CIRS Blog about Rural California
By Linda Childers
Olivia Basurto was concerned when her nine-year-old son Samuel came home from school with a rash on his arms. After trying to treat the pink bumps with over-the-counter creams, and having no success, Basurto called to make an appointment with a dermatologist.
She quickly learned that in her small rural town of Pixley (population 3,310), in the Central Valley, physician specialists are a rare commodity. The nearest specialist was either in Porterville or Fresno, located almost an hour away, and they had a three-month wait.
But then, the Pixley Medical Clinic, a rural health clinic that provides family practice medicine to residents of Pixley and the surrounding cities, asked Basurto if she would be open to a telemedicine appointment with a dermatologist. The doctor, a retired dermatologist volunteer with The MAVEN Project, could assess her son’s rash and offer medical advice.
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.
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.
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.
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.
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.
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.”
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.
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.
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.