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Health Insurance Report September 2011
 

Health Insurance Report September 2011

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    Health Insurance Report September 2011 Health Insurance Report September 2011 Document Transcript

    • Healthcare Insurance Gaps in Farmers Markets:A summary of coverage and needs among marketsmanagers and producers in the United States 1 Farmers Market Coalition Page September 2011 Photo courtesy of Lisa Bralts-Kelly
    • Healthcare Insurance Gaps in Farmers Markets:A summary of coverage and needs among market managers and producers in the United States By Andrew LoveExecutive SummaryThe Farmers Market Coalition (FMC), with support from the USDA Risk Management Agency, conducted asurvey of farmers market managers and producers selling at farmers markets in the spring of 2011. Theresults of the survey appear in the following report, and have been gathered by analyzing the answersprovided by the 393 respondents. Instances where fewer than 393 respondents provided an answer areindicated as such for each graph where appropriate.The survey indicates that people who work in the farmers market community are disproportionatelyuninsured when compared to the national average. According to the most recent U.S. Census Bureaustatistics 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 costas the primary reason. Those who are currently covered received their coverage through theiremployer’s plan (28.3%), an individual/family plan (30.1%), or a spouse’s plan (22.5%). A small numberof 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) theprevalence of self-employed, small-scale business operators who sell at a farmers market, and 2) thelarge number of volunteer market managers. According to USDA, more than 60% of farmers markets aremanaged by volunteers (Ragland and Tropp, 2009). On the producer side, small businesses do not havethe economies of scale to warrant discounts to either the business owner, or the employees that workwith the business owner.In an effort to assess the degree of need for affordable health coverage among the farmers marketsector, the Farmers Market Coalition sought input on interest in several low-cost alternatives to majormedical plans, including supplementary, alternative coverage. In general, farmers market managers andfarmers responding to the survey felt that plausible offerings could include a mini-medical plan, adiscount card, or a nationally sponsored health insurance policy that could be provided to those in thefarmers market community.IntroductionRemarkably, farmers markets thrive despite limited capital on the part of farmers and marketorganizations. Limited capital means minimal financial padding which could keep business operational inthe event of a physical injury, illness, or even loss of life. Temporary or permanent loss of an operator ormanager 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 ortheir spouse’s off-farm employment for health benefits. With one or both spouses often working off-farmeither part-time or full-time, production capacity is limited. By extension, so too is farm income, furthercreating dependence on off-farm jobs. farmers ● consumers ● communities P.O. Box 504 ● Charlottesville, VA ● 22902 info@farmersmarketcoalition.org ● 434-984-0175 ● 877-FMC-0553 ● www.farmersmarketcoalition.org Farmers markets are good for everyone. Join us to make them even better.
    • A study by the Social Responsibility Initiative at The Ohio State University found that health insurance isidentified 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 ―anaffordable and accessible national health care program would free up time and resources farmers at theRural-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 thefact 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 andranchers rely on individual policies, which generally provide less comprehensive coverage with higherdeductibles and co-pays. In a preliminary survey conducted by the Farmers Market Coalition (FMC) inMarch 2010, 62% of producers with health insurance purchase it themselves. These problems areexacerbated by limited cash flow and wide variations in annual income from year to year, compoundingthe impact that medical debt can have in putting a farm business in jeopardy (Blankenau, Bailey, andHudson, 2009). Value added vendors, and even market managers, face similar obstacles to healthinsurance.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 byvolunteers (Ragland & Tropp, 2009), with still others managed with part-time staff, very few of which areeligible for benefits. This adds to management turnover and other human resource risks which stuntfarmers 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 marketorganizations.SurveyThe Farmers Market Coalition’s (FMC) interest in health care coverage began with anecdotal stories aboutthe adversity faced by those in the farmers market community when attempting to find affordableinsurance plans. Conversations with FMC members, as well as discussions on the FMC listserv, indicateda strong need for further research on health insurance in the farmers market community. Meanwhile, themilestone passage of the Healthcare and Education Affordability Reconciliation Act in 2010 presented aunique 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 approximately500 producers in 2010, with the assistance of the San Francisco Insurance Center. Results from thissurvey substantiated FMC’s concerns of disproportionate levels of uninsured amongst the farmers marketcommunity.The survey results indicated that those in the farmers market community are disproportionatelyuninsured when compared to the general population. According to the most recent U.S. Census Bureaustatistics from 2009, approximately 16.7% of the U.S. population is uninsured. By contrast, 29% of theAIM survey respondents were uninsured.After reviewing these results, FMC became increasingly interested in understanding the currenthealthcare coverage characteristics and needs of those in the farmers market community, particularlyfarmers market managers. With the assistance of the San Francisco Insurance Center, FMC beganconstructing and then disseminating a survey to determine the prevalence of health care amongst farmers ● consumers ● communities P.O. Box 504 ● Charlottesville, VA ● 22902 info@farmersmarketcoalition.org ● 434-984-0175 ● 877-FMC-0553 ● www.farmersmarketcoalition.org Farmers markets are good for everyone. Join us to make them even better.
    • farmers market staff, volunteers, and producers.The importance of this research is underlined by the morbidity rates that are strongly correlated with lackof insurance. Healthcare coverage is vital to ensuring good health. For some, it provides a safety net forthose who find themselves in need of costly medical care. For everyone, it is an important component ofpreventive care and a long healthy life. Those who have access to healthcare coverage have access tothe 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 uninsuredworking-age Americans have a 40% higher risk of death than their privately insured counterparts. TheHenry J. Kaiser Family Foundation’s report The Uninsured: A Primer, Key Facts About Americans WithoutHealth Insurance demonstrates a clear correlation between lack of insurance and a host of other medicalproblems. To name a few, the uninsured are more likely than their insured counterparts to have noregular source of care, postponed seeking care because of cost, needed care but did not get it, and tohave not filled a prescription, because of cost.Two other recent developments in the intersection of healthcare and farmers markets have alsocompelled FMC to delve into the issue. One, the recent passage of the Patient Protection and AffordableHealth Care Act has and will continue to change both the healthcare system and the health insuranceindustry. The repercussions are not yet fully known, as the bulk of the changes do not go into effectuntil 2014. However, it is already clear that while certain changes such as zero cost preventive care andremoval of pre-existing conditions clauses for children under 19 are welcomed by us all, there is a costassociated with these mandated benefits and those costs have found their way down to the consumer inthe form of increased premiums, potentially making health insurance even less affordable for those in thefarmers market community.Considering that lack –- or undercoverage — of health insurance clearly jeopardizes one’s health, andthat the farmers market community is disproportionately more likely to be uninsured, FMC seeks tounderstand 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 localfood, and by extension farmers markets. In 2010, there were 6,132 farmers markets, a 16% increasefrom the 2009 figure of 5,274. The USDA Farmers Market Directory for 2011 indicates that there was asimilar 17% increase in the number of farmers markets between 2010 and 2011, to 7,175 farmersmarkets. Growing sales in farmers markets equate to more produce, more products, and a growth in theindustry as a whole. It is imperative that this growth be safeguarded by providing information andservices to workers so that they can purchase adequate health insurance.Structure of the SurveyThe survey was composed of 24 multiple choice questions. Questions were constructed with the intent ofdetermining 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 frompurchasing insurance.The survey was disseminated through Farmers Market Coalition networks via email in the beginning ofApril 2011, and was open for three weeks, closing on April 22, 2011. There were 393 respondents to thesurvey, including local and state farmers market organization staff, volunteers, and farmers. The FarmersMarket Coalitions wishes to thank all those who responded to the survey to taking the time to providetheir input. farmers ● consumers ● communities P.O. Box 504 ● Charlottesville, VA ● 22902 info@farmersmarketcoalition.org ● 434-984-0175 ● 877-FMC-0553 ● www.farmersmarketcoalition.org Farmers markets are good for everyone. Join us to make them even better.
    • DemographicsWhile the survey itself did not target a specific demographic, certain response trends are evident in thesurvey results. Of the 393 respondents, 275 were women, representing 74.9% of the total response poll,while 97 or 25% of respondents were male. Gender of Respondents 26% Male Female 74% n=272Respondents did represent a wide variety of age ranges. Divided into ten year cohorts, the surveyindicates 11.6% of respondents in the 20-29 age range, 17.2% were 30-39, 18.9% were 40-49, and34.7% 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%). Abouta quarter of respondents (25.5%) were single. Current Age of Respondents 25.00% 18.9% 19.1% 20.00% 17.2% 15.6% 13.2% 15.00% 11.6% 10.00% 4% 5.00% 0.00% 20-29 30-39 40-49 50-54 55-59 60-64 65+ farmers ● consumers ● communities P.O. Box 504 ● Charlottesville, VA ● 22902 info@farmersmarketcoalition.org ● 434-984-0175 ● 877-FMC-0553 ● www.farmersmarketcoalition.org Farmers markets are good for everyone. Join us to make them even better.
    • n=272More than one-third of the respondents (33%) indicated that they were a business owner and solebusiness employee. This population is likely over-represented by producers rather than marketmanagers.Rate of InsuredOne of the primary goals of the survey was to assess the prevalence of heath care coverage in thefarmers market community. Were those in the community less likely, as likely, or more likely to beinsured 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 USAToday noted that ―The percentage with private insurance was the lowest since the government begankeeping data in 1987.‖ Those in the farmers market community are facing even more difficultcircumstances. Of those surveyed, 33.6% said that they have no health insurance, compared to the66.4% that said they do have coverage. Healthcare Insurance Coverage in the Farmers Market Community 34% 66% Insured Not Insured n=369Health Care Coverage and CostThere are likely a variety of reasons behind the apparent under-coverage amongst those in the farmersmarket community. One factor may be the small scale business models. FMC’s survey indicated that justover 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 theorythat farmers market vendors are operating smaller scale business models than their industrialequivalents. farmers ● consumers ● communities P.O. Box 504 ● Charlottesville, VA ● 22902 info@farmersmarketcoalition.org ● 434-984-0175 ● 877-FMC-0553 ● www.farmersmarketcoalition.org Farmers markets are good for everyone. Join us to make them even better.
    • Number of Employees in Responding Farms and Farmers Market Organizations 41.9% 35.0% 50% 40% 30% 8.6% 20% 7.0% 4.0% 3% 10% 0% 1 2 to 5 6 to 10 11 to 25 26 to 50 51+ n=370These smaller scale models tend to limit the affordability and availability of health care plans, both for theowner and the employees. Statistics gathered from Blue Shield’s Healthcare and Technology 2010Conference Presentation show that while 95% of large group employers offer healthcare to theiremployees, 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 employerthat 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. Ofthe 31.9% that indicated they do not have healthcare, 92.6% identified cost as the primary reason. Oneof our respondents summarized some of the frustrations felt by many. ―I cant afford $500/month with$10,000 deductible for my husband and myself. Thats the best deal I could find. We are healthy, dontvisit doctors, and almost moved back to Canada when we had a health crisis last fall. I dont trust thatinsurance companies would pay a claim even if I had health insurance.‖ A handful of individuals leftcomments stating that one member of the family held a part-time job simply for the health insurancebenefits offered through the employer.The farmers market community, far from being alone in feeling the effects of expensive premiums. A2010 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 thatthe 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 scaleoffered 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 wereassociated with a more robust healthcare plan, the respondents indicate a nearly unanimous decision forlower premiums. Close to 91% of those surveyed said they would prefer to pay $250 or less. Of that91%, 65% reported that they would like to pay between $10 and $150. farmers ● consumers ● communities P.O. Box 504 ● Charlottesville, VA ● 22902 info@farmersmarketcoalition.org ● 434-984-0175 ● 877-FMC-0553 ● www.farmersmarketcoalition.org Farmers markets are good for everyone. Join us to make them even better.
    • The preference for less expensive healthcare premiums may be difficult to realize due to the increasingcosts 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: AComprehensive 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 uninsuredrespondents were willing to pay. The average monthly premium for a family was $527. Less than 1% ofFMC’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 forpersons aged 60-64. For family policies, premiums ranged from $2,573 for policies covering childrenunder 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 tothe more expensive national averages, than it is to the uninsured population’s preference for a moremodest rate. The most common premium was between $200-$399, with the second most commonpremium being even slightly more expensive at $400-$599. Granted there are some people paying $199and under for their healthcare plans, however it’s less common than the more expensive premium rateswhich both the farmers market community, and the national population, are typically paying forhealthcare.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 Employers Plan 28.30% Individual/Family Plan 30.10% Spouses Plan 22.50% Medicare, Medicaid, or Tricare 8.50% Other 16.60% n=222Medical care was the most popular form of healthcare provided, with 98.6% of those insured currentlybeing covered by a medical plan. The majority of the insured (67%), only rely on their healthcarecoverage 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 thepopulation covered under a dental plan.Slightly over 23% of respondents who currently have health care, indicated that their plan coveredthemselves, their spouse, and their children. This stands in contrast to the 40% of people whose healthcare plans cover only themselves.Those who do have healthcare primarily use their insurance plans to cover routine medical expenses. Infact, 67% of respondents indicate that they use their plan either for routine checkups (31%) or routinecheckups, prescriptions, and/or occasional minor treatments (36%). A smaller, but still significantpercentage (19%), indicated that they use their coverage plan often for multiple reasons such as farmers ● consumers ● communities P.O. Box 504 ● Charlottesville, VA ● 22902 info@farmersmarketcoalition.org ● 434-984-0175 ● 877-FMC-0553 ● www.farmersmarketcoalition.org Farmers markets are good for everyone. Join us to make them even better.
    • prescriptions, labs, x-rays, physical therapy, inpatient/outpatient treatment, etc. Only a smallpercentage, 7%, noted that they never use their plan, and 5% indicated that the use their plan for―other‖ purposes.Possible SolutionsOne tactic that might address the financial constraints of the uninsured population is a nationalhealthcare plan for people who work in the farmers market industry. FMC has been tentatively exploringthe possibility of such a plan by researching both feasibility and consumer interest. When asked if theywere interested in a national healthcare plan sponsored by FMC, 80% responded that they were eithersomewhat interested (31%) or very interested (49%).Given that 92.6% of respondents identified ―cost‖ as the barrier that prevents them from purchasinghealth insurance, it comes as no surprise that 90.5% indicated ―cost‖ as one of the factors that wouldhave the greatest influence on whether or not they were to enroll in a national healthcare program. Othersignificant factors include annual deductible (60.2%) and doctor/provider network (57.2%). Otherimportant 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 willingto spend on a monthly basis if they were offered discounts on medical coverage that were the mostrelevant 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 consistentwith previous responses regarding their monthly budget for medical expenses. Respondents were nearlysplit 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 whenbuying insurance, 78% ranked healthmedical coverage as the most important and 16% ranked it assomewhat important. Respondents were then asked which factors were the most important whenchoosing a healthcare plan. Answers were very comparable when asked about the importance ofchoosing a plan either on cost or benefits. For cost, 56% thought it was somewhat important, whereas36% thought it was the most important. The importance rankings of choosing medical plan based onbenefits 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. WhileFMC currently does not offer such a plan, the question was asked in order to gauge industry interest. Theresults clearly demonstrate that there is such an interest, with 57% saying they were somewhat or veryinterested. 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=338After consulting with experts in the insurance industry, FMC identified three alternatives to traditional farmers ● consumers ● communities P.O. Box 504 ● Charlottesville, VA ● 22902 info@farmersmarketcoalition.org ● 434-984-0175 ● 877-FMC-0553 ● www.farmersmarketcoalition.org Farmers markets are good for everyone. Join us to make them even better.
    • healthcare coverage and assessed interest in them via this survey. Those three alternatives includedsupplemental medical coverage, a mini medical plan, and a discount card. Supplemental medicalcoverage, as the survey explained, hypothetically costs $16-$55 per month, filling deductible gaps andcovering 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 upto age 64 and $570 for entire families. It provides reimbursements for a certain percent of services (suchas office visits, lab & X-rays, hospitalization, and surgeries) and access to a large national PPO network ofdoctors 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 tosupplement 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 24/7access to a doctor via phone/email with prescription-writing capabilities; 10%-60% discounts onprescriptions, medications, alternative health, chiropractic care, vision/dental through Aetnas PPOnetwork; 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=3351=Least Important5=Most Important*Scores indicate the mean responseReception to both the supplemental medical coverage, and mini medical plan were tepid. Supplementalmedical coverage was ranked as somewhat important by 30% and most important by 10%. The minimedical plan, which was more popular than the supplemental medical coverage, was rated as somewhatimportant by 28% of respondents and most important by 25% of respondents. A partial explanation forthe lack of interest could be due to a lack of familiarity with these coverage options. This unfamiliaritycould lead to poor comprehension of the plan’s offerings, thereby generating uninformed opinions of justhow interested the respondents are to the plan.The discount card did receive slightly more positive results with 19% indicating that they were veryinterested, and 39% indicating they were somewhat interested. The discount card, which does not offeras comprehensive a coverage plan as the other two options, might very well appeal to the limitedbudgets of the survey pool considering it’s extremely low, $15 per month, premium.LimitationsThe design of the survey does carry some limitations that need to be mentioned. One, while everyindividual was asked the name of the organization they work for, there is still some ambiguity as to whatpercentage of the people worked for a farmer or small business, were the owner of a farm or smallbusiness, or worked for the farmers market itself. This means that one cannot infer the respondents’ rolein the farmers market, nor can one infer if the survey is representative of the variety of different jobtypes that are present at a farmers market. farmers ● consumers ● communities P.O. Box 504 ● Charlottesville, VA ● 22902 info@farmersmarketcoalition.org ● 434-984-0175 ● 877-FMC-0553 ● www.farmersmarketcoalition.org Farmers markets are good for everyone. Join us to make them even better.
    • The design of Constant Contact, which was the platform utilized to conduct the survey, does not allowone to identify an individual’s entire list of responses. In other words, one can determine how manypeople answered a certain question, and which answer they selected, but it is not possible to then look atthe relationships that might exist amongst groups of people who had similar answers. For example, onecan notice how many respondents indicated they would prefer to pay $100-$150 for their premium, butit’s not possible to see how that group responded to questions about the mini medical plan, or if thosepeople are more likely to be married, have kids, etc.ConclusionFMC’s ―Health Insurance Survey‖ validates the previous statistical findings of the Agricultural Institute ofMarin’s survey. Both studies reveal that those employed in the farmers market industry are, whencompared to the general population, disproportionately more likely to be uninsured. AIM’s survey poolrevealed a 29% uninsured rate, while FMC’s pool revealed a 34% uninsured rate. Both figures are wellabove 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 leastperceived 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 tothe prohibitive insurance costs faced by this community. One is the rising national cost of healthcare thatis being experienced by all people regardless of their industry. Secondly, small businesses are thepredominant business scale amongst vendors, and small businesses are at significant disadvantage whenit comes to purchasing affordable healthcare. Small businesses are not able to take advantage of theeconomies of scale that are achievable by larger businesses, and are left with more expensive monthlypremiums, both for the employer and the employee.This report has shown that lack of healthcare coverage in farmers markets is a real problem, and thatproblem is created by prohibitive costs. One solution to the predicament is to create a large scalehealthcare plan that would take advantage of the economies of scale offered to organizations thatrepresent 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 publichealth issue not only for those who make up the farmers market community, but for all who rely on thiscommunity for their own nourishment, health and income. Without this community, consumers are forcedto get their food from businesses where food quality and sourcing is less transparent and sustainablefarming practices, price movement and ethics are questionable. All of which can adversely affect thehealth and well being of consumers.The uninsured, like so many in the farmers market community, face serious threats to their health thatinclude a reduced lifespan, greater likelihood of death, less reliable access to healthcare and an inabilityto sustain their businesses should they become ill. This current state of susceptibility that America’s smallbusinesses and farmers are in must be remedied. The viability of our communities and our nation as awhole are at stake should these farmers continue to have inadequate and unaffordable access tohealthcare, as they will ultimately not be able to produce the food that sustains us all. farmers ● consumers ● communities P.O. Box 504 ● Charlottesville, VA ● 22902 info@farmersmarketcoalition.org ● 434-984-0175 ● 877-FMC-0553 ● www.farmersmarketcoalition.org Farmers markets are good for everyone. Join us to make them even better.
    • ReferencesBailey, 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 Uninsuredand Underinsured. Center for Rural Affairs. Available here.Cecere, D. New Study Finds 45,000 Deaths Annually Linked to Lack of Health Coverage. CambridgeHealth Alliance, September 2009. Available here.DeNavas-Walt, C., Proctor, B. D., Smith, J.C. September 2010. Income, Poverty, and Health InsuranceCoverage 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 theRural-Urban Interface: Does the Cost of Health Insurance Make a Difference? Social ResponsibilityInitiative Topical Report 09-05. Available here.Ragland, E. and Tropp, D. 2009. USDA Farmers Market Manager Survey, 2006. U.S. Department ofAgriculture, Agricultural Marketing Service. Available here.Tallon, James R., Rowland, Diane. The Uninsured: A Primer, Key Facts About Americans Without HealthInsurance. 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 HealthInsurance Plans (AHIP), October 2009. Available here. farmers ● consumers ● communities P.O. Box 504 ● Charlottesville, VA ● 22902 info@farmersmarketcoalition.org ● 434-984-0175 ● 877-FMC-0553 ● www.farmersmarketcoalition.org Farmers markets are good for everyone. Join us to make them even better.
    • Appendix AQuestions included in the 2011 FMC Health Insurance Survey1. Date of Birth2. Home Zip Code3. Gender4. Current Age5. Marital Status6. Number of Children7. Employer/Name of Organization or Company8. Employer Zip Code9. 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  Other13. 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  Other15. Please check the types of insurance you currently have:  Medical  Dental  Vision  Life  Disability 13  Accident  Critical Illness Page  Other
    • 16. Under your current health insurance plan, who is covered?  You only  You + Spouse  You + Children  You +Spouse + Children17. What is your current monthly premium cost?  Less than $100  $100-$199  $200-$399  $400-$599  $600-$799  $800-$999  $1,000 or more18. 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 andor 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  Other19. Please rate your overall interest in a national health insurance/benefits plan sponsored by theFarmers Market Coalition  Definitely not interested  Probably not interested  Don’t care one way or the other  Somewhat interested  Very interested20. Please check the areas that would have the greatest influence on whether or not to enroll in anational health insurance/benefits plan sponsored by the Farmers Market Coalition21. If a national organization like FMC were to provide you and your family with health-related coveragesand discounts that you see value in, such as medical, dental, vision, life disability and alternative healthto name a few, what would be your total monthly budget for any or all such products (which could beused to enhance your existing coverage or stand-alone coverage) ?  $10-$25  $26-$100  $101-$200  $201-$300  $301-$400  $401-$60022. 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 farmers ● consumers ● communities P.O. Box 504 ● Charlottesville, VA ● 22902 info@farmersmarketcoalition.org ● 434-984-0175 ● 877-FMC-0553 ● www.farmersmarketcoalition.org Farmers markets are good for everyone. Join us to make them even better.
    •  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 Disability23. Please read about the following two plans and rate them based on how important they might be foryou:*Supplemental Medical Coverage: $16-$55 cost per month. Fills in deductible gaps and covers excessexpenses 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 entirefamilies. 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 tosupplement 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 Important24. How interested would you be in an FMC-sponsored Discount Card (approximately $15 per month toinclude family benefits such as free 24/7 access to a doctor via phone/email with prescription-writingcapabilities; 10%-60% discounts on prescriptions, medications, alternative health, chiropractic care,vision/dental [through Aetnas PPO network]; and free towing/roadside assistance). Click here for morebackground 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=VeryInterested farmers ● consumers ● communities P.O. Box 504 ● Charlottesville, VA ● 22902 info@farmersmarketcoalition.org ● 434-984-0175 ● 877-FMC-0553 ● www.farmersmarketcoalition.org Farmers markets are good for everyone. Join us to make them even better.