JEFFERSON CITY — Tom Brown usually does not make a big deal about his birthday. But this year is different.
This time, he's turning 65 and will be covered by the federal health care plan Medicare.
This will be the first time Brown will have health insurance since his wife lost her teaching job more than four years ago. Medicare will cover only Brown himself; his wife is not 65 yet.
As a full-time farmer in La Grange, Brown faces the hardships that many self-employed Missourians face when it comes to buying insurance. In his case, he says he just can't afford it.
Farmers and many others who are self-employed do not have group insurance offered by employers. Although the Missouri Farm Bureau offers insurance to its members, bureau officials acknowledge it might not be any cheaper than other insurance.
According to the U.S. Bureau of Labor Statistics, farmers have one of the most dangerous jobs in America, ranking highly with loggers, roofers and fishermen. Farming is dangerous because of the animals, which can be unpredictable, the machinery and the use of pesticides. Farmers' families are also at a high risk because many work and live on the premises.
Brown said that being without insurance changes the way he works on the farm. "It's always a concern of the job. That's why you're always careful," he said.
Richard Williams, a Tipton farmer, said that not being able to buy insurance at a group rate changes the way he runs his business.
He said he has no money left to invest on his farm after spending 15 percent of his income on insurance. He has a policy with a $5,000 deductible, all for "high-priced insurance we never use," Williams said. "When we go to the doctor, we just pay the bill and move on because with such a high deductible there's nothing else to do."
A study of the Midwest by The Access Project, a health-care advocacy group based at Brandeis University near Boston, found that farmers pay a high price for health care coverage. The study surveyed 2,017 noncorporate farmers in seven states in the Midwest. It found the median out-of-pocket cost was $11,200. Those who got their insurance through group insurance spent a median of $5,600.
Various studies have found that as many as 90 percent of farmers may have insurance, but it is often costly and includes limited coverage.
The Access Project found that 90 percent of those surveyed did have health insurance, but many could barely cover the costs. There is no government-collected data on the number of farmers with or without health insurance.
Williams said he would rather spend the money he would pay for health insurance on his farm, replacing one his trucks — the newest of which has 150,000 miles on it. The same study found that among those with financial problems, 34 percent delayed making investments of their farms.
Even so, the Williams family never forgets how fortunate they are.
"We had friends whose wives had an illness, but they were waiting for Medicaid to kick in before they could treat it," Williams said.
But not all families can wait around. Angela Johnston, who is married to a farmer in Memphis, Mo., went to work for the state so that she and her daughter, who both have health problems, would be able to afford treatment.
Back in 1994, the family paid $1,200 a month in insurance costs. They couldn't afford it, so Johnston went to work. "I knew when I first started, I'm going to be working for a long time. I knew that I couldn't stay home," she said.
The Access Project's study found that of the farm families surveyed, 65 percent paid for their health-care costs out of family savings while another 22 percent incurred credit card debt.
For the Johnston family, the decision to get health care insurance has paid off. Their daughter had a unicameral bone cyst and has had three surgeries. Her father had to be hospitalized for two days after inhaling mold while cleaning out one of the farm's grain bins.