Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-25T18:04:33.090Z Has data issue: false hasContentIssue false

Assessing the Impact of Health Insurance and Other Socioeconomic Factors on Inequality in Health Care Expenditures among Farm Households

Published online by Cambridge University Press:  15 September 2016

Hisham S. El-Osta*
Affiliation:
U.S. Department of Agriculture Economic Research Service
*
Correspondence: Economic Research Service ▪ 1400 Independence Avenue SW ▪ Mail Stop 1800 ▪ Washington, DC 20250–1800 ▪ Phone 202.694.5564 Email HELOSTA@ers.usda.gov.

Abstract

This research uses data from the 2005–2011 Agricultural Resource Management Survey and a two-part-model regression procedure to examine the impact of health insurance and other relevant socioeconomic factors on the distribution of health care expenditures among U.S. farm households. Findings show the importance of privately acquired health insurance coverage in explaining inequality in health care expenditures. The results also reveal, among other things, a statistical positive association between health care expenditures and farm operators who fall into the baby boomer age category. A similar statistical association is found for higher income levels but not for inequality of income.

Type
Research Article
Copyright
Copyright © 2015 Northeastern Agricultural and Resource Economics Association 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ahearn, M. 2009. “Theme Overview: Implications of Health Care Reform for Farmers and Rural Residents.Choices 24(4). Available at www.choicesmagazine.org/magazine/pdf/block_43.pdf (accessed January 2013).Google Scholar
Ahearn, M. 2011. “Potential Challenges for Beginning Farmers and Ranchers.Choices 26(2). Available at www.choicesmagazine.org/magazine/pdf/cmsarticle_33.pdf (accessed January 2013).Google Scholar
Ahearn, M., Black, N., and Williamson, J. 2013. “Implications of Health Care Reform for Farm Businesses and Families.” 2013 annual meeting of the Agricultural and Applied Economics Association, Washington, DC.Google Scholar
Ahearn, M.C., El-Osta, H., and Mishra, A.K. 2013. “Considerations in Work Choices of U.S. Farm Households: The Role of Health Insurance.Journal of Agricultural and Resource Economics 38(1): 1933.Google Scholar
Altindag, D., Cannonier, C., and Mocan, N. 2011. “Impact of Education on Health Knowledge.Economics of Education Review 30(5): 792812.Google Scholar
Angrist, J.D., and Krueger, A.B. 1991. “Does Compulsory School Attendance Affect Schooling and Earnings?Quarterly Journal of Economics 106(4): 9791014.Google Scholar
Bharadwaj, L, Findeis, J., and Chintawar, S. 2013. “U.S. Farm Households: Joint Decision Making and Impact of Health Insurance on Labor Market Outcomes.Health Economics Review 3(16): 119.Google Scholar
Baily, J.M. 2009. “The Top 10 Rural Issues for Health Care Reform.Center for Rural Affairs, Lyons, NE. Available at http://files.cfra.org/pdf/Ten-Rural-Issues-for-Health-Care-Reform.pdf (accessed February 2013).Google Scholar
Bartus, T. 2005. “Estimation of Marginal Effects Using Margeff.The Stata Journal 5(3): 309329.Google Scholar
Becker, G. 1965. “A Theory of the Allocation of Time.The Economic Journal 75(299): 493517.Google Scholar
Belotti, F., Deb, P., Manning, W.G., and Norton, E.C. Forthcoming. “TPM: Estimating Two-Part Models.” The Stata Journal.Google Scholar
Berrebi, Z.M., and Silber, J. 1985. “The Gini Coefficient and Negative Income: A Comment.Oxford Economic Papers 37(3): 525526.Google Scholar
Blakely, T.A., Kennedy, B.P., Glass, R., and Kawachi, I. 2000. “What Is the Lag Time between Income Inequality and Health Status?Journal of Epidemiology and Community Health 54(4): 318319.Google Scholar
Blank, R.M. 1997. It Takes a Nation: A New Agenda for Fighting Poverty. Princeton, NJ: Princeton University Press.Google Scholar
Blough, D.K., Madden, C., and Hornbrook, M. 1999. “Modelling Risk Using Generalized Linear Models.Journal of Health Economics 18(7): 153171.Google Scholar
Boisvert, R.N., and Ranney, C. 1990. “Accounting for the Importance of Non-farm Income on Farm Family Income Inequality in New York.Northeastern Journal of Agricultural Economics 19(1): 111.Google Scholar
Bound, J., Jaeger, D.A., and Baker, M. 1995. “Problems with Instrumental Variables Estimation When the Correlation between the Instruments and the Endogenous Explanatory Variables Is Weak.Journal of the American Statistical Association 90(430): 443450.Google Scholar
Bureau of Economic Analysis. 2005. “News Release: State Personal Income.BEA, U.S. Department of Commerce, Washington, DC. Available at www.bea.gov/newsreleases/regional/spi/2005/spi0305.htm (accessed August 15, 2012).Google Scholar
Bureau of Economic Analysis. 2012. “National Income and Product Accounts” tables. BEA, U.S. Department of Commerce, Washington, DC. Available at www.bea.gov/iTable/iTable.cfm?ReqID=9&step=l (accessed August 15, 2012).Google Scholar
Bureau of Labor Statistics. 2009. “Census of Fatal Occupational Injuries” website. U.S. Department of Labor, Washington, DC, www.bls.gov/iif/oshcfoi1.htm (accessed March 2013).Google Scholar
Burt, O.R., and Finely, R.M. 1968. “Statistical Analysis of Identities in Random Variables.American Journal of Agricultural Economics 50(3): 734744.Google Scholar
Centers for Medicare and Medical Services. 2012. ”Office of the Actuary: Table 3. National Health Expenditures, Aggregate, and Average Annual Growth from Previous Year Shown, by Source of Funds, Selected Calendar Years 1960–2010.” U.S. CMMS, Baltimore, MD. Available at www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/tables.pdf (accessed August 1, 2012).Google Scholar
Centers for Medicare and Medical Services. 2013. “National Health Fact Sheet.U.S. CMMS, Baltimore, MD. Available at www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet.html (accessed April 2013).Google Scholar
Chen, C., Tsaur, T., and Rhai, T. 1982. “The Gini Coefficient and Negative Income.Oxford Economic Papers 34(3): 473478.Google Scholar
Chiappori, D.A. 1988. “Rational Household Labor Supply.Econometrica 56(1): 6389.CrossRefGoogle Scholar
Clark, D., and Royer, H. 2010. “The Effect of Education on Adult Health and Mortality: Evidence from Britain.” NBER Working Paper 16013, National Bureau of Economic Research, Cambridge, MA.Google Scholar
Cohen, S.B., and Yu, W. 2012. “The Concentration and Persistence in the Level of Health Expenditures over Time: Estimates for the U.S. Population, 2008–2009.Medical Expenditure Panel Survey Statistical Brief 354, Agency for Healthcare Research and Quality. Available at http://meps.ahrq.gov/mepsweb/data_files/publications/st354/stat354.pdf.Google Scholar
Congressional Budget Office. 2008. Geographic Variation in Health Care Spending. CBO, U.S. Congress, Washington, DC. Available at www.cbo.gov/sites/default/files/cbofiles/ftpdocs/89xx/doc8972/02-15-geoghealth.pdf (accessed August 15, 2012).Google Scholar
Conti, G., Heckman, J., and Urzua, S. 2010. “The Education-Health Gradient.American Economic Review: Papers and Proceedings 100(2): 234238.Google Scholar
Cutler, D.M., Lleras-Muney, A., and Vogl, T. 2008. “Socioeconomic Status and Health: Dimensions and Mechanisms.” NBER Working Paper 14333, National Bureau of Economic Research, Cambridge, MA. Available at www.nber.org/papers/wl4333.pdf?new_window=l (accessed April 2013).Google Scholar
Deavers, K.L., and Hoppe, R.A. 1992. “Overview of the Rural Poor in the 1980s.” In Duncan, C.M., ed., Rural Poverty in America. Westport, CT: Auburn House.Google Scholar
D'Agostino, R.B., and Belanger, A.J. 1990. “A Suggestion for Using Powerful and Informative Tests of Normality.The American Statistician 44(4): 316321.Google Scholar
D'Antoni, J.M., and Mishra, A.K. 2012. “Health Insurance and Joint Off-farm Labor Allocation Decisions of Farm Families.” Southern Agricultural Economics Association 2012 Annual Meeting, Birmingham, AL.Google Scholar
DeNavas-Walt, C., Proctor, B.D., and Smith, J.C. 2008. “Current Population Reports, P60-235, Income, Poverty, and Health Insurance Coverage in the United States: 2007.” Current Population Report P60-239, U.S. Government Printing Office, Washington, DC.Google Scholar
DeNavas-Walt, C., Proctor, B.D., and Smith, J.C. 2011. “Income, Poverty, and Health Insurance Coverage in the United States: 2010.” Current Population Report P60-239, U.S. Government Printing Office, Washington, DC.Google Scholar
Diehr, P., Yanez, D., Ash, A., Hornbrook, M., and Lin, D.Y. 1999. “Methods for Analyzing Health Care Utilization and Costs.Annual Review of Public Health 20: 125144.Google Scholar
Dow, W.H., and Norton, E.C. 2003. “Choosing between and Interpreting the Heckit and Two-Part Models for Corner Solutions.Health Services and Outcomes Research Methodology 4(1): 518.Google Scholar
Duan, N., Manning, W.G. Jr., Morris, C.N., and Newhouse, J.P. 1983. “A Comparison of Alternative Models for the Demand for Medical Care.Journal of Business and Economic Statistics 1(2): 115126.Google Scholar
Ellis, R.P., Fiebig, D.G., Johar, M., Jones, G., and Savage, E. 2012. “Explaining Health Care Expenditure Variation: Large-sample Evidence Using Linked Survey and Health Administrative Data.” Working paper 1, University of Technology, Sydney Business School. Available at http://econpapers.repec.0rg/paper/utsecowps/l.htm (accessed January 2013).Google Scholar
El-Osta, H.S., Bernat, G.A. Jr., and Ahearn, M.C. 1995. “Regional Differences in the Contribution of Off-farm Work to Income Inequality.Agricultural and Resource Economics Review 24(1): 114.Google Scholar
El-Osta, H., and Morehart, M. 2009. “Welfare Decomposition in the Context of the Life Cycle of Farm Operators: What Does a National Survey Reveal?Agricultural and Resource Economics Review 38(2): 125141.Google Scholar
Ettner, S.L. 1996. “New Evidence on the Relationship between Income and Health.Journal of Health Economics 15(1): 6785.Google Scholar
Ewing, J. 2011. “Closing the Gaps in the Rural Primary Care Workforce.” National Conference of State Legislatures, Washington, DC. Available at www.ncsl.org/research/health/closing-the-gaps-in-the-rural-primary-care-workfor.aspx (accessed May 2013).Google Scholar
Fields, G.S. 2003. “Accounting for Income Inequality and Its Change: A New Method with Application to the Distribution of Earnings in the United States.Research in Labor Economics 22: 138.Google Scholar
Fiorio, C.V., and Jenkins, S.P. 2007. “Ineqrbd: Regression-based Inequality Decomposition Following Fields (2003).” Presentation, UK Stata User Group Meeting 10. Available at www.stata.com/meeting/13uk/fiorio_ineqrbd_UKSUG07.pdf (accessed June 2013).Google Scholar
Fordyce, M.A., Chen, F.M., Doescher, M.P., and Hart, L.G. 2007. “2005 Physician Supply and Distribution in Rural Areas of the United States.” Final Report 116, WWAMI Rural Health Research Center, University of Washington, Seattle, WA.Google Scholar
Fosler, G.D. 2012. “Health Care: A Common Global Appetite” web page. The GailFosler Group, New York, NY. Available at www.gailfosler.com/commentary/chart-of-the-week/health-care-a-common-global-appetite (accessed July 2013).Google Scholar
Foster, A.C., and Kreisler, C.J. 2011. “Health Care Spending Patterns of U.S. Consumers by Age, 1998, 2003, and 2008.” In Consumer Expenditure Survey Anthology, 2011. Report 1030, Bureau of Statistics, U.S. Department of Labor, Washington, DC. Available at www.bls.gov/cex/anthology11/csxanthol11.pdf (accessed September 2012).Google Scholar
Giles, S. 2003. “Health Care Costs: On the Rise Again.Journal of Economic Perspectives 17(2): 125148.Google Scholar
Gould, W.W. 1991. “SG3: Skewness and Kurtosis Tests of Normality.Stata Technical Bulletin 1: 2021.Google Scholar
Gourieroux, C., Monfort, A., Renault, E., and Trognon, A. 1987. “Generalized Residuals.Journal of Econometrics 34(1): 532.Google Scholar
Government Accountability Office. 2012. “Patient Protection and Affordable Care Act: Estimates of the Effect on the Prevalence of Employer-sponsored Health Coverage.” GAO-12-768, report to the ranking member, Committee on Health, Education, Labor, and Pensions, U.S. Senate, Washington, DC.Google Scholar
Greene, W.H. 2008. Econometric Analysis, 6th edition. Upper Saddle River, NJ: Prentice Hall. Google Scholar
Hawk, W. 2011. “Household Spending by Single Persons and Married Couples in Their Twenties: A Comparison.” In Consumer Expenditure Survey Anthology, 2011. Report 1030, Bureau of Statistics, U.S. Department of Labor. Available at www.bls.gov/cex/anthology11/csxanthol11.pdf (accessed October 2012).Google Scholar
Hay, J.W., and Olsen, R.J. 1984. “Let Them Eat Cake: A Note on Comparing Alternative Models of the Demand for Medical Care.Journal of Business and Economic Statistics 2: 279282.Google Scholar
Health Care Cost Institute. 2012. Health Care Cost and Utilization Report: 2010. HCCI, Washington, DC. Available at www.healthcostinstitute.org/files/HCCI_HCCUR2010.pdf (accessed September 2013).Google Scholar
Hoppe, R.A. 2007. “The Importance of Farm Program Payments to Farm Households.Amber Waves 5(3): 1623.Google Scholar
Huber, P.J. 1967. “The Behavior of Maximum Likelihood Estimates under Nonstandard Conditions.” In Proceedings of the Fifth Berkeley Symposium on Mathematical Statistics and Probability. Berkeley, CA: University of California Press.Google Scholar
Jarque, C.M., and Bera, A. 1987. “A Test of Normality for Residuals and Regression Residuals.International Statistical Review 55(2): 163172.Google Scholar
Jones, C.A., Parker, T.S., Ahearn, M., Mishra, A.K., and Variyam, J.N. 2009. “Health Status and Health Care Access of Farm and Rural Populations.Economic Information Bulletin 572, Economic Research Service, U.S. Department of Agriculture, Washington, DC.Google Scholar
Kaiser Commission on Medicaid and the Uninsured. 2011. “The Uninsured and Their Access to Health Care: Key Facts.KCMU, Washington, DC. Available at www.kff.org/uninsured/upload/1420-13.pdf (accessed March 2012).Google Scholar
Kawachi, I., Kennedy, B.P., and Wilkinson, R.G. 1999. The Society and Population Health Reader, Volume 1. Income Inequality and Health. New York, NY: The New Press.Google Scholar
Liao, P., and Taylor, J.E. 2010. “Health Care Reform and Farm Women's Off-Farm Labor Force Participation: Evidence from Taiwan.Journal of Agricultural and Resource Economics 35(2): 281298.Google Scholar
Mallar, C.D. 1977. “The Estimation of Simultaneous Probability Models.Econometrica 45(7): 17171722.Google Scholar
Manning, W.G., Duan, N., and Rogers, W.H. 1987. “Monte Carlo Evidence on the Choice between Sample Selection and Two-Part Models.Journal of Econometrics 35(1): 5982.Google Scholar
Marmot, M. 2002. “The Influence of Income on Health: Views of an Epidemiologist.Health Affairs 21(2): 3146.Google Scholar
Meara, E.R., Seth, R., and Cutler, D.M. 2008. “The Gap Gets Bigger: Changes in Mortality and Life Expectancy by Education 1981–2000.Social Determinants 27(2): 350360.Google Scholar
Mellor, J.M., and Milyo, J. 2001. “Re-examining the Ecological Association between Income Inequality and Health Journal of Health Politics, Policy, and Law 26(3). 487522.Google Scholar
Mellor, J.M., and Milyo, J. 2002. “Income Inequality and Health Status in the United States: Evidence from the Current Population Survey.The Journal of Human Resources 37(3): 510539.Google Scholar
Mishra, K.A., El-Osta, H.S., and Ahearn, M.C. 2012. “Health Care Expenditures of Self-employed Farm Households in the United States.Agricultural Economics 43(1): 7588.Google Scholar
Mullahy, J. 1998. “Much Ado about Two: Reconsidering Retransformation and the Two Part Model in Health Econometrics.Journal of Health Economics 17(3): 247281.Google Scholar
Mwabu, G. 2007. “Health Economics for Low-Income Countries.” Center Discussion Paper 955, Economic Growth Center, Yale University. Available at www.econ.yale.edu/growth_pdf/cdp955.pdf (accessed March 2012).Google Scholar
National Advisory Committee on Rural Health and Human Services. 2008. “The 2008 Report to the Secretary: Rural Health and Human Services Issues.” NACRHHS, U.S. Department of Health and Human Services, Washington, DC.Google Scholar
Newhouse, J.P. 1992. “Medical Care Costs: How Much Welfare Loss?The Journal of Economic Perspectives 6(3): 321.Google Scholar
Newhouse, J.P., Manning, W.G., Keeler, E.B., and Sloss, E.M. 1989. “Adjusting Capitation Rates Using Objective Health Measures and Prior Utilization.Health Care Financing Review 10(3): 4154.Google Scholar
Office of the Assistant Secretary for Planning and Evaluation. 2008. “The Effects of Health Care Cost Growth on the U.S. Economy.” Final Report for Task Order #HP-06-12, U.S. Department of Health and Human Services, Washington, DC. Available at http://aspe.hhs.gov/health/reports/08/healthcarecost/report.pdf (accessed August 2012).Google Scholar
Organization for Economic Cooperation and Development. 2012. “OECD Health Data 2012: How Does the United States Compare?OECD, Paris, France. Available at www.oecd.org/unitedstates/BriefingNoteUSA2012.pdf (accessed December 2013).Google Scholar
Park, T, Ahearn, M., Covey, T., Erickson, K., Harris, J.M., Kuethe, T., McGath, C., Morehart, M., Norton, A., Vogel, S., Weber, J., Williams, R., and Wozniak, S. 2010. Agricultural Income and Finance Outlook. Report AIS-90, Economic Research Service, U.S. Department of Agriculture. Available at www.ers.usda.gov/publications/ais-agricultural-income-and-finance-outlook/ais90.aspx#.UZzG5tiE5qM (accessed March 2013).Google Scholar
Parker, T.S. 2009. “Medical Costs Account for the Largest Share of Nonmetro Federal Transfer Payments.Choices 24(4). Available at www.choicesmagazine.org/magazine/pdf/article_105.pdf (accessed July 2013).Google Scholar
Parker, T, and Gibbs, R. 2005. “Low Earnings but Steady Job Growth in Low-employment Counties.Amber Waves 3(4): 8.Google Scholar
Parker, S.W., and Wong, R. 1997. “Household Income and Health Care Expenditures in Mexico.Health Policy 40(3): 237255.Google Scholar
Riedl, B.M. 2004. “Another Year at the Federal Trough: Farm Subsidies for the Rich, Famous, and Elected Jumped Again in 2002.Heritage Foundation Backgrounder 1763, May 24.Google Scholar
Sastre, M., and Ayala, L. 2002. “Europe vs. the United States: Is There a Trade-off between Mobility and Inequality?” ISER Working Paper 2002–26, Institute for Social and Economic Research, Colchester, UK. Available at www.iser.essex.ac.uk/publications/working-papers/iser/2002-26.pdf (accessed November 2013).Google Scholar
Schiller, B.R. 2004. The Economics of Poverty and Discrimination. Upper Saddle River, NJ: Prentice Hall.Google Scholar
Schoenman, J.A.J. 2012. “The Concentration of Health Care Spending.NIHCM Foundation Data Brief, National Institute of Health Care Management, Washington, DC.Google Scholar
Seshamani, M., Lambrew, J., and Antos, J.T. 2008. “Financing the U.S. Health System: Issues and Options for Change.The Leaders’ Project on the State of American Health Care, Bipartisan Policy Center, Washington, DC.Google Scholar
Smith, J.P. 1999. “Healthy Bodies and Thick Wallets: The Dual Relation between Health and Economic Status.Journal of Economic Perspectives 13(2): 145166.Google Scholar
Smith, J.P. 2004. “Unraveling the SES-Health Connection.Population and Development Review 30(Supplement): 108132.Google Scholar
Smith, R.J., and Blundell, R.W. 1986. “An Exogeneity Test for a Simultaneous Equation Tobit Model with an Application to Labor Supply.Econometrica 54(3): 679685.Google Scholar
Stanton, M.W., and Rutherford, M.K. 2005. “The High Concentration of U.S. Health Care Expenditures.” Research in Action 19, AHRQ Publication 06–0060, Agency for Healthcare Research and Quality, Rockville, MD.Google Scholar
Stock, J.H., Wright, J.H., and Yogo, M. 2002. “A Survey of Weak Instruments and Weak Identification in Generalized Method of Moments.Journal of Business and Economic Statistics 20(4): 518528.Google Scholar
Subramanian, S.V., and Kawachi, I. 2004. “Income Inequality and Health: What Have We Learned So Far?Epidemiologic Reviews 26(1): 7891.Google Scholar
Sundaram-Stukel, R., and Deller, S. 2009. “Farmer Health Insurance Cooperatives: An Innovative Solution for Other Americans?Choices 24(4). Available at www.choicesmagazine.org/magazine/pdf/article_101.pdf (accessed June 2012).Google Scholar
Terza, J.V., Basu, A., and Rathouz, P.J. 2008. “Two-Stage Residual Inclusion Estimation: Addressing Endogeneity in Health Econometric Modeling.Journal of Health Economics 27(3): 531543.Google Scholar
Thomas, D. 1990. “Intrahousehold Resource Allocation: An Inferential Approach.Journal of Human Resources 25(4): 635664.Google Scholar
Tu, H.T. 2004. “Rising Health Costs, Medical Debt, and Chronic Conditions.” Issue Brief 88, Center for Studying Health System Change, Washington, DC.Google Scholar
United Nations. 2002. “Poverty and Education.” In State of World Population.” United Nations Population Fund, New York, NY. Available at www.unfpa.org/swp/2002/english/ch7/page4.htm (accessed December 16, 2011).Google Scholar
U.S. Department of Agriculture, Economic Research Service. ARMS Farm Financial and Crop Production Practices. Available at www.ers.usda.gov/data-products/arms-farm-financial-and-crop-production-practices.aspx (accessed September 2012).Google Scholar
Vella, F. 1993. “Simple Tests for Sample Selection Bias in Censored and Discrete Choice Models.Journal of Applied Econometrics 7(4): 413421.Google Scholar
Vella, F. 1998. “Estimating Models with Sample Selection Bias: A Survey.The Journal of Human Resources 33(1): 127169.Google Scholar
Wagstaff, A., van Doorslaer, E., and Paci, P. 1991. “Equity in the Finance and Delivery of Health Care: Some Tentative Cross-country Comparisons.” In McGuire, A., Fenn, P., and Mayhew, K., eds., Providing Health Care. Oxford, UK: Oxford University Press.Google Scholar
Weber, J., and Ahearn, M. 2013. “Wealth, Farm Programs, and Health Insurance.Briefing Room, Economic Research Service, U.S. Department of Agriculture, Washington, DC.Google Scholar
White, H. 1980. “A Heteroskedasticity-consistent Covariance Matrix Estimator and a Direct Test for Heteroskedasticity.Econometrica 48(4): 817830.Google Scholar
Wooldridge, J.M. 2002. Econometric Analysis of Cross Section and Panel Data. Cambridge, MA: The MIT Press.Google Scholar
Yoo, M. 2011. “Does Increased Education Lower Health Care Spending? Findings for Self-managed Health Conditions.” Paper presented to the Fifth Biennial Conference, Health and Healthcare in America, Los Angeles, CA; Department of Economics, Rutgers University. Available at http://econweb.rutgers.edu/myoo/paper_YOO.pdf (accessed February 2013).Google Scholar
Zheng, X., and Zimmer, D.M. 2008. “Farmers’ Health Insurance and Access to Health Care.American Journal of Agricultural Economics 90(1): 267279.Google Scholar