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Caught Between the Cracks of Health Care for the Undocumented

Before businesses open their doors and morning commuters flood the streets, Fresno County’s farm workers have already harvested hundreds of pounds of tomatoes, peaches and grapes on the nearly 1.9 million acres of the county’s farmland.

The produce is loaded onto trucks to be shipped throughout the country, but bringing that produce to the nation’s table tops is not an easy task. The undocumented workers who make up the vast majority of the state’s agricultural labor force suffer both minor and major injuries in the field, a surprisingly harsh work environment. Then they struggle to find the health care they need.

For more than 30 years, undocumented farm workers relied on the county’s health care safety net, the Medically Indigent Services Program (MISP), which provided specialty care coverage for illnesses that require the care of a medical specialist to low-income uninsured adults with no other source of care. In 2013, a court ruling allowed the county to remove the undocumented workers from the program, but the county agreed to provide temporary funding to continue the coverage.

MISP is currently still available in several other counties throughout the state, including Riverside and Los Angeles Counties. However, some of these counties face similar pressures to exclude undocumented immigrants from receiving services and are working hard to not go down Fresno’s path.

Agriculture remains one of the most dangerous industries in the United States. According to the National Center for Farmworker Health (NCFH), farmworkers face hard physical labor and a range of occupational hazards including pesticide exposure, respiratory problems, infectious diseases and operating hazardous machinery.

Advocates say the economy and public health are compromised because of the lack of access to health care. It can lead to the spread of communicable diseases and a depleted workforce, one that powers a county agricultural industry valued at $5.6 billion. A lack of coverage also leads to an increase in emergency room visits that leave taxpayers footing the bill.

“I think it’s not only to the benefit of those who need it, because for them it’s a matter of their health and livelihood, but there’s a lot of interests that are served when coverage is provided,”

Mona Tawatao, senior litigator with the Western Center on Law and Poverty.

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