Farm families in northwest Iowa reported spending a median of $5400 per year on health costs (premiums and out-of-pocket expenses), according to a survey completed by 717 farm families. The survey was conducted In March of 2001 by Agri-Safe of Spencer Hospital as part of a community health planning effort.

Among the respondents, more than half live on farms that are not financially stable as defined by self-report of marginal or at risk. Results of the survey indicated that the economic situation of farm families greatly influences the health status, utilization of services and ability to access care. It was found that almost one half (41.3 percent) of the families in the lowest income bracket (less than $25,000) spend more than 30 percent of their income on health care costs. It is these farmers who are also most likely not to have health care coverage and who would be eligible for either Medicaid or the Healthy and Well Kids in Iowa (hawk-i) program.

Some 8.4 percent of the households with income under $25,000 have no health insurance, while only 1.7 percent of those with incomes greater than $100,000 report not having health insurance. "This disparity among income levels furter justifies the need to increase utilization rates of current government funded plans such as Medicaid or hawk-i," notes Natalie Roy, director of Innovative Public Health and one of the authors of the agricultural health survey.

Among the 1643 persons represented in the survey, 95.4 percent have health coverage, including 52.3 percent with self-purchased plans, 47.6 percent with employee-sponsored plans, and a mere 1.4 percent with Medicaid or public plans.

According to the survey, both men and women with coverage from a self-purchased plan are less likely to receive important preventative services than those covered by an employee plan.. High deductibles that correspond with self-purchased plans may be one factor contributing to the difference.

"Health insurance is an important determinant of access to care," says Roy, "and farmers represent a unique group of consumers who are most likely to self-purchase their own health insurance plan. Self-purchased plans typically cost more and provide less coverage than employer purchased group plans."

Of the 474 farm children under the age of 18 represented in the survey, 28 percent qualify for Medicaid but are not covered under the plan, and another 18 percent qualify for hawk-i but are not covered under the plan. Efforts are underway to increase enrollment in these health plans especially among those farmers who spend a high percentage of their income on health coverage.

Iowans can receive enrollment information for hawk-i or Medicaid by calling 1-800-257-8563 from 7 a.m. to 7 p.m. Monday through Friday. Bilingual operators staff the line. No family pays more than $20 per month for health care coverage through the hawk-i program.

After deducting 20 percent of earned income, families can earn as much as indicated on the following chart and still qualify for the hawk-i program.

FAMILY SIZE INCOME

1 $17,720

2 $23,880

3 $30,040

4 $36,200

5 $42,360

6 $48,520

7 $54,680

8 $60,840

Questions about the survey may be addressed to Kristi Fisher, AgriSafe Clinic, Spencer Hospital, 1217 2nd Ave E, Spencer, IA 51301. Phone: (712) 264-6579. FAX (712) 264-6482. E-mail: kfisher@spencerhospital.org