Serving The (Still) Uninsured

California leads the nation in Affordable Care Act enrollment, but there are still millions in the state without health insurance.  Some of the people most likely to remain uninsured are undocumented Californians.  They can buy private insurance, but they are specifically excluded from getting coverage through health care reform.  To learn more about this specific group of what’s called “the remaining uninsured” I decided to visit an organization in Sonoma County trying to fill some health care gaps.

When I arrive at the Graton Day Labor Center a woman named Maria is standing behind a table filled with containers of homemade food.  There’s oatmeal (with no added sugar, she tells me), tortillas and salsa and fish for tacos, and salad.

Maria is selling the food to laborers heading out to work for the day in agriculture, construction and hospitality.  They’re all members of the Day Labor Center which connects its members with employers and also does significant training and advocacy work.  Maria makes nutritious food to try to keep her customers healthy, but she herself does not have health insurance.

Speaking in Spanish, she first jokes, “I don’t have insurance because I don’t get sick!” Then she explains the real reason, “It’s because they won’t accept me because I don’t have social security.”

Maria is undocumented, and even though her kids have coverage through a special program, she can’t qualify for expanded MediCal or sign up for Covered California.

“This new Obamacare hasn’t helped my situation at all,” she says.

When I ask what would happen if she got really sick, she laughs and holds up a little plastic container.  “I’d pass a box around because I couldn’t afford it.” 

She’s not alone. Up to a million undocumented immigrants in California are expected to remain uninsured, regardless of health care reform.  Jesus Guzman, an organizer with the Graton Day Labor Center, explains,

“That leaves a lot of low-wage workers without any healthcare coverage. Certainly not through Obamacare, the ACA, and what’s usually the case not through their employer, and not through their own pockets.  That leaves a population very much vulnerable.”

Earlier this year, State Senator Ricardo Lara proposed a bill which would give undocumented Californians access to expanded Medi-Cal and a unique insurance exchange with state subsidies.  A program like that is expensive, though, and the bill is not expected to pass.  Lara’s staff says they’ll be back with another proposal next year.  Given that, Guzman says preventive care makes the most sense for uninsured people.  He says the organization knows that access to services and resources can be a challenge.

“What we can do here is serve as a conduit between some of  those organizations and the folks that need them.”

The organization partners with community health centers and hosts a physician’s assistant once a week.  They offer trainings in heart healthy practices, and provide job skill and safety education.  Because diabetes is a huge problem among Latinos, nutrition’s another big push.

That’s why, once a month, the Redwood Empire Food Bank drops off produce at the Graton Day Labor Center.  Out of the back of a van, Morgan Smith unloads boxes heavy with lettuce, cabbage, cauliflower, oranges, apples, and sweet potatoes.  He also brings special boxes for diabetics.

“This month the box has things like brown rice, dried black beans, high fiber cereal, a bunch of canned tuna and canned chicken,” Smith says. “Healthy carbos, healthy fats, healthy proteins, about twenty-five pounds of shelf-stable food, which will hopefully help someone  get through the month a little bit.”

Smith is also a registered nurse.  Smith is also a registered nurse.  He and a colleague set up tables in the Graton Day Labor Center Parking Lot and give free diabetes screenings and share prevention information.  Maria and her sisters get in line, and confer about their family health history as she holds out her finger

Smith tells Maria her results are normal, and then lets her know about two clinics near where she lives if she needs further care.

Inside the center, Maria’s sister Flor joins other members collecting produce.  Like her sister, she’s undocumented and uninsured. She says, if she got insurance tomorrow, she’d go to the doctor and get check-ups for the whole family. She knows full well that preventive care only goes so far.

“A while back my husband was injured in an accident at work,” she explains. “And a bill came, oh my! He had only cut the tip of his finger off and it cost $10,000.”

Flor says, eventually her husband’s employer paid the bill, but only because her husband had worked for him for so long. Otherwise, she says, she doesn’t know what they would have done.