UW-Madison: Cooperative makes health care accessible to farmers

CONTACT: Byron Crouse, 608-265-6727, [email protected]

MADISON – If you’re shopping for affordable health insurance, here’s a handy tip: Don’t be a farmer. Even in America’s Dairyland, high insurance costs for farm families can literally add insult to injury.

In a job where the labor is strenuous, the equipment is sometimes dangerous and accidents can happen in a flash, many farmers are priced out of the health insurance market. If they can afford any kind of coverage at all, it is typically a high-deductible, catastrophic-care policy that still leaves them exposed to staggering expenses before their benefits kick in.

When even the cost of inadequate insurance is out of reach, it puts farmers in a dilemma. Should they take their chances and go without (an estimated 18 percent of Wisconsin farmers are uninsured)? Can their spouse get family health insurance through a job off the farm? Or is it the tipping point that pushes them out of farming for good?

“We need to feed our cows, to continue to produce the milk which is our livelihood, and how do you choose between that and paying for the health insurance for your family?” asks Sandi Cihlar, who operated a third-generation dairy farm with her husband for 30 years. “I know for many farm families it was just an impossible cost.”

A University of Wisconsin-Madison physician is one of the key figures behind a major – and surprisingly successful – effort to attack the problem. Byron Crouse has partnered with the Wisconsin Federation of Cooperatives (WFC) on a new program called the Farmers’ Health Cooperative of Wisconsin. In its first year and a half of existence, the co-op has not only saved farmers money, but improved their health coverage.

Crouse is all-too-familiar with the difficult health care choices facing agricultural producers. As associate dean for rural and community health at the UW-Madison School of Medicine and Public Health, Crouse also practices family medicine at the UW Health clinic in Belleville, Wis., a village of 2,000 residents on the Dane-Green county line, where he tends to the medical needs of farm families on a regular basis.

“They’re involved in a very physical job, working around heavy machinery, working around power tools – the classic being the PTL, or power takeoff on the back of a tractor, which drives the augers, combines and other things. That thing is spinning around anywhere from 1,000 to 3,000 rpm just waiting to catch anything that dangles near it,” Crouse says.

Pesticides, herbicides and other frequently used chemicals are another occupational hazard. “You walk around a farm and it’s just filled with important elements for efficient modern farming, all of which have major risks.”

Crouse says those risks shouldn’t have to mean exorbitant health insurance premiums. Sharing risk among a large group of policyholders, he says, is what insurance should be all about.

“Somewhere, decades ago, our insurance process, I think, went astray and started looking at different tiers of risk instead of pooling all members into a single risk.” Because farmers don’t qualify for group coverage, Crouse says, they must purchase policies as individuals or small businesses, which saddles them with some of the highest premiums in the market.

The Cihlar family’s experience is a representative example. During a 13-year period when milk prices had declined, the farm’s insurance premiums rose more than 150 percent – and that was before the next renewal notice arrived with an additional 29 percent increase. But due to her health history, Cihlar felt she had nowhere to turn.

“In 1989, I had heart surgery, and I’m fine now. I’ve run five-mile snowshoe races and I’m doing just great, but because of that, no other insurance company would touch me without a significant increase,” Cihlar says.

Several years ago, when WFC launched its initiative, Crouse was one of the first people it turned to. He became the academic partner for a grant from the Wisconsin Partnership for a Healthy Future to create the Farmers’ Health Cooperative of Wisconsin (FHCW). Boosted by a federal appropriation secured by Wisconsin Congressman David Obey and Sen. Herb Kohl, the cooperative became a reality in 2007.

Crouse’s credentials promoting rural health were well established. Before Belleville, he practiced family medicine in Spooner, an even smaller community in northwest Wisconsin, while also teaching at the Duluth (Minn.) Family Practice Residency. At the University of Minnesota School of Medicine, he rose to become the first director of the Minnesota Rural Health School. It was his combination of academic expertise and clinical experience that made him a logical partner for the WFC initiative.

“Part of our work with Dr. Crouse, and this is where he’s so valuable, is we’re trying to demonstrate that farmers are not as risky as what insurers and their actuaries have typically thought of them as being,” says WFC president and CEO Bill Oemichen. “We know it anecdotally, but we want to prove it based on evidence, scientific evidence and physical evidence, that this is, in fact, the case.”

In convincing an insurance carrier to partner with the cooperative, it fell to Crouse to demonstrate that the sometimes dangerous working conditions are not the whole story when it comes to the health of farmers and their families.

Crouse’s primary role in the startup and evaluation of the project has been creating an evidence-based system of assessing the health care needs of farmers in Wisconsin and how a health care plan could address them.

“He certainly provided us a lot of our intellectual heft. Without it I think we would be a lot further behind. So I think he’s critical to the success of this program,” Oemichen says.

Any producer coming into the cooperative must participate in a health risk assessment, which is intended to get baseline data not only on a macro level – for example, how many have hypertension, diabetes and other chronic problems – but also what conditions should be addressed for each individual member.

Crouse thought it was particularly important to cover preventative care, which farmers’ high-deductible policies usually exclude. Farmers ever-conscious of the bottom line will often balk at the extra cost of such services, he says.

“If you talk to a farmer about a colonoscopy, (they’ll ask) ‘How much is that going to be? Am I going to have to give up a whole day of work if I’m going to have the sedatives and can’t be driving the truck that afternoon?’ So then, add in the cost of several thousand dollars on top of that coming right out of pocket, and that’s a huge barrier to getting effective preventive services to these people.”

“Farmers in general are much healthier in different areas than the general population,” Cihlar says. “They get more physical exercise, there’s less smoking. They really are healthier if they are able to get the prevention care that they need.”

Another thing Cihlar appreciates is that the Farmers’ Health Cooperative covers workplace injuries, which, she says, is practically unheard of. Most farmers, she believes, are not aware that their policies don’t cover them.

Preventative care and coverage of work-related injuries are among the main reasons that two-thirds of the cooperative’s members report they have better health coverage than before – with more than half seeing their premiums go down, and another third holding steady.

Helping create a health insurance plan for farmers was not on Crouse’s radar when he came to UW-Madison from Minnesota in 2001. But he feels emphatically that it’s exactly the kind of thing UW-Madison ought to be doing.

“This is what a university should be about. When I moved from Minnesota to Wisconsin the mantra ‘the Wisconsin Idea’ was a new slogan to me,” he says. “In Minnesota, there’s a lot of talk about the University of Minnesota being a land-grant institution, and obviously that’s where the concept of the Wisconsin Idea emanates from. But I think it’s a much more culturally inculcated value here in Wisconsin.”

Oemichen adds, “To me, this is the epitome of the Wisconsin Idea: the university using its resources to help community partners like, in this case, the Wisconsin Federation of Cooperatives, to go out and try to meet a significant need of an important population within the state.

“I think it helps to demonstrate that the University of Wisconsin-Madison isn’t just self-absorbed within its walls in the city of Madison but reaches across the entire state and to every corner of the state.”

Editor’s note: This story is part of a series of stories about the Wisconsin Idea. Find more at http://wisconsinidea.wisc.edu.