Health & Occupational Safety

Monday, 08 May 2017

On April 13, the Centers for Medicare and Medicaid Services (CMS) released a final rule regarding market stabilization within the health insurance marketplace.[i] The rule makes several changes to current ACA provisions, including open enrollment, Special Enrollment Periods, and guaranteed availability, among others. It is likely that these changes will make access to health insurance more difficult for eligible farmworkers and their families.

Perhaps one of the most significant changes made in the rule is the shorter timeframe for open enrollment 2018. Like past open enrollment periods, this year’s open enrollment period was supposed to be from November 1st, 2017 to January 31st, 2018. Now, open enrollment 2018 will end six weeks sooner on Dec. 15th. Farmworkers, especially those who are limited English proficient or lack familiarity with the U.S. health care system, rely on in-person assistance to successfully enroll in health insurance through the marketplace. Farmworker enrollment efforts are often more time-intensive, requiring several appointments pre- and post-enrollment. Assuming that there are no changes in navigator funding, it will be critical that outreach and enrollment programs in farmworker communities are prepared to provide the same level of assistance within a shorter timeframe.

The rule also re-interprets the ACA’s guaranteed availability provision. Insurers are required to accept all consumers who enrolled, regardless of past payment history. Now, under the rule, insurers can penalize new consumers who re-enroll in health insurance and have premium debt from the last 12 months.[ii] Farmworkers who migrate or lack access to postal services may inadvertently miss a premium payment. Some farmworkers will need assistance to make timely monthly premium payments in order to avoid any future penalty.

Lastly, the rule made several changes to eligibility and enrollment during special enrollment periods (SEPs). Beginning in June, 100% pre-enrollment verification will be required for enrollment outside of the open enrollment period due to a permanent move, loss of minimum essential coverage, or Medicaid/CHIP denial. Enrollment will be pended until the verification process is complete, which involves submitting supporting documents to the marketplace (either online or by mail) within 30 days. This presents an enormous challenge to farmworkers, especially migratory workers and workers in the U.S. on H-2A temporary work visas, who may not have access to documents like leases or utility bills, or may not live in places where these documents are in their name. Fortunately, CMS recognized that not all consumers will be able to fulfill the verification requirements. CMS will implement “reasonable flexibility” that will allow individuals to send a letter about their situation if they are not able to provide sufficient supporting documentation. This may be an important tool for farmworker consumers who are unable to provide supporting documentation regarding their SEP eligibility.

Farmworkers and their families, given the risky and low-paying nature of farm work, need affordable and accessible healthcare options. The final CMS rule presents a new set of obstacles for farmworkers to obtain affordable health insurance. Assisters in farmworker communities will need to develop strategies to overcome these obstacles and maintain access to health insurance for eligible farmworkers and their families. FJ will continue to provide timely information around issues that affect farmworker access to health insurance.

 

[i] You can find the final rule at https://www.gpo.gov/fdsys/pkg/FR-2017-04-18/pdf/2017-07712.pdf.

[ii] The penalty would be added to their monthly premium and would only apply to consumers who are applying for health insurance with the same issuer or an issuer in the same control group.

by Virginia Ruiz
(0 total comments)
Tuesday, 28 March 2017

Day 5 of National Farmworker Awareness Week focuses on farmworker health.  Farmworker Justice has been working to protect  farmworkers' access to health care through close monitoring of the Affordable Care Act (ACA) and the impacts any changes would have for farmworkers. 

Current efforts to replace the Affordable Care Act threaten to roll back important gains in health insurance coverage achieved for farmworkers and their families. By increasing costs for young, rural, low-income individuals, the failed American Health Care Act (AHCA) would have substantially reduced access to health insurance for farmworkers and their families.

The AHCA’s provisions, including eliminating the employer mandate, modifying the eligibility for tax credits, ending Medicaid expansion, and modifying the structure of Medicaid, would have left many farmworkers with higher costs and fewer options for health insurance. Lawfully present farmworkers, especially H-2A workers, would have lost their access to affordable health insurance due to the bill’s proposed changes in immigrant eligibility for tax credits. The AHCA proposed restricting eligibility for tax credits to individuals who met the “qualified alien” definition under the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA).

The ACA has provided farmworkers and their families a level of access to health insurance coverage that was previously unattainable.  While the ACA can be improved, efforts to eliminate provisions such as income-based subsidies, immigrant eligibility, Essential Health Benefits, and Medicaid expansion, will only impede access to health care to farmworker families. Farmworkers need greater, not reduced access to affordable health care.

by Matt Clark
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Friday, 18 November 2016

Yesterday, 6 ½ years after proposing rules to update protections for workers from slip, trip, and fall hazards, OSHA issued a final fall-protection regulation that excludes workers on farms, ranches and dairies. Farmworker Justice is extremely disappointed that the final rule excludes agriculture from these important safeguards.
Worker injuries and deaths related to falls in agriculture are among the highest in all industries. OSHA’s explanation of the regulation repeatedly refers to the submission by Farmworker Justice as well as other worker advocates of extensive evidence to show the prevalence of falls in agriculture and that these injuries are easily preventable.

OSHA declined to include agricultural operations in the final rule, stating that the agency has not gathered and analyzed data and information necessary to support a rule. The agency had ample time – years -- to study farmworkers’ injuries and deaths resulting from falls from ladders and machinery and other hazards.
The agency did attempt to narrowly define what is covered under the agriculture exemption, stating that “if an operation performed on a farm is not an “agricultural operation” or integrally related to an agricultural operation, such as a food manufacturing or other post-harvesting operations, then the final general industry rule applies.”
Farmworker Justice will continue to help farmworkers advocate to end the history of discrimination in occupational safety standards and improve occupational safety and health in their workplaces. The full text of OSHA’s standard on “Walking-Working Surfaces and Personal Protective Equipment (Fall Protection Systems)” is available here. The comments submitted by Farmworker Justice are here

by Virginia Ruiz
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