What does health care coverage look like for the average California farmworker? Rather bleak. According to health care consultant Joel Diringer, JD, MPH, approximately half of California’s 650,000 farmworkers have no health care coverage. The other half receives seasonal coverage from their employer for a few months of the year and/or relies on Medi-Cal / Covered California eligibility.
Diringer spoke at the February WCAHS seminar series on the challenges of health care reform, especially now with Congress proposing to eliminate the Affordable Care Act (ACA) this year. Part of this challenge is that almost all of California’s farmworkers are foreign born (primarily from Mexico), and approximately 56% do not have work authorization.
Unauthorized farmworkers are not eligible for Covered California or Medi-Cal and county indigent health programs provide them with only minimal services. Of those Western US farmworkers that seek medical care, 27% go to clinics, 48% go to private providers, and 1% go to the emergency room (2012 National Agricultural Worker Survey, data for Western US farmworkers).
Under the ACA, large agricultural employers with 50 or more workers are required to offer their full time employees health coverage, although this does not apply for short-term work (6 months or less), which many farmworkers do as they follow seasonal crops. In addition, with the average California farmworker family income being $20,000 - $25,000, many farmworkers find employer health care plans prohibitive due to high co-pays, premiums and deductibles.
An ACA repeal could potentially eliminate the large employer mandate of providing employee health insurance, funding subsidies through Covered California, Medi-Cal expansion, and any increases in Medi-Cal funding.
In the future, solutions for farmworker health care and coverage may be at the state and local level. For example, states could re-establish or increase funding for preventative and primary health services at farmworker clinics, maintain or expand worker safety protection, and allow more flexibility to health care policies.
At the local level, some very large growers, such as the berry grower Reiter Affiliated Companies, have been able to successfully offer low cost, affordable medical clinic services to their employees for just a few dollars a month. In a period of labor shortage La Clínica Fresalud gives Reiter Affiliated employees an incentive to stay. Currently there is a movement in Monterey County to develop year-round health care for farmworkers by having employers pay for health insurance while the farmworkers are seasonally employed, with the county covering the off-season for those that do not qualify for Medi-Cal or Covered California.
Without a doubt, health care coverage will continue to be a complicated challenge for all, but opportunities exist to better understanding employer farmworker coverage, new and flexible approaches to health care, implications of farmworkers not having health care coverage, and models of migrant health centers.