Indigenous Undocumented Farmworkers Left Out of Health Care Reform

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For a Spanish translation of this article, click here

OXNARD, Calif. – In the two summers teenager Rodrigo Perea worked in the lush strawberry fields of Oxnard to supplement his family income, he more than once experienced what scores of farmworkers do from working long hours in the scorching sun: nausea, dizziness and fainting spells.

When he came to after one such spell, the foreman told the youngster -- 15 years old at the time -- to go rest under the shade of a nearby tree for a while and then return to his job.

“I was feeling so bad, I wanted to throw up,” the Oaxacan native, now almost 18, just over 5 feet tall and a junior at Rio Mesa High said on a recent day. “But I went back to work in a few minutes because I needed the money.”

Indigenous farmworkers in the United States – who range from 17 to 25 percent of all farmworkers -- have higher rates of acute illnesses, chronic diseases and injuries compared with the general population, due largely to the demands of their jobs and dismal living conditions. Yet, too few receive health care.

Of the estimated 650,000 farmworkers in California, about 75 percent of them don’t have health insurance, and few are eligible for federally funded public health care programs because of their undocumented status, according to Don Villarejo, who has researched and written about the state's farmworker population for many years and is founder of the California Institute for Rural Studies.

Even so, as the nation prepares to roll out full implementation of the landmark Affordable Care Act (ACA) on Jan. 1, 2014, this population with some of the most serious health problems will be left out.

“Farmworkers are screwed under ACA,” asserted Cesar Hernandez, director of corporate social responsibility at the headquarters here of Reiter Affiliated Companies, growers of Driscoll’s Berries. “This population has been completely ignored by the ACA.”

Injuries unique to farmworkers

While farmworkers feed the nation, they are mostly invisible to Americans.

University of Pennsylvania anthropology professor and author Philippe Bourgois observes: Few people in the United States know “that the delicious, health-giving fruit they worthily devour is produced cheaply by literally breaking the backs, knees, hips …of Latino farmworkers.”

Barbara Hollinger, a professor at UCSF School of Nursing, who previously worked for 10 years in a county-run clinic for farmworkers in Firebaugh in California’s Central Valley, said farmworkers have high rates of musculoskeletal disorders from standing for hours on end on ladders to harvest produce, or from bending over hoes to weed and prune.

Chronic diseases tend to develop earlier among them, partly because they don’t eat nutritious food, she said.

“If you’re working in 110 degree temperature, you can’t bring a packed lunch with you,” Hollinger said. “So you are at the mercy of food trucks.”

She said “diabetes is a huge, huge issue among them” exacerbated by obesity and stress, as well as a genetic predisposition to the disease.

Even though the state is home to a $26 billion agricultural industry, very few farmers here provide their workers with health insurance. Few observe state heat laws that were enacted in 2005 -- according to Cal/OSHA data, a quarter of employers inspected in 2011 did not obey the laws.

“There are a lot of employers who do not recognize the rights of farmworkers,” asserted Michael Marsh, directing attorney in the Salinas office of California Rural Legal Assistance (CRLA).

Undocumented and powerless

A “substantial majority” of California’s farmworkers are undocumented, according to Marc Grossman, a spokesman for the United Farm Workers (UFW) of America.

In Ventura County, where Oxnard is located, there are an estimated 25,000 farmworkers, the majority of them undocumented, noted Lauro Barajas, regional director in the Oxnard office of UFW. Some farms hire them on the strength of the documents they submit, as long as those documents look reasonably authentic,” said Rob Roy, president of the Ventura County Agricultural Association.

Undocumented workers’ fear of deportation deprives them of bargaining power with their employers and inhibits them from challenging illegal employment practices. That same fear keeps many of them from going to health care facilities when they are sick.

“There is a pervasive fear among them of getting caught,” Grossman said. “The last thing they want to do is show up at a health facility and announce who they are.”

Alberta Lopez de Salazar, who spent the first few years of her life in the U.S. as an undocumented farmworker in California, recalled a conversation she had with a supervisor nearly two decades ago as she and other farmworkers were forced to pick berries for 10 hours in pouring rain. When she asked him if she could go home and change, he threatened to suspend her from work for three days if she did so. And then, she said, he taunted her with the remark, “You are from Oaxaca, and this is how you work.”

Conditions haven’t improved much since then, Lopez said.

She said that in the early years, she and many other undocumented female farmworkers were not even aware that they were entitled to pre-natal care under Medi-Cal, the federal and state-funded health insurance program for low-income people. She said they were told by other farmworkers that if they accepted that health care benefit, “the state would take away our children and train them to be soldiers.” Now, as a community health educator – or promotora -- with the Mixteco Indigena Community Organizing Project in Oxnard, she works hard to dispel that and other myths, she said.

Nearly half of the indigenous Mexican farmworkers in California live in the central coast region from Oxnard to Watsonville, and speak about 23 different indigenous languages, many of them very different from Spanish.

Salinas Valley farm worker Manuel Garcia said in his native Triqui through an interpreter that whenever he complained to his supervisor that he could smell chemicals while harvesting green beans, the supervisor would tell him not to worry, that they were spraying “medicine” on the plants to make them grow better.

He said that even though his eyes frequently burned from the spraying, he didn’t go to the nearby community clinic because he couldn’t afford the $30 co-pay. Additionally, no one there spoke his language.

“As difficult as it is for Spanish-speaking people to discuss their health issues, the problem is even worse for non-Spanish (speaking) people,” UFW’s Grossman said.

Doing “the right thing”

A few California farms have responded to hired farmworkers’ health care needs by providing company-funded medical clinics for their employees. The Western Growers Assurance Trust opened the Cedar Health and Wellness Center in Salinas two years ago. It serves up to 80 patients a day, charging patients $5 per visit for bilingual, confidential health care.

The handful of Ventura County farms that contract with UFW are entitled to such benefits as health insurance, paid family leave, paid holidays and sick days, and rest periods while on the job, said Grossman.

Reiter Affiliated Companies funds three low-cost clinics for its employees and their families in Oxnard, Santa Maria and Watsonville.

Additionally, the company offers its workers medical, dental and vision benefits, said Hernandez. Currently, it offers a family PPO, dental and vision plan for $39 a week. The plan does have a $25,000 benefit cap per incident. (Under Obamacare, insurers will be prohibited from having caps.)

“We want to do the right thing by our employees,” Hernandez said. “Our people are our people.”

But even with the premiums being “pretty affordable,” Hernandez said, only half the workforce participates in the insurance plans. And only about 60 percent of the employees take advantage of Reiter’s low-cost clinics.

In most farms though, workers don’t have sick days. They lose wages if they take time off to see a doctor. The desire to put food on the table trumps their need to see a doctor.

Rise in premiums could force end to health coverage

Hernandez worries that come Jan. 1, 2014, when Obamacare is fully implemented and insurers raise their premiums – something that is happening already -- Reiter might be forced to tell their seasonal workers that they will no longer be able to cover them, and that they could buy their insurance on Covered California, the health insurance marketplace exchange. He is hoping it will not come to that, he said.

But if it did, most of their farmworkers “will either ride out their illness, go to the ER, seek out traditional healers or make trips to Mexicali or Tijuana,” Hernandez said.

Farmworker advocacy groups are also anxiously following the immigration reform discussions currently under way in Washington. As things stand now under the Senate bill, undocumented farm laborers might have to wait about 10 years before they can become citizens and access federal health care programs.

From his home in Oxnard, young Rodrigo Perea is among those following the immigration reform debate. He himself has received a renewable two-year deportation reprieve under the Deferred Action for Childhood Arrivals (DACA) program last year, allowing him to work anywhere he likes, as well as access health care benefits through state-funded Medi-Cal.

He said he can’t wait for the day when his parents and Oaxaca-born sister get on the path to U.S. citizenship. But equally important, he said, is for them to have access to affordable health care.

“I have seen my father suffer without it,” Perea said.

Correction: This story was updated on June 26. The story incorrectly stated that the percentage of indigenous farmworkers nationwide was 90. According to researchers, it is between 17 and 25 percent. Estimates of the number of farmworkers in California was revised to 650,000.