Kansas Health Institute | Information For Policy Makers. Health for Kansans.

ADMIRE — By Mike Shields

KHI News Service

Sept. 22, 2008

ADMIRE By the time he was 26, Kevin DeDonder, now 34, had his own place about four miles down the road from the farm where he grew up.

His parents still farm there, the place his grandparents farmed before them.

"I don"t know anything else but farming," DeDonder said. "I never had a job that wasn"t agricultural."

That was true until he took a part-time job loading parcel delivery trucks so he could have health insurance for himself, his two young children and wife.

"I started at UPS, basically for the health insurance. The premium (cost) is almost equal to the wage," he said.

He gets up every work day about 3:30 a.m. so he can make the 14-mile drive to the Emporia freight dock of United Parcel Service. He"s back home by about 8:30 a.m. to start his farm chores, often wrapping up around 9 or 9:30 p.m.

"He goes from before the sun comes up to after the sun goes down," said his wife, Misty DeDonder, an Iraq War veteran studying at Emporia State University to become a school teacher. "He usually eats sandwiches on his tractor. But he doesn"t work Sunday. It"s nice to have that day."

The DeDonders" circumstances are common among farm families on the Great Plains and elsewhere in the U.S.

In a country where most people get their health insurance through their employers, farmers, like other self-employed persons are left to fend for themselves to a greater degree than most.

Many solve the problem the way Kevin DeDonder does, taking a second job in town.

There is a saying common among mid-size operators like him:

"I"m too big to be part time and too small to be full time, so I work night and day."

Medical debt common

"Slightly over half of our farmers and operators get their insurance through off-farm employment, either their own or their spouse"s," said Alana Knudson of the Center for Rural Health at the University of North Dakota. "That leaves more than a third that need to get it through the individual market, which makes it even more difficult. Since farmers are aging faster than the general population, that means they usually have chronic conditions and with health insurance, the older you get the more expensive it becomes."



Knudson has co-authored a series of reports produced by the The Access Project based on surveys of farmers and ranchers in Kansas, Iowa, Minnesota, Missouri, Montana, Nebraska and the Dakotas.

Knudson said the surveys showed that the majority of farmers and ranchers on the Great Plains have insurance, even if they are working extra hours off the farm like Kevin DeDonder to get it or keep it.

But many, she said, pay too much for policies that cover too little, making medical debt common and creating one more financial hurdle for farmers already operating on thin margins.

"The majority of our survey respondents had health insurance, in fact, over 90 percent," Knudson said. "But although they have health insurance, the products that they have do not necessarily prevent them from financial risk. They are underinsured.

"I think one of the respondents gave a wonderful quote," she said. "This is not a health care crisis this is a health care cost crisis. We have 90 percent saying they have health insurance but still more than a quarter of them saying there was a financial burden including premiums and out-of-pocket expenses and one of five said they had outstanding medical debt.

"The current system is very difficult for small business owners like our farm and ranch operators to be able to maintain adequate coverage and to be able to keep their businesses financially solvent."

The problems described by Knudson and the The Access Project reports are more than statistics for Donn Teske, a farmer and president of the Kansas Farmers" Union.

He gets his insurance through his wife"s plan. She works at the hospital in Onaga.

"After reading all of the exclusions on our policy I discovered the only time I"m covered is when I"m in town and not on the farm," Teske told members of a congressional subcommittee earlier this year. "My brother has also faced health problems that drove him into debt and he was forced into medical bankruptcy in order to deal with his health care bills."

Rural vitality

These problems are no secret at the Kansas Farm Bureau headquarters in Manhattan. The organization claims about 40,000 of the state"s farmers and ranchers as members.

"Sixty-five to 80 percent of the income of our members doesn"t come from farming," said spokesman Harry Watts. "And the bigger point is that many of these folks take the job for the health insurance. Rural health care in terms of access and cost is really the number one priority of our members."

Watts said the Farm Bureau for decades focused its efforts on solving the problem by seeking relief at the Statehouse in Topeka and in the halls of Congress in Washington, D.C.

Now, he said, "what I think is happening is a bit of a paradigm shift. We"re seeing how we might engage change by actually working with members in our communities. We"ll continue to do the good work in Topeka and D.C., but there are things we can do with our organization in our communities. I think we can roll up our sleeves and make a difference."

Watts said the Farm Bureau has launched the Kansas Hometown Prosperity Initiative to work with the Kansas Commission on Rural Policy approved by this year"s Legislature.

The goal of the initiative is to work with Farm Bureau members in their communities to help them develop the processes for pulling together the leadership and resources to solve problems such as inadequate health care or a dying Main Street.

"Kansas Farm Bureau is in the very early stages of our research efforts on rural healthcare," Watts said. "We don"t have a specific plan, we just know that access and cost is one of our members" primary issues and our organization is looking for potential solutions."

Scaling back

The Kansas Health Policy Authority is preparing its recommendations for the 2009 Legislature, which will include some measures meant to assist small businesses, but nothing in the agency"s plan offers specific remedies for farmers, said policy director Barb Langner.

"These guys are in the individual (health insurance) market," she said. "They"re in a group of one and if you have health issues, you"re just priced out of the market. Farmers are in a precarious position."

Langner said a proposal the agency offered to this year"s Legislature was aimed at providing "some relief" for individual and small group policyholders.

"It didn"t go anywhere. It was too contentious."

Among other things, she said, lawmakers and industry lobbyists had "concerns about combining the individual and small group markets because the rules governing those two are very different. That"s why we"re scaling back this year."

Farmer Kevin DeDonder is hoping he"ll be able to scale back this year, too. His wife is about to complete her student teaching and has her eyes on a job in the local school district. Kevin DeDonder"s mother also works at the local school. That"s the way his parents kept health insurance after his father left his off-the-farm job a few years ago.

"I hope when Misty gets her job that I"ll be able to devote all my time to farming," he said.

He"s young and healthy. What about going a few months with no health insurance but a little more sleep?

"No," he said, sounding a little tired as he said it. "That would be just stepping off the edge."

-Mike Shields is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at mshields@khi.org or at 785-233-5443, ext. 123.