Agricultural health care issues remain in California

California farmworkers harvest food that is essential to good health. More than 90 percent of artichokes in the United States come from California. The same can be said of walnuts, plums, celery, garlic, berries, and many other fruits and vegetables. The state’s 76,400 farms had an income of $54 billion in 2014.

But a sizable percentage of those same workers are still struggling to get access to health services for themselves and their families. 

Seven out of ten agricultural workers came from another country, and 90 percent of them from Latin America. An estimated 60 to 70 percent are undocumented. Despite many obstacles, including immigration status, low income, and language and cultural barriers, 61% have found a way to get health care either through insurance or local health centers, according to the National Center for Farmworker Health. 

That still leaves almost four in 10 without regular care. 

Fear of deportation, or triggering official inquiries that might lead to family members being deported, looms large as a reason.  

Peter Lee, executive director of Covered California, recently said that the person’s “information will not be shared nor used by any agency that deals with migratory issues.”

But a recent Kaiser Family Foundation survey indicates that 38 percent of people are “worried” or “very worried” that they will call the authorities’ attention to themselves should they enroll in a health plan.

One example is “Antonio”, who asked to use a pseudonym. He and his wife and two daughters strawberries, a $2.5 billion-a-year industry in California, and other fruits and vegetables near Watsonville, Calif. 

They are from the southern Mexican state of Oaxaca and crossed the border with help of a smuggler six years ago.

The strawberry harvest runs from February through November, sometimes 10 hours a day, with short breaks.  They get $4 for a box which could be sold at a market for $48. 

It also means they are exposed to fertilizers and other chemicals all day, backs bent, unless they work at an organic farm.

“People start to get itches, pimples on the skin, because of the chemicals and the pesticides,” said Antonio. 

“We use Mexican medicines, we go to Mexican stores, or pharmacies and just explain what we are feeling,” said Antonio, explaining what they did after they felt ill. “That’s how we cure ourselves, or sometimes we stay without cure.” 

“The problem is ‘Agricultural Exceptionalism’. That prevents the growers from having to give them basic rights under the ‘National Labor Relations Act’, or even the ‘Fair Labor Standard’s Act’, they’re exempt,” said Ann López, director of the Center for Farmworker Families, a non-profit organization in the Salinas valley, dedicated to improve the lives of farmworker families.

“Then they die at age 49,” said López, referring to the life expectancy for farmworkers according to a California Research Bureau study in the late 1990s. 

María, another example, and another pseudonym, a farmworker for over 20 years, does have access to healthcare and uses it especially for her four kids. She is an American citizen, originally from the Mexican state of Michoacan, who lives at one of the 26 migrant labor camps across California.

She prefers to use the local community clinic only if really needed, even when their kids are enrolled into Medi-Cal.

“We don’t go to the doctor,” said María, “for us to pay for a doctor here is really expensive. When I take my kids I have to pay $120 just for an appointment.”

She recently had to take her six-year-old son to the hospital due to an emergency with one of his kidneys, and now they are waiting for the bill. The clinic was closed on Sundays, when the son was in deep pain.

Because she lives with her husband, who is also employed, they are not able to use Medi-Cal because “they say our income is too high,” she explained, “whatever we make in our jobs, will go to the hospital or clinic.”

María believes that it is difficult for farmworkers to obtain some sort of health insurance or because of the high risk of injury or illness for them. 

Documented and insured, some still don't use health services

It is the early afternoon on a Saturday and Rufino Jiménez, originally from Oaxaca, has just finished packing his minivan with whatever produce he did not sell at the Pleasanton farmers’ market. He will eat his lunch while driving 90 minutes to his next destination in the central valley, and then back to Santa María where he lives. A normal day for him.

He pays $17 a month for insurance he gets through his employer, but has no time for a break even if its a medical one.

“We work seven days a week. On Saturdays we come here (to Pleasanton), Sundays to Los Angeles,” said Jiménez, “sometimes like today, I can’t breathe because of allergies, but I don’t know any place to go here, or have no time to go to the doctor.”

Two blocks away from the farmer’s market there is a local clinic, one of 35 across Alameda County, that accepts low-income patients, with or without legal migratory status.

Options for low-income patients 

The HealthPAC (Health Program of Alameda County) serves people up to 200 percent of the poverty level.  It’s service population has been  reduced from 90,000 people to just over 33,000 due to the Affordable Care Act. Close to 40,000 of them were automatically enrolled into Medi-Cal, and about 10,000 were eligible for Covered California. 

The remainder are primarily undocumented individuals who are not eligible for Medi-Cal, Covered California or health insurance under the ACA. 

The clinics provide the same scope of services as Medi-Cal, including primary-care, specialty care, emergency and preventative services.

“Historically, going back to the 1980s, the county has had a strong commitment of always providing care to low-income residents regardless of immigration status,” said Danice Cook, HealthPAC Administrator for Alameda County Health Care Services Agency.

Cook believes the shift came when counties took over the responsibility to provide for health services, rather than the state. 

“State law does not require you to serve undocumented, but once Alameda county took over, similar to San Francisco, the board said ‘We are going to cover folks who cannot access or get health insurance otherwise regardless of their immigration status. It is our responsibility to cover residents in the county.’

“These are individuals that are going to continue to show up at our clinics and emergency rooms, and if you have a structured program that offers primary care and preventative care, individuals are less likely to show up at the ER,” explained Cook.

People automatically get enrolled in HealthPAC after they visit the clinic for the first time, and it only takes 30 minutes. The county also seeks enrollees by going to day labor centers and to organizations that work with the undocumented population.

HealthPac also visits schools.

“We are also reaching out to about 3,500 kids to let them know they are now eligible for Medi-Cal, and help them enroll,” said Cook. 

[This story was originally published by Alianza News.]

[Photo by Gerardo Fernández/Alianza News.]