CIRS Blog about Rural California

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By Hannah Guzik

If Washington, D.C. legislators approve cuts to government health care, California’s rural counties are among those who will suffer most, according to a new report.

Those who live in the state’s rural counties—which are largely in Northern California—are more likely than urban residents to be enrolled in the low-income health program called Medi-Cal, according to the report released June 6th from the Georgetown University Center for Children and Families and North Carolina Rural Health Research Program.

Medi-Cal covers 28 percent of adults and 54 percent of children in California’s rural counties, researchers found. Meanwhile, in the state’s metro areas, 21 percent of adults and 44 percent of children are enrolled in the health program.

Before the federal Affordable Care Act and state reforms opened the gates of Medi-Cal to most low-income adults and children, a quarter of the state’s rural residents under age 65 were uninsured. But by mid-2015, that uninsured rate had fallen to 11 percent.

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By Hannah Guzik

Amidst anxiety about potential federal funding cuts to health programs, California has one bright spot. The state’s new tobacco tax is expected to generate about $1.2 billion next fiscal year for the state’s low-income health program.

Now, California legislators and Gov. Jerry Brown are battling over how to spend the money.

Immigrant rights’ advocates are asking the state to use a portion of the Proposition 56 funding to expand health coverage to undocumented young adults.

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BY SEAN COCKERHAM AND MICHAEL DOYLE

WASHINGTON — California Republicans representing some of the nation’s most Obamacare-dependent areas in America took a giant political risk on Thursday by voting to repeal the landmark health care law, as they believed their political danger was eased as they got something to brag about back home.

They said they were convinced for much the same reason as so many other undecided Republicans who helped give GOP leaders the health care win they had so desperately sought: The addition of $8 billion to the bill to help with insurance costs for people with pre-existing conditions.

The congressmen dismissed estimates that the money isn’t nearly enough: an analysis by the liberal Center for American Progress said it would subsidize care for only 76,000 people out of millions.

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By Paulina Rojas

SAN BERNARDINO, Calif., Weeping as she narrated her story, Lupé (not her real name) an undocumented immigrant living in the Inland Empire, said she began feeling helpless and scared when her young son began having convulsions a few years ago. Like her, he had no health insurance.

Luckily for her, the nearby SAC Health System (SACHS), a federally qualified health clinic that does not turn uninsured patients away, enrolled the boy as a patient. The medications the clinic provided kept the boy’s convulsions under check.

Last May, when California launched its Health for All Kids program, SACHS helped enroll Lupé’s son in full-scope Medi-Cal, California’s name for the government program for poor people known as Medicaid in the rest of the nation.

Designed to provide health insurance for undocumented children who were left out of the Affordable Care Act because of their immigration status, the Health for All Kids is largely (71 percent) funded by the state, with the rest paid out of federal funds for emergency coverage.

Lupé’s son is among an estimated 250,000 children in California who have so far benefited from the program, said Dr. Jason Lohr, a family medicine practitioner at SACHS.

Lohr was a panelist at a February 7 round table ethnic media briefing here co-sponsored by New America Media and SACHS. Some 51 stakeholders, advocacy groups and media participated.

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By Hannah Guzik

If the federal Affordable Care Act is repealed, as some Republican lawmakers and President-elect Donald Trump have proposed, nearly 5 million Californians could lose health coverage, according to a new report.

In the last two years, the health law has enabled about 3.7 million California adults to enroll in the state’s low-income health program, known as Medi-Cal, and 1.2 million residents to receive subsidies to help them pay for insurance through Covered California. Repealing the health law could have a “devastating impact” on these groups, according to the December report from the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research.

In recent days, Trump and some Republican legislators have said that they want to repeal the health law and replace it with something else. It’s unclear whether the replacement would still provide funding for health coverage to adults under Medi-Cal or provide subsidies to those who purchase insurance on the state’s exchange.

Under the ACA, the number of uninsured residents in the state has decreased by almost half, from 6.5 million in 2013 to 3.3 million in 2015, according to the report. Since the majority of the health law’s provisions took effect in 2014, California has seen the largest decline in the uninsured rate of any state nationwide.

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California requires overtime pay for farmworkers, one of four states to do so. In 1976 the 10/60 standard (that requires overtime after 10 hours a day or 60 a week, different than the standard eight hours a day and 40 hours a week for non-farmworkers) was established in 1976.

Across the U.S., workers hired directly by the farm that employed them averaged 41 hours of work in July 2015; California farmworkers averaged 43.6 hours. Most harvest workers are employed less than eight hours a day, but some work six days a week during the harvest. Workers most likely to be affected by an 8/40 overtime pay requirement are irrigators and equipment operators, who often work 60 or more hours a week during busy periods.

Sonoma County farm labor contractors (FLCs) Four Seasons Vineyard Management and Ridge Vineyards were fined $42,000 by the Department of Labor (DOL) in February 2016 for poor housing for farmworkers. Four Seasons deducted rent from the wages of workers and turned rental payments over to Ridge.

Two California Court of Appeals decisions in 2013 required employers to pay piece rate workers for nonproductive time and to pay them for rest periods at their average piece-rate earnings. Before these 2013 rulings, employers could pay only piece-rate wages to workers as long as their piece-rate earnings exceeded the minimum wage.

Many workers planned to sue for back wages. AB 1513 gave employers a "safe harbor," allowing them to pay any back wages due piece-rate workers after July 1, 2012 without penalties. However, employers who faced suits for unpaid productive time and for using fictitious workers to reduce wages were excluded from the safe harbor.

Two farms are affected by these exclusions, Gerawan Farming and Fowler Packaging. Both face United Farm Workers-initiated suits, and both sued in January 2016 to have the AB 1513 exemption declared unconstitutional.

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This is the second in a series of stories about how health care reform is affecting newly insured Medi-Cal patients.

By Robin Urevich

The Affordable Care Act, with its promise of health care for most Americans, represents a welcome step forward for physicians who have cared for the uninsured.

Michael Core, a primary care doctor at The USC Eisner Clinic, treats some of the city’s poorest people in a spare no-frills office just south of downtown Los Angeles. Core says it’s great that his previously uninsured patients have access to a range of specialists that they never did before—at least on paper.

Many of them are part of the ACA’s huge expansion of the state’s Medi-Cal program. State officials say the increase in recipients—3 million new enrollees in 2014— hasn’t affected the quality of service they receive, but both patients and physicians report potentially dangerous long waits for specialty care.

Many of the newly insured are baffled by insurance and have trouble navigating the health care system. Core now spends much of his time deciphering his patients’ paperwork and helping them cut through insurance company red tape.

Many of the clinic’s patients come from the communities just south of LA’s central core, where incomes are low and many people live in crowded conditions. The area suffers a severe shortage of primary care doctors and dentists and is considered medically underserved by the federal Department of Health and Human Services.

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By Anna Challet

 

The safety net for uninsured Californians is full of holes – and those holes are much bigger for the state’s undocumented people.

 

That’s one of the main findings of a new study by the statewide health care advocacy coalition Health Access. The organization’s executive director Anthony Wright says the "uneven safety net" puts the state’s remaining uninsured in a position to “live sicker, die younger, and be one emergency away from financial ruin.”

 

“Counties should maintain strong safety nets for the remaining uninsured, through the county-led programs that provide primary and preventative care,” Wright said on a press call. “Counties that do not serve the undocumented should reconsider this policy, and focus their indigent care programs on the remaining uninsured population that actually has the most need for a safety net.”

 

Over a year into the full implementation of the Affordable Care Act, some 3 million Californians still lack health insurance. For many, that’s because coverage is still unaffordable. And almost half of the 3 million are undocumented, and thus shut out from federal health programs.

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By Hannah Guzik

A group of 13 women sit in a circle under a painting of ancient Mesoamerica featuring the first indigenous president of Mexico, Benito Juárez. Under the painting is a quote by Juárez, in Spanish. Translated, it reads, “Among individuals, as among nations, respect for the rights of others is peace.” The room is sparse, with folding chairs, incense burning on a small table and blocks in a corner for the toddlers who sometimes come with their mothers. The women, wearing the same jeans and T-shirts they wear to work in the fields, sip tea in paper cups. There’s a printout of a chrysalis and butterfly taped to the wall.

The women here at the Mixteco/Indigena Organizing Project in downtown Oxnard are part of a new support group and are learning how to manage stress and deal with difficulties in their lives, sometimes including domestic violence and mental illness. As indigenous people, they’ve felt their “outsider status” in both Mexico and the United States. They face other troubles every day as members of an often invisible minority group in California.

The support group is sponsored by the nonprofit Organizing Project, formed in 2001 to help indigenous immigrants in Ventura County and statewide. As the Affordable Care Act has expanded health care to much of California’s population, the nonprofit has stepped up the services it offers to those who have been largely left out of health reform: undocumented residents.

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By Fran Kritz

President Obama’s executive action on immigration, announced in November, could potentially come with a much sweeter — and healthier — deal for undocumented immigrants in California than in the rest of the country.

While undocumented immigrants in the U.S. do not qualify for coverage under the Affordable Care Act, California law allows “certain lawfully present immigrants” to be covered by Medi-Cal, the state’s low-income health program. Immigration experts say they expect that provision to apply to the new Deferred Action for Parental Accountability program announced by the president, which allows undocumented people who have a child who is a U.S. citizen or lawful, permanent-resident to apply for a work permit and deportation protection if the applicant has been in the U.S. since Jan. 1, 2010.

Over four million people in the U.S. are likely to qualify for the program beginning in 2015, and over a million of those live in California, according to the National Immigration Law Center in Los Angeles. That means more than a million Californians could be newly eligible for Medi-Cal, if their incomes are low enough to qualify.

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By Daniel Weintraub

California is a land of health extremes, and to see what that means, you need only travel a few miles from the state Capitol.

Placer and Yuba counties border each other about a half hour’s drive north of downtown Sacramento. Both places are largely rural. But the similarities end there.

Placer’s residents are, on average, much healthier than their neighbors across the county line. A person living in Yuba County is much more likely to suffer from chronic disease and die at an early age than someone living in Placer. In fact, Placer’s residents are among the healthiest in California, while Yuba’s are among the sickest by many measures.

The easiest explanation for the difference is wealth. Health and wealth are connected, here and almost everywhere in California and across the country. No one is sure exactly why they go together, but the answer is more complicated than the fact that people with higher incomes also tend to have better access to medical care. Even when access to care is the same, health disparities remain, because a large share of a person’s health is determined by things outside a doctor’s office or hospital room.

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By Lynn Graebner

Counties all over California are cheering the state’s decision to expand Medi-Cal to more than 1.4 million low-income adults – and bracing for the $1.3 billion the state expects to take away from county health services over the next four years.

Counties should see savings on January 1, 2014, when Medi-Cal expands to include childless adults under the age of 65 with incomes less than 138 percent of the federal poverty level or $15,856 for an individual annually. The federal government will pay 100 percent of the costs for new enrollees from 2014-2016 and 90 percent in 2020 and beyond.

“On paper, you’d think there would be savings,” said David Luchini, Assistant Director of the Fresno County Department of Public Health. But the UCLA Center for Health Policy Research predicted in a Sept. 12, 2012 report that three to four million Californians would remain uninsured in 2019. Counties say it is way too early to count on savings from the ACA and to chop away at county health care safety nets.

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By Leslie Griffy

Agricultural businesses and the insurance companies that serve them are scrambling to prepare for the changes that health care reform will bring over the next few years.

Many smaller farmers struggle with the details of the Affordable Care Act, such as how to count seasonal farmworkers to determine who they must insure. Employers of more than 50 will face fines if they don’t insure eligible workers.

Meanwhile, three of California’s agricultural-focused health insurance providers required waivers from ACA rules to continue operation. Those waivers expire next year.

“There is a lot of confusion,” said Norm Groot, president of Monterey County Farm Bureau. “I think everyone is really put off with the amount of complexity, particularly for agriculture.”

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By Leah Bartos

With all Americans required to enroll in health insurance under the Affordable Care Act, will the existing safety net clinics become a thing of the past?

For generations, grassroots-style community clinics have worked to fill the coverage gap. Their mandate: to treat any patient who walks in the door, regardless of ability to pay.

But by January of next year, all those patients should have health insurance. In theory.

Despite the requirement  — and penalty fee for noncompliance — a projected 3 to 4 million Californians will remain uninsured through 2019, according to a UC Berkeley Labor Center study. Of the remaining uninsured, the report projects that nearly 40 percent still won’t be able to afford coverage, and that three-fourths will be U.S. citizens or lawfully present immigrants. More than half will include households with incomes at or below 200 percent of the federal poverty level.

For many, California’s safety net clinics will continue to be their best — or only — option for care.

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By Leah Bartos
California Health Report

In the coming year, millions of currently uninsured Californians will gain coverage under the federal Affordable Care Act — but that does not necessarily mean it will be any easier for them to see a doctor.

As the state prepares for the expected onslaught of newly insured patients, health-care professionals are warning there may not be enough doctors — particularly, those practicing primary care — to meet the increased demand. Some say that the problem will be even more amplified in rural California, which already suffers a physician shortage and dwindling workforce, as the majority of rural physicians nears retirement and recruitment of new doctors lags in replacing them.

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Originally posted on the New America Media website on Jan. 23, 2013.

Editor’s Note: There are an estimated 600,000 crop workers, and an additional 20,000 livestock workers, in California at any given time. Theirs are physically demanding jobs that carry a high risk of occupational injury – yet the vast majority of these workers lack health insurance. That could change in 2014 when the Affordable Care Act is fully implemented, although significant barriers will need to be overcome between now and then, if most farmworkers are to benefit. Don Villarejo has worked for more than three decades as a researcher and advocate on behalf of California farmworkers, and has authored major studies on farmworker health in the state. He recently spoke to New America Media editor Jacob Simas.

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