Undocumented immigrants might have the least to lose if the Supreme Court's upcoming decision on the Patient Protection and Affordable Care Act dismantles a portion -- or all -- of the landmark health law.
While millions of state residents could earn health insurance through implementation of the federal law, it prevents undocumented immigrants from gaining health insurance through the expansion of Medi-Cal or from obtaining subsidized individual coverage in the newly created California Health Benefit Exchange.
If the law is implemented as written, an estimated nine out of 10 non-elderly state residents will gain insurance, according to a research brief from the UCLA Center for Health Policy Research and the UC Berkeley Labor Center. Meanwhile, roughly 50 percent of undocumented immigrants are expected to remain uninsured.
Enter the Project for Development of Private Health Insurance for Farmworkers, which is striving to create an innovative, private insurance product intended to fill that gap -- at least for the state's undocumented farmworkers.
The project -- a collaboration between growers, farm labor contractors, foundations, and community health centers -- would provide undocumented farmworkers with an affordable, practical, and accessible primary care and dental benefits package, according to policy consultant Arnold Torres.
Ultimately, the goal of the project is similar to that of the federal healthcare law: To provide affordable preventative care to people, in order to improve their long-term health and lower costs within the health care system.
"When you are undocumented in this country, you don't have much going for you except your work ethic," Torres said. "That work ethic should be worth so much more than what these workers are getting in return for it right now."
"If these workers are healthier, they are going to be better investments, and they are going to do their job easier, and be more productive. But their health is going to be better, so everybody wins."
To clarify: Not all undocumented immigrants are uninsured -- and some undocumented immigrants do stand to benefit from implementation of the Affordable Care Act.
"The undocumented are not synonymous with being uninsured," said Dylan Roby, director of the Health Economics and Evaluation Research Program at the UCLA Center for Health Policy Research.
Currently, an estimated one million of the state's approximately two million undocumented immigrants have some form of health insurance, possibly through their employers, a private insurance product, or programs that don't exclude people based on immigration status, like the Healthy Kids insurance program, according to Roby.
If the health reform law is fully implemented, undocumented immigrants could at least benefit from the law's consumer protections, if they choose to buy their own insurance outside the state Exchange.
Those protections guarantee that people's health insurance costs will be based not on their health status or pre-existing conditions, but on age, family size, tobacco use, and geographic location.
Also, if undocumented people are working for larger businesses -- either under falsified documents, with temporary visas, or because employers are turning blind eyes -- they could benefit from a mechanism in the law that requires employers with more than 50 employees to offer affordable health insurance coverage or pay a fee.
And if they are working for smaller businesses, their employers couple offer and pay for benefits through the state-based Small Business Health Options Program Exchanges.
"Certainly, the way the Affordable Care Act is structured, it will be harder for them to buy coverage than anyone else... but there are some added protections that the undocumented will benefit from," Roby said.
The undocumented would not be subject to the law's insurance mandate, which would take effect in 2014 and require all people to maintain health insurance, or pay a tax penalty.
Still, an estimated one million undocumented people in the state -- including many of the farmworkers who are essential to the state's agricultural industry, worth an estimated $37.5 billion -- will remain uninsured and with limited access to medical care.
Among farmworkers -- a majority of whom are poor and undocumented -- an estimated 70 percent lacked health insurance in 2000, according to a 2012 Central Coast Health Network policy brief.
"It is a very, very large disappointment that these very serious inequities were allowed to remain in the law," Torres said.
They are still working out the details, but Torres and representatives from community clinics that serve farmworkers -- including Clínica del Valle de Salinas, in Monterey County, and Clínicas del Camino Real, in Ventura County -- are working together to develop a benefits package for undocumented farmworkers that would include preventative care, offered in clinics and in the fields.
Agricultural employers would shoulder a portion of the cost of year-round coverage, and farmworkers would be expected to provide an affordable co-pay for medical visits.
Two pilot programs on the Central Coast are expected to launch within the first six months of 2013, and the programs should be in full operation by the summer of 2013, Torres said. A program for the San Joaquín Valley is also in the plans.
Guadalupe Sandoval, managing director for the California Farm Labor Contractor Association, questioned how employers would fund health insurance for temporary, seasonal workers. Still, he said, the program might help employers retain workers.
"I would assume the principle holds true for agricultural workers: If you put in your time, and are loyal to that employer, and are eligible for benefits, you probably wouldn't want to leave and lose your benefits, particularly if you have a family," Sandoval said.
Torres acknowledged that was just one of the challenges involved in providing farmworkers the health coverage they deserve.
Farmworkers, he said, "are absolutely vital to the economic interests of the state, but this workforce is not a priority for American society."
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