Health Care Reform and Farmworkers
Will health care reform reach farmworkers? Not likely
Thursday, 15 October 2009 12:44
Newsletters - Fall 2009 Newsletter
Congress began debating health care reform as this newsletter was being finalized. The outcomes were not predictable, but one thing is clear: most farmworkers would not experience any progress from the legislation most likely to pass.Despite facing disproportionate health risks due to the dangers of their jobs and the consequences of poverty, most agricultural workers do not have health insurance because their employers do not provide it and they cannot afford to purchase it on their own. Federally-funded migrant health centers only reach about one-quarter of farmworkers. Medicaid does not serve unauthorized immigrants (except in dire emergencies), and the majority of farmworkers are undocumented.
Farmworkers need and deserve health care reform. The nation needs to provide better medical care at lower cost and provide incentives for preventive care. And poor people should not be forced to delay medical treatment until they experience an emergency, when the health consequences and medical costs are most severe.
The biggest obstacle for farmworkers is the unwillingness of Congress to confront our broken immigration system. A majority of farmworkers are undocumented. The health reform proposals will deny almost all unauthorized immigrants access to health care unless they are financially well-off.
The major proposals would expand Medicaid coverage to individuals and families who are considered poor but are somewhat above the official poverty line. Undocumented workers are not eligible for Medicaid (although medical providers are reimbursed for their emergency medical treatment). Children born in the United States to undocumented parents are eligible.
The major proposals also would subsidize (through tax credits or other mechanisms) low- and moderate-income people to afford insurance, but would exclude undocumented workers. Depending on the proposal, individuals may be required to purchase health insurance if their employer does not provide it. There would be an "exchange" or other mechanism to create a "marketplace" of insurance policies for small employers and for individuals and families whose employers don't provide insurance. Such a marketplace may or may not include a low-cost public option. If required to buy health insurance on their own, undocumented farmworkers will not likely be able to afford it. We believe a public option is needed to try to address farmworkers' particular needs for health care, which generally have not been addressed adequately by companies in the private market.
There are obstacles for authorized immigrants and U.S. citizens. The major proposals would encourage or require employers to provide health insurance, but would exempt "small employers" (generally, those employing 25 employees or less) from requirements. They would allow employers to exclude "seasonal" workers from the count of employees with the result that many large companies would be considered "small" employers. Farmworker Justice and its allies successfully objected to an effort to specifically exclude seasonal agricultural workers from the count of employees; the proposals now refer to seasonal employees who work less than 140 days per year, regardless of occupation.
Generally, under the proposed new system, insurance policies will be regulated in ways that reduce obstacles to obtaining health insurance for many employers as well as individuals and families. Some farmworkers - U.S. citizens and legal immigrants - will continue to be eligible for Medicaid and some who earn higher incomes may be more likely to obtain health insurance coverage. Unfortunately, many farmworkers will be left out of the system for a number of reasons and consequently may face even greater obstacles to finding health care.
Note: Facebook users are encouraged to join the group Undocumented Workers Deserve Health Care Reform.
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