALTH INSURANCE SURVEY, NORTH DAKOTA, MAY 2000
Households With Public Health Insurance
Item Total Regions
1 2 3 4 5 6 7 8
Medicare 306 27 61 30 26 26 47 56 33
22% 31% 26% 21% 22% 15% 20% 23% 25%
Medicaid 57 4 7 9 8 4 7 10 8
4% 5% 3% 6% 7% 2% 3% 4% 6%
CHAMPUS 3 - - 1 - - 1 1 -
- - - 1% - - - - -
Healthy Step 13 - 2 - - 3 - 4 4
1% - 1% - - 2% - 2% 3%
VA 21 1 1 4 - 1 5 6 3
2% 1% - 3% - 1% 2% 2% 2%
IHS 4 - 1 3 - - - - -
- - - 2% - - - - -
Other 14 1 3 1 3 1 - 4 1
1% 1% 1% 1% 3% 1% - 2% 1%
Households in Survey 1,374 87 239 145 116 170 239 245 133

HEALTH INSURANCE SURVEY, NORTH DAKOTA, MAY 2000
In the Last 12 Months, Did Any Household Member Not Receive Medical Care or Delay Medical Care Because of No Health Insurance or Inadequate Health Insurance?
Item Total Regions
1 2 3 4 5 6 7 8
Yes 87 2 10 11 4 8 18 24 10
6% 2% 4% 8% 3% 5% 8% 10% 8%
No 1,287 85 229 134 112 162 221 221 123
94% 98% 96% 92% 97% 95% 92% 90% 92%
Number of Households 1,374 87 239 145 116 170 239 245 133

HEALTH INSURANCE SURVEY, NORTH DAKOTA, MAY 2000
Households With One or More Members Without Health Insurance
Item Total Regions
1 2 3 4 5 6 7 8
1 Household Member not Covered 60 4 15 6 2 4 10 12 7
4% 5% 6% 4% 2% 2% 4% 5% 5%
2 Household Members not Covered 29 2 3 3 - 3 7 6 5
2% 2% 1% 2% - 2% 3% 2% 4%
3 Household Members not Covered 10 - 2 1 1 1 2 1 2
1% - 1% 1% 1% 1% 1% - 2%
4+ Household Members not Covered 18 - 3 - 2 2 4 4 3
1% - 1% - 2% 1% 2% 2% 2%
Households in Survey 1,374 87 239 145 116 170 239 245 133
    
    
HEALTH INSURANCE SURVEY, NORTH DAKOTA, MAY 2000
Reasons Given for Not Having Health Insurance
Item Total Regions
1 2 3 4 5 6 7 8
Too Expensive/Can't Afford 101 5 19 8 3 8 21 20 17
86% 83% 83% 80% 60% 80% 91% 87% 100%
Don't Need It/Healthy 15 - 2 2 - 1 4 3 3
13% - 9% 20% - 10% 17% 13% 18%
Medical Problems/Preexisting Conditions 9 1 3 - - - 1 2 2
8% 17% 13% - - - 4% 9% 12%
Don't Believe in Insurance 4 - - - 1 1 2 - -
3% - - - 20% 10% 9% - -
Religious Convictions 1 - 1 - - - - - -
1% - 4% - - - - - -
Free or Inexpensive Care Available 1 - - - 1 - - - -
1% - - - 20% - - - -
Other 4 - 1 - - - 1 2 -
3% - 4% - - - 4% 9% -
Households With at Least One or More Uninsured Members 117 6 23 10 5 10 23 23 17

Methods

This survey was conducted by North Dakota Agricultural Statistics Service (NDASS) at the request of the North Dakota Department of Health. Response to this inquiry was voluntary. A random sample of 1571 farm and ranch operators were selected from the universe of active producers maintained by the NDASS. All individual responses are protected from disclosure by statute.

Instructions to the respondent said, "Please report for all members of the household of the farm operator identified . . . Do not include other households which may be associated with the operation." In this manner the reporting unit was restricted to the household of active farm operators. The questionnaire was mailed on March 20. Included was a cover letter from the State Health Office requesting cooperation, and postage paid return envelopes. A total of 523 questionnaires, or 33 percent, were returned by mail and only 9 questionnaires were returned with an undeliverable or unknown address.

Telephone follow-up began on April 3 and continued through April 13. A total of 843 (54 percent) questionnaires were completed by telephone, using computer- assisted data collection techniques.

Combining mail and telephone response, only 88 (6 percent) respondents refused to complete an interview. This is a remarkably low refusal rate for a voluntary survey. The residual 117 respondents not tabulated as complete or refusal include operators who have left farming, and those that were inaccessible by phone during the data collection period.

Respondents were given the opportunity to comment on survey content. Comments were prompted with the statement "such as availability, affordability, coverage of your current health insurance." Comments were tabulated by the subject they addressed.

Respondent Comments

The volume of respondent comments on the 2000 Health Insurance Survey of Farm and Ranch Operators was extraordinary, far exceeding the volume of comments received on typical NDASS surveys. A total of 619 comments was recorded from 1,374 interviews. A tabulation of significant comment categories was made.

    The following representative comments from each category are paraphrased:

HIGH PREMIUMS: 55 percent of all comments (most frequent)
    Very concerned about high monthly premiums. Can't afford not to carry it, we could lose the farm.

    With low farm prices, we will have to cancel our insurance due to the cost.

    I have a $1,000 deductible and pay 20 percent of the next $5,000; this costs $500 a month.

     We are old and just can't afford to keep up the premium for the medicare supplement, we don't know what we're going to do.

    Monthly premiums have more than doubled in two years. There is no prescription program. Have to pay $2,000 before insurance pays 80 percent. Monthly premiums are too high.
        

HIGH DEDUCTIBLES: 13 percent of comments
    All we have is major medical...can't afford better coverage. Our deductible is still $5,000, this is ridiculous.

    It's a problem, with high deductibles we can't go in for our eyes and ears, or annual checkups. Can't pay the premium and the clinic bill both.

    $5,000 deductible and premium is still 3 times the cost of food.

    Health insurance never covers anything. I don't remember ever reaching our deductible so we always pay out of pocket.

OFF FARM EMPLOYMENT: 11 percent
     A farm wife: the only reason I'm working is the insurance and retirement benefits. It is not for the take home pay.

    My husband works off the farm to get us insurance. He works around the clock between his job and the farm. What will we do when he wants to retire?

    We're OK because of wife's position, but if I had to do this solely from the farm, we would have dropped it. Neighbors have dropped because they could not afford it and they have kids.


PLEASED WITH COVERAGE:    5 Percent
    Happy with insurance we have.

    Just me in the household, I'm pleased with the coverage.


PRESCRIPTION COVERAGE: 4 Percent
     Wish Medicare would cover pills.

    It takes almost all of my Social Security check to pay for medicine.


NEED FULLY DEDUCTIBLE PREMIUMS: 4 percent
    Premiums are too high for the self-employed. We should be able to deduct her health insurance premiums from taxes.


SAFETY NET ONLY: 3 Percent
    I have nursing home insurance. Health insurance is too expensive.

    ...have cancer coverage only...

    Insurance for major medical only. Routine physicals and tests for preventative care are not covered.


FOR MORE INFORMATION CONTACT:
Larry W. Beard, State Statistician
North Dakota Agricultural Statistics Service
NDSU, IACC Bldg., Room 448
P.O. Box 3166
Fargo, ND 58108-3166
Telephone: (701) 239-5306
E-Mail: nass-nd@nass.usda.gov

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