Topic: US Farm households’ access to health insurance and health care along the life course
Keywords: farm households – health insurance – health care – life course approach
Health care and health insurance policies are shifting in both the US and Europe. The extent to how these changes will impact the farm population is not well understood but, in the US, farm households have pointed to the rising costs of health care and insurance as a threat to their livelihood. In rural areas, the difficulties paying for health care and insurance are compounded by the lower density of health care providers, lower proportion of employers offering health insurance benefits, and fewer insurance options on state insurance marketplaces. Despite farm households’ challenges meeting their health needs, we actually know little about their lived experiences including their health needs, how they access health insurance and health care, and the consequences on the farm operation. Using a life course approach, we draw from a primary dataset of 1,064 survey responses and 31 interviews to explore: 1) the extent to which farm households’ health care needs change along the life course, 2) whether health needs impact the farm operation differently as farm households age, and 3) the differences in how farm households access health care and health insurance. Examining differences across age is particularly important in the US context because beyond the associations of age with wealth, health inequalities, and physical fitness, age is associated with the cost of health insurance and type of coverage available. Our preliminary findings indicate that issues are salient at any age. Younger farm households seem to be the most vulnerable and the most dissatisfied with their coverage despite reporting the lowest health expenses. Middle age households, who should be the least vulnerable, report challenges in accessing care and similar levels of dissatisfaction. Older households are also negatively impacted by health expenses despite eligibility for Medicare (the single-payer coverage for individuals over 65 and individuals with disabilities). Ultimately, our preliminary findings show how even a more privileged strata of the population, one that is mostly white, overall well educated, and owns business assets, experience
challenges meeting their health care needs. These findings point to structural issues with the way health care is organized. Considering that US health scholars and policy makers tend to focus on individuals’ ability to navigate the health systems through knowledge and resources, our work highlights the importance of more widely adopting a political economy perspective that explicitly considers the extent to which the organization of health care and insurance systems impede access to care. With recent increases in medical cost sharing in Europe, our study is relevant beyond the US context as it provides insights into how farm households navigate a health care system with high out-of-pocket expenses.