This year, access to affordable health care is more important than ever amid the ongoing COVID-19 pandemic. While the Affordable Care Act (ACA), created by former president Barack Obama, has reduced some access disparities across various demographics, insurance gains made by Black and Latinx Americans have since stalled “and even eroded” since 2016. Latinx people face the highest disparity. A study of data collected from 2013 to 2018 shows 24.9% of Latinx adults uninsured in 2018 compared with 8.6% of white adults.

Latinx people facing an uninsured rate nearly three times that of their white peers is a national health concern. Several factors are responsible for creating this barrier, including ACA eligibility, cultural and language barriers, and a lack of understanding and support for Latinx adults –especially immigrants and migrant workers navigating health care.

The ACA is Not for Everyone

Suzanne Gladney, an immigration attorney and director of the Migrant Farmworkers Assistance (MFA) in Lafayette County, Missouri, has worked to help seasonal migrant farm workers and immigrants for 39 years. Gladney stressed that many immigrants – Latinx or otherwise – come from countries with more universal health care systems and many people arriving in America simply aren’t aware of or don’t understand how health care works. People are used to going to the doctor when they are sick or hurt and receiving care; they may not understand having to apply, pay monthly, and still pay costly medical bills after the fact.

While the ACA helped close gaps across Black, Hispanic, and white uninsured rates from 2013 to 2016, rates have risen slightly since, while Latinx adults specifically continue to report significantly higher uninsured rates than Black or white adults. Two major components of the ACA contribute to the disparity in access Latinx people face: Deferred Action For Childhood Arrivals (DACA) recipients and anyone below the federal poverty level are not eligible to apply. DACA recipients, commonly referred to as Dreamers, accounted for 649,070 U.S. residents as of December 2019 – each one ineligible for the most affordable and accessible health insurance in the country.

Even if a potential ACA applicant can afford it, Gladney said, if their tax return shows them below the federal poverty level, they are not eligible. Most farmworkers MFA works with are below that level and even those who aren’t may find it too expensive. Health care seems like an obvious priority but when there are more urgent bills such as housing and heating, finding insurance may be pushed aside for another day.

“The hard things in life are the things you always put off,” Gladney said. “There’s only so much time in the day.” She stressed that many families focus on direct needs like taking care of the house and family and putting food on the table. The ACA has a Spanish speaking help line potential applicants can call to ask questions, but according to Gladney, many people end up on hold for the entirety of their short and infrequent work breaks. And if the places available to help navigate the process are only open during the workday, it’s easy to give up. “Those simple things make people feel like, when am I supposed to do this?”

Cultural and Language Barriers

People born and raised in America learn and understand that one has to apply and pay for health insurance, but many don’t fully comprehend how it works. Gladney pointed out that if even patients and providers who were raised in the American health care system don’t understand it, how are people who don’t speak the language supposed to? “There’s so many barriers to it and it’s so complicated – it’s something that’s really hard for people to understand.”

Andy Roman, a Dreamer residing in the Kansas City area, said that many people coming to America to better their lives are so focused on financially stabilizing their family that they don’t realize they need to put themselves and their health first, especially those working in labor jobs. However, he added, they may not know why they need to apply for health insurance, how and where they can, and who to go to for questions or help without someone offering that support along the way.

Roman said the fear that one ailment or illness could potentially bankrupt the family prevents uninsured Latinx people from seeking health care. “The Latinx community is so afraid of losing their position financially, especially now in this time of a pandemic. A lot of people keep to themselves to figure it out and if they can’t, they may turn to religion and say, it’s my turn to go. That to me is terrifying.” Roman believes the lack of education and advocacy for Latinx people navigating health care has cost lives and is the starting point for change. “A lot of lives have been lost because we haven’t educated certain groups of people on what they should be able to do or need to be able to do themselves.”

Advocacy is Necessary

Gladney believes another way to improve support for Latinx people in health care is for providers to invest in advocacy-focused staff positions. Organizations such as MFA and clinics like the Health Care Collaborative (HCC) of Rural Missouri and its Live Well clinics have Community Health Workers (CHW) and similar advocacy positions whose purpose is to help patients access and afford care that meets their needs. CHWs often help patients apply for ACA, Medicaid, and food stamps, and help with lengthy and difficult application processes. In schools, CHWs may notice a child experiencing repeated health issues and request a check in to ensure a pathway to care if something is wrong.

According to Gladney, MFA takes advocacy one step further – a member attends patient appointments to interpret, during migrant season they will pick up prescribed medications and deliver them to labor camps, and they will continue to connect with patients to see how their treatment is working and relay any issues or concerns back to the health care provider. Many migrant workers aren’t able to use phones, either due to a lack of cell towers at labor camps or because they don’t have a U.S. phone number, and don’t have transportation – having providers come to them allows more opportunities for MFA workers to spot health issues that need attention. Health clinic staff come to labor camps to perform basic blood pressure, glucose, and vision screenings as well as offer COVID-19 tests this year.

Gladney suggests that CHW and similar advocates in the field keep an eye out for patients who qualify for ACA, Medicaid, or other insurance and help as many people apply for insurance as possible. She also hopes to see a change in the current system for billing insurance across states as many migrants have Medicaid for their kids in another state and are only in Missouri for a month. However, applying locally and then reapplying in their permanent state later takes extra time and money. Gladney suggests a system where Medicaid is able to be billed by other states rather than have a separate process. She holds the same view of ACA which gives three choices for insurance companies, meaning if someone moves they may have to change insurance providers.

“There are so many barriers in health insurance, especially for immigrants,” Gladney said. “It’s not just that process, it’s everything about our societal system. Most people who have lived here their whole lives and always had some sort of coverage just don’t realize how many there are, because it’s never been a barrier for them.” Gladney urges people to consider that everyone is better off if people are well.  “This isn’t a charity issue, this is a justice issue,” Gladney said. “Everybody has a right to health care.”

MFA offers a holistic program for migrant and seasonal farm workers and their families who live and work in Lafayette County. It assists with a variety of legal services, immigration cases, and are involved with several programs in the Wellington, Lexington, and Santa Fe school districts. Other resources include food distribution and donations of cleaning supplies, masks and other COVID-19 safety materials, clothing, and school supplies. For more information, visit http://www.migrantfarmworkersaf.org/. Farm workers living and working in Lafayette County can call 816.968.2227.