Stories reveal how health care remains a distant dream for many undocumented Latinos
“Una de cal, otra de arena.” — Loosely translates as “One step forward, one step back.”
Statistics suggest that Hispanics are increasingly getting access to health services, or at least health insurance, but still not enough. But cultural and income barriers continue to be key factors that prevent this community from accessing health services and health insurance.
The state and federal government has taken steps, at least until now, to bring down these barriers, at least in California. Legislative achievements, such as the Medicaid expansion and opening the ACA to undocumented people, have been essential in solving these problems of access to care.
Writing stories on these issues posed some interesting and challenging problems, not least of which was how to best match statistics and personal stories.
Gathering numbers is difficult, especially when trying to assess improvements and needs among a dynamic population in flux.
Talking to people is one of the main reasons I work on these stories — to go to their workplaces, their homes, or meet them out on the street; to learn about their culture, habits, their past, obstacles and how they attempt to overcome them, what brought them here, and so on.
The 61 percent
One example: 61 percent of farmworkers have some sort of access to health care coverage, services, or health insurance. That is a high number, and without further analysis, it might suggest that California has partly solved this decades-old problem of providing farmworkers with decent health coverage.
María (a pseudonym), a farmworker with 21 years of experience in the state, has access to health plans, clinics, and hospitals, but using these services is really difficult for her and her family. Her children have access to Medi-Cal, California’s Medicaid program.
They prefer use the local clinic near the Watsonville area where they live.
“We don’t go to the doctor,” said María. “For us to pay for a doctor here is really expensive. When I take my kids I have to pay $120 just for an appointment.”
This clinic her family uses started closing on Sundays. One Saturday night, one of her three sons had a sharp pain and had to go to the local hospital. They are anxiously awaiting the hospital bill.
Rufino Jiménez is another example of the 61 percent who does not use medical services. He is a legal resident, originally from the Mexican state of Oaxaca, and pays $17 a month for health insurance he receives through his employer.
He does not have time to go see a doctor. He does not even have time to stop and eat his lunch.
I talked to him after he finished packing up his employer’s minivan with the produce he did not sell at the Pleasanton’s farmers market. It’s early afternoon on a Saturday and we talk while waiting in line to buy his lunch at a local restaurant. He will have his burrito while driving 90 minutes east and south into the Central Valley to the next farmers market, and later he will drive to his home near Santa María.
The next day, on a Sunday, he will pick up more produce and head to Los Angeles.
“We work seven days a week, and have no time to stop,” said Jiménez.
He said he has trouble breathing because of allergies, like many farmworkers, but does not have time to see a doctor, or does not even know where to see one. I told him about Axis, a low-income community health clinic, located two short blocks from where we are standing.
He did not even consider learning more about it.
Nine out of 10 patients at this and other low-income clinics in Alameda County are Hispanics. The programs that fund these clinics have changed drastically since the implementation of the Affordable Care Act three years ago, and have seen their population drop from about 90,000 to 30,000. The majority of such patients have been enrolled into Medi-Cal, or entered the private health insurance market through the ACA.
The farmworker issue is more troubling than expected, and California’s agriculture, the strongest in this country, depends largely on these workers.
Jiménez and María have access to health care, to clinics, and to decent housing.
There are many more, however, like the family I met from Oaxaca, who have more difficult situations. Access to health care for them is extremely limited.
They visit Mexican stores and try to find “medicine” that someone told them would work for whatever problem they have. On occasions, a minivan shows up in their community to offer dental and other health services, similar to what they might find at Mexican consulate events.
The family’s situation in Mexico was one of extreme poverty, and their ethnic group had difficulty finding jobs in the neighboring towns because of language and cultural barriers. After struggling, they moved north to the state of Sonora, where they made enough money to pay for a coyote, and eventually crossed the desert for three days and nights. Once in Arizona, they were “shipped” in a minivan to their current destination, near Watsonville.
They struggled for many months to find work, and are now slowly settling and finding their way around while they contribute to the agricultural economy of the area.
I talked to many more people who share similar stories. They are part of the 61 percent; they are enrolled into Obamacare, Medicaid, or have access to local clinics, but still have difficulties meeting their health needs.
Pedro Enriquez, a 50 year-old man from Mexico, considers traveling to Mexico for his dental care, despite having many affordable options in the area. His niece, a nurse, told him to enroll into Covered California. He did, but lost coverage after forgetting to pay a monthly bill.
We have a saying that is often invoked, and that explains a huge part of our culture, “Once the child has drowned, the well is covered.”
“We tend to act when it is too late. We come here from Mexico, or other countries, to work — that is our goal, so we forget about things like paying attention to our health. We think those issues will disappear, will go away,” said Enriquez.
He added, “We are shy to ask for help.”
Veronica Meza is a schoolteacher in Mountain View and runs a theater company she founded 14 years ago. She’s a journalist herself, and someone I have collaborated and worked with for almost a decade. Her parents have lived in Los Angeles since the 1990s, and still prefer to travel to Ensenada, in Baja California, for their medical and dental needs.
The Medicaid expansion that is benefitting thousands of undocumented children in the state is definitely helping to achieve a broader switch in the culture. Most of us come from Latin American countries with high levels of corruption and inefficient social services. We do not trust our governments or bureaucratic systems that provide, or should provide, their most vulnerable populations with quality health insurance and services. In addition, for undocumented people, the fear of deportation always looms over any health care decisions they make.
Covering these stories is challenging. After meeting and talking to people, I was taken back by the real need for health care services — services that some don’t even know exist. For some, access to health care has become a luxury or a privilege. The best part of reporting these stories has been to learn what’s going on first-hand, right from the people — to meet them in the street and their work places.
Read Gerardo Fernandez Moreno’s fellowship stories here.