Unlikely Heroes in the U.S. Food System

by Mary Hall on April 5, 2013

Does your health insurance company support your local farmer? 

For a growing number of people, the answer is “yes.”  If you’re one of these fortunate individuals, you merely purchase a CSA membership from your local farmer, send your receipt to your health insurance company, and receive a rebate of up to $200 on a season’s worth of fresh fruits and vegetables.  It’s generally called a “CSA wellness rebate.”  It started with one insurance company in Madison, Wisconsin, and has grown to include six insurance companies in four states.

To the uninitiated, CSA stands for “community supported agriculture.”   To become a member of a CSA farm, you purchase a share in advance. Shares in our region can range anywhere from $100 for membership in an organic garlic CSA to $625 for membership in an established organic CSA that offers a wide variety of produce June through mid-October.  You can also find a CSA that offers a half-bushel option for $395.  Your upfront payment helps to cover the initial costs of the grower’s operation and commits you to the farm for the season.  In return for your investment, you receive a share of the farm’s produce each week during the growing season.

It’s easy to see how a $200 “CSA wellness rebate” would benefit CSA members and CSA farms. 

But what does a health insurance company get out of this type of arrangement? 

To fully appreciate the answer to that question, consider what health insurance companies are up against these days.  American eating habits are costing them a lot of money.  Those eating habits can be traced back to problems in our nation’s food system. 

Past Food Supply vs Current Food Supply
Sources: Flickr and Creative Commons

Problem #1: The U.S. agricultural system does not produce enough fruits and vegetables to enable every American to meet USDA guidelines for daily consumption.

Source: U.S. Department of Agriculture

In 2010, three researchers from the National Cancer Institute (NCI) published an article entitled “Healthfulness of the U.S. Food Supply: Little Improvement Despite Decades of Dietary Guidance.” The results of their research reveal the extent to which the U.S. food supply fell short of Federal dietary guidelines over the 35-year period from 1970 to 2005.

Several categories of foods are worth mentioning.  In terms of fruits and vegetables in general, the U.S. food supply contains less than half the amount needed for Americans to meet USDA dietary guidelines. The supply of dark-green vegetables, orange vegetables, and legumes, in particular, contains one-third the amount needed to meet dietary guidelines.  While the supply of “total grains” appears to be adequate, when you examine the difference in supply between “refined” and “whole grain,” you see that the supply of refined grain has steadily increased while that of whole grains has declined to the point where the whole grain supply is one-third of what is recommended to meet guidelines.

Given the types of crops receiving government subsidies, it’s not surprising to see that our agricultural system produces an overabundance of items from one category in particular: SoFAAS.   SoFAAS refers to Solid Fats, Alcoholic beverages, and Added Sugars, which are noted as undesirable because “ they add energy without adding much in the way of nutrients and they displace nutrient-dense foods in the diet.”   Added sugars make up the greatest portion of SoFAAS calories, followed by solid fat.

Three major forces influence our nation’s food supply: government policies, industrial marketing efforts, and consumer demand.   “Government policies” (agricultural and economic) and “industrial marketing efforts” are responsible for pushing foods through the distribution channels, whereas “consumer demand” exerts the pull.  According to National Cancer Institute researchers, given data from the past 35 years, “it may be unrealistic to expect a groundswell in consumer demand that would be sufficient to “pull” a healthy food supply through the distribution channels.”  In other words, given our present situation, it seems that two out of three major forces are working  against a healthy food supply.

Problem #2: The cost of processed foods has been dropping, while the cost of fresh fruits and vegetables has been rising.

A 2010 article entitled “The Economics of Obesity” states that food prices have been steadily dropping over the past several decades.  “Since 1978, food prices have dropped 38% relative to the prices of other goods and services.”  Yet, since 1983, the price of fresh fruits and vegetables has increased by 190% and all fruit and vegetables by 144%.  During that same time, the price of fats and oils, sugars and sweets, and carbonated beverages, increased at much lower rates.  The bottom line: “high-calorie foods have become much cheaper than more healthful alternatives.”

Problems in our Food Supply have Health Consequences.

  • nearly 3 out of 4 Americans are not eating recommended amounts of fruits and vegetables
  • 2 out of 3 Americans are overweight or obese; 1 out of 3 is obese

Rising Rates of Obesity result in Rising Medical Rates.

Health insurance companies are faced with the challenge of rising medical costs associated with rising rates of obesity. For each obese policyholder, health insurance companies pay out roughly $1,400 more than they pay out for a normal weight policyholder in any given year.

What does a Health Insurance Company get out of the CSA wellness rebate?

By now it is probably quite obvious that they get yet another tool to fight rising medical costs associated with overweight and obesity.  You might think a CSA membership is similar to other wellness rebates, like fitness center memberships or an aerobics class. You would be wrong. The CSA wellness rebate offers two unique advantges: cues and commitment. If you’re feeling a little lazy (okay, right, none of us is lazy; let’s say “busy”), you can skip an aerobics class now and then.  It’s not as if your entire aerobics class is showing up at your house once a week.  But those CSA vegetables, well, they are showing up at your house once a week.  If you’re too “busy” to eat them this week, they’ll still be in your house next week–along with your next share of fresh vegetables.  Fresh vegetables in the house serve as “cues” to eat healthy.  The relationship the CSA member establishes with the grower reinforces the “commitment” to eating healthy.  The end result: policyholders improve their health and insurance companies save with reduced medical costs.

But the story does not end there.  These CSA wellness rebates boost local food systems and increase sustainable agricultural practices.  The very first CSA wellness rebates, in Madison, Wisconsin, resulted in a 450% increase (from 2,000 to 9,000) in the number of farm shares purchased from CSA growers during the first 5 years of the program.

Full disclosure: You may have discerned an overtly enthusiastic treatment of the subject matter in this blog.  I must confess, last summer I fell in with a pack of local farmers and food progressives.  I’ve enjoyed boxes of CSA vegetables and, as a result, lost a fair amount of objectivity when it comes to CSA shares.  From my vantage point, CSA wellness benefits offer the potential to promote health and sustainable farming . . . while giving consumers a little extra pull in shaping our national food supply.  Maybe policymakers will take note.




David Reedy April 5, 2013 at 6:23 am

Very interesting story. I wasn’t aware of the insurance companies rebates.

There is the added benefit to your friends and neighbors as you share excess distributions with them.

Mary Hall April 5, 2013 at 9:23 am

It sounds like you know the ins and outs of CSA membership.. .
Thanks for reading!

Jeff Sepesi April 5, 2013 at 4:33 pm

Interesting article. As a CSA member in Minnesota, I was wondering which other states besides Wisconsin have insurers promoting this idea?

On your Problem #1, are you saying that in the unlikely event that everyone started following USDA guidelines, there would not be enough vegetables to go around? Does this include a consideration of all supply types: fresh, frozen (almost as nutritious as fresh, although not as much fun) and canned?

Mary Hall April 7, 2013 at 6:44 pm

To answer your first question, Wisconsin, Minnesota, Iowa, and now, Maryland have insurers promoting this program. Maine Health, an integrated health system (in Maine) also offers a csa wellness rebate to its employees. Here’s the rundown of CSA wellness rebates that I am aware of:

Maine Health, just mentioned above

Health Tradition Health Plan – part of the Mayo Clinic Health System—in Wisconsin, Minnesota, and Iowa. A CSA wellness rebate is listed as one of five wellness rebates available to their subscribers (http://www.healthtradition.com/wp-content/uploads/2011/12/EatWellMoveMore-rebate-form-members-2013a.pdf)

According to Nicole Tichenor, in her February 6, 2013 article “From CSA to HMO,” (http://rodaleinstitute.org/2013/from-csa-to-hmo/) –The University of Maryland Extension and the Johns Hopkins Bloomberg School of Public Health are partnering on a project to begin this work in Maryland.

Finally, through the Fairshare CSA Coalition (www.csacoalition.org/our-work/csa-insurance-rebate/), the following insurers offer rebates in Wisonson
• Physicians Plus
• Unity Health
• Dean Health

Regarding your second question, yes—based on what the National Cancer Institute has stated, it appears that if we all simultaneously reached for the recommended daily amounts of fruits and vegees, many of us would come up short. I will look into your question on how the NCI views canned/frozen vs fresh vegetables. What struck me as interesting is how the lack of adequate amounts of fresh produce in the food supply would obviously affect the price of fresh produce (relative to the overabundant processed foods in the system) – making it difficult for many to eat healthy.

Thank you for your thoughtful questions!

Angela April 15, 2013 at 8:10 pm

Hi Mary! Super interesting post, in that it highlights the messed up relations between food industry/production, health care concerns/access and for-profit insurance. Good use of figures, too! It is really ironic that the benefits of CSAs/unprocessed foods have to be raised by insurance companies. And that’s just benefitting the more well-off people. In Detroit, people started urban farming, because they lacked the access to fresh fruit and veg entirely!

maillotfoot2013 June 1, 2013 at 2:55 am

This is really great, I think so,If you’re one of these fortunate individuals, you merely purchase a CSA membership from your local farmer

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