By Lisa Morehouse
California may lead the nation in numbers of people signed up for health insurance under the Affordable Care Act, but there are still millions in the state without health insurance.
Some of the people most likely to remain uninsured are undocumented Californians. While they can buy health insurance with their own money, they are specifically excluded from receiving any benefits under the ACA. Community groups and non-profits in cities and towns across California work to fill in the gaps.
One of them is Graton, a small town in Sonoma County, about 20 miles west of Santa Rosa.
When I arrive at the Graton Day Labor Center a woman named Maria is standing behind a table filled with containers of homemade food. There’s oatmeal -- with no added sugar, she tells me -- tortillas and salsa, fish for tacos, and salad.
Maria (because of her immigration status, we are not using her last name) is selling the food to laborers heading out to work for the day in agriculture, construction and hospitality. They’re all members of the Day Labor Center which connects its members with employers and also does training and advocacy work. Maria makes nutritious food to try to keep her customers healthy. She clearly cares about good health, but she does not have health insurance.
Speaking in Spanish, she first jokes, “I don’t have insurance because I don’t get sick!”
Then she explains the real reason. “It’s because they won’t accept me because I don’t have social security,” she says in reference to a Social Security number.
Maria is undocumented, so she can’t qualify for expanded Medi-Cal or sign up for Covered California.
“This new Obamacare hasn’t helped my situation at all,” she says.
When I ask what would happen if she got really sick, she laughs and holds up a little plastic container. “I’d pass a box around because I couldn’t afford it.”
She’s not alone. Up to a million undocumented immigrants in California are expected to remain uninsured after the ACA is fully implementation in 2019.
“That leaves a lot of low-wage workers without any health care coverage," says Jesus Guzman, an organizer with the Graton Day Labor Center. "That leaves a population very much vulnerable.”
Earlier this year, State Senator Ricardo Lara proposed a bill which would give undocumented Californians access to expanded Medi-Cal and a dedicated insurance exchange with subsidies available, funded by the state. But the bill is currently on hold in the Senate appropriations committee. Lara’s staff says they’ll be back with another proposal next year. Given that, Guzman says preventive care makes the most sense for the uninsured undocumented immigrants. Access to services and resources can be a challenge.
“What we can do here is serve as a conduit between some of those (health) organizations and the folks that need them.”
Graton Day Labor partners with community health centers and hosts a physician’s assistant once a week. They offer trainings in heart healthy practices, and provide job skill and safety education.
Because diabetes is a huge problem among Latinos, nutrition is another big push. Once a month, the Redwood Empire Food Bank drops off produce at the Graton Day Labor Center. Out of the back of a van, Morgan Smith unloads boxes heavy with lettuce, cabbage, cauliflower, oranges, apples, and sweet potatoes. He also brings special boxes for diabetics.
“This month the box has things like brown rice, dried black beans, high fiber cereal, canned tuna and canned chicken,” Smith says. “Healthy carbos, healthy fats, healthy proteins, about 25 pounds of shelf-stable food, which will hopefully help someone get through the month.”
Smith is also a registered nurse. He and a colleague set up tables in the center's parking lot. They give free diabetes screenings and share prevention information. Maria and her sisters get in line, and confer about their family health history. Maria holds out her finger for a blood sugar test.
Smith tells Maria her results are normal, and then lets her know about two clinics near where she lives if she has any health needs.
Inside the center, Maria’s sister, Flor, joins other members collecting produce. Like her sister, Flor is undocumented and uninsured. She says that if she got insurance tomorrow, she’d go to the doctor and get check-ups for the whole family. She knows well that preventive care only goes so far.
“A while back my husband was injured in an accident at work,” she explains. “And a bill came, oh my! He had only cut the tip of his finger off, and it cost $10,000.”
Flor says that eventually her husband’s employer paid the bill, but only because her husband had worked for him for so long. Otherwise, she says, she doesn’t know what they would have done.
Lisa Morehouse reported this story for the 2014 California Endowment Health Journalism Fellowship, a program of USC's Annenberg School for Journalism and Communication.