Supreme Court Upholds Health Care Reform, But Farmworkers Will Still Face Challenges in Access to Health Care

The Supreme Court’s decision upholding as constitutional most of the health system reform legislation, the Affordable Care Act (ACA), will enable millions of people to gain access to health care and to improve their health.  Unfortunately, many migrant and seasonal farmworkers – due to the nature of their agricultural work and rural communities – will face significant obstacles in taking advantage of the new law.  Farmworker Justice will work with community-based organizations, medical providers and government agencies to reduce those obstacles.  However, our broken immigration system will continue to interfere with health care access for hundreds of thousands of farmworkers and their children until Congress enacts immigration policy reform.

The Supreme Court’s Decision. Many provisions of the far-reaching ACA were not challenged.  The Supreme Court ruled that the ACA’s mandatory health insurance coverage, or “minimum coverage,” requirement is constitutional.  Most uninsured people will be required to either buy health insurance or pay a tax that will be collected by the IRS.  There will be tax credits, subsidies, health insurance exchanges and other mechanisms to achieve this goal.  For those people who are poor or just above the poverty level, the ACA provides for expanded Medicaid coverage.  The Court found a constitutional problem with the way the law created financial pressure on states to expand Medicaid coverage.  Congress, the Administration and the states must address Medicaid funding.

Farmworkers and the ACA. Harvesting fruits and vegetables and tending livestock subject workers to numerous occupational health risks, from dangerous machinery to pesticide exposure, from repetitive hand movements to intense heat.   While a mostly young population, farmworkers often face heightened risks of illness due to crowded and unsanitary housing and unsafe transportation.  Wages are very low and few farmworkers receive paid sick leave or other fringe benefits.  Most farmworkers do not have health insurance and face geographic, financial, language and other barriers to obtaining health care.  Figuring out our health system and taking off time from work to visit the doctor are very difficult for many farmworkers.  Government-funded community and migrant health centers address the special needs of farmworkers and do so at low cost, but reach fewer than 20% of farmworkers.

The ACA will positively impact farmworker health through Medicaid expansion (whose funding will depend partly on the response to the Court’s decision), the Small Business Health Options Program (SHOP), and dedicated funding for community and migrant health centers, enabling them to expand services and double their capacity by 2015.  Unfortunately, many farmworkers and their family members will not be eligible for the subsidized health insurance exchanges or for Medicaid because they lack authorized immigration status.  Farmworkers perform a vital role in our economy and deserve health care; their lack of health insurance coverage defeats the purposes of the law, which includes making health insurance affordable and available to everyone.  However, for there to be a real solution to the lack of healthcare for farmworkers, we must reform our immigration laws and give undocumented farmworkers the opportunity to earn legal immigration status.  We must also support farmworkers in their quest to improve their wages and working conditions and to obtain employment benefits, including employer-provided health insurance.

Farmworker Justice will continue to advocate for improved health care access, work with medical providers to assure high-quality medical care, and educate farmworker organizations about the new health law’s programs.