Why are insurance enrollment numbers low for farmworkers and their families?

Under the Affordable Care Act, many farmworkers and their families could benefit from health insurance offered in their state’s marketplace. The plans will cover a range of services from preventative care to ER visits to maternity care. If eligible, they will likely qualify for subsidies to reduce the cost of health insurance premiums and co-pays. Yet few farmworkers are enrolling in the marketplaces. Generally, enrollment numbers for Latinos are low. Covered California, the state marketplace for California, reported that fewer than 1,000 Latinos enrolled in coverage during October. There are several reasons for these low enrollment numbers. Both in the state- and federal-run marketplaces, Latinos are finding it difficult to access information and apply for health insurance. Additionally, many immigrant families are reluctant to reveal the immigration status of family members when applying for insurance coverage.

71% of farmworkers speak Spanish as their dominant language. Spanish speakers are encountering numerous challenges to enrollment. Spanish language websites for both federal and state marketplaces have been slow in implementing online enrollment tools, and some are still not fully operational. And in California, a state where 32.8% of the population is Latino, the paper application is not yet available in Spanish. Furthermore, some states have placed burdensome requirements on navigators - individuals who are trained and certified to help people in the community find insurance plans. Such laws have discouraged some community-based organizations from assisting with outreach and enrollment efforts. There are several ways to apply for health insurance – by phone, online, on paper, or in person with the help of a navigator or application assister. While many Spanish speakers may be more comfortable applying for health insurance in person, all of these options should be available to them.

For immigrant families, barriers to enrollment go beyond issues related to access. In focus groups that we conducted with farmworkers over the summer, many had concerns about sharing sensitive information required for enrollment. Among the top concerns is that information about immigration status could be used to find and deport undocumented family members. On October 25, Immigration and Customs Enforcement (ICE) issued a memo stating that information included in the marketplace application will not be used for immigration law enforcement purposes. Despite these assurances from ICE, fear and misinformation remain. Some navigators have told individuals that they should be careful because their information can be shared with immigration enforcement authorities. One-third of U.S. citizen children of immigrants live in “mixed-status families,” households that include members with a different immigration status. In farmworker communities, 24% of farmworker families are mixed-status. Reassurances for mixed-status families are crucial to boost Latino and farmworker enrollment.

Over the next several months, marketplace websites will continue to improve and more options will be available for the enrollment of Spanish-speakers. We are hopeful that with more options, farmworker communities will see improved access to affordable and preventative healthcare.