domingo, 03 de diciembre de 2006
Hired Hands: Insuring their futureVintners, agencies seek coverage for all
Ernestina Bernabe, pruning grapevines in a Napa vineyard last month, is one of the many workers in the region who have no health insurance. Recognizing the importance of its work force, a Napa vintners group donated more than $1 million to a nonprofit health group to help provide coverage to uninsured children. Sacramento Bee/Hector AmezcuaIn this land of haute cuisine and genteel tasting rooms, it wasn't tough to convince the local powers that be that health insurance for all children was a civilized policy.To do so, however, public officials and vintners had to acknowledge that some of the kids who need insurance are undocumented or the offspring of undocumented workers from Mexico."It's not something we're afraid to say. It's just the way it is," said Mark Diel, executive director of Children's Health Initiative Napa County. The nonprofit group is part of a county-by-county movement to patch together coverage for the most vulnerable of the insurance crisis: California's 700,000 uninsured children, an estimated 10 percent of them undocumented.Insuring the undocumented has been a major sticking point in the national debate over immigration reform and continues as an issue for many California counties.Even in Napa, where Mexican immigrants have been recruited for generations to pick grapes, the letters page of the local paper bristles with accusations that immigrants are reaping free benefits while Americans suffer.But Diel said he's only received one call objecting to immigrant kids getting insurance, which for undocumented children is subsidized privately.Residents, he said, largely accept that foreign workers -- and their families -- are as essential to this valley's lifeblood as a top-notch enologist or the perfect French oak wine cask.In recognition of this dependence, the Napa Valley Vintners trade group last year donated more than $1 million to the Children's Health Initiative.The contribution may seem small for most counties, but in Napa -- where an estimated 4,000 kids are uninsured -- it's enough to cover a quarter of the initiative's operating costs for three years and premiums for some undocumented kids.So far, it is the single largest donation from a business group to any children's health initiative in California, though efforts are afoot to graft Napa's model onto other farming regions and even onto the entertainment industry."Keep in mind that the people who allow us to live our great lifestyle often don't have health insurance," said Napa vintner John Shafer. He provides employer-sponsored medical insurance to his 17 full-time winery employees, but not to crews of workers brought to work in his vineyards by outside labor contractors."You go to the restaurants here and the hotels, and the workers are also Hispanic immigrants," Shafer said. "Do we have a responsibility to take care of them? The answer is yes."Even among the many employers in Napa who offer insurance to full-time workers, insurance cost increases have taken a toll, leaving legions of spouses and children without coverage.On a recent autumn day in the Stag's Leap region of Napa, where some of America's finest wines are born, Ernestina Bernabe -- like most of the the crew sawing through gnarled grapevines -- doesn't have health insurance and rarely sees a doctor.Lupe Gutierrez, crew supervisor and a 20-year veteran of vineyard work, was among the few with employer-sponsored insurance, but he had to drop his wife and children from his plan when the cost rose to $500 a month.Instead, for $45 a month, Gutierrez was able to enroll his children in Healthy Families, a state program coordinated locally by the Children's Health Initiative. His wife remains uninsured.Premiums for Healthy Families are subsidized by donations from private foundations, state tobacco taxes and other public funds. Children qualify if they are legal immigrants and if their families earn too much to be eligible for Medi-Cal. Healthy Kids, a newer program administered by nonprofits like the one Diel runs, insures children who are undocumented or whose family income exceeds Healthy Families limits.To make sure no federal laws restricting aid to illegal immigrants were violated, the Napa County Board of Supervisors initially voted against allowing undocumented children to benefit from $300,000 the county earmarked for the Children's Health Initiative. A new state law giving counties more discretion has freed county social workers to direct undocumented families to the Healthy Kids fund.Board Chairman Bill Dodd said he'd even support using county money to pay full premiums for the undocumented if the community lacked the vintner and foundation subsidies."I'd expect the public to understand that every dollar of that would protect them, too," Dodd said. "Public health doesn't know borders."Randy Snowden, Napa County's health director, said he supports increasing preventive care for county residents. Without it, he said, "instead of spending $100 on a prescription for someone, you end up spending $1,000 a day for a hospital stay."In downtown Napa, at the Community Health Clinic Ole, 16-year-old Juan Carlos Barrajas rose from a dentist's chair, rubbing his jaw after getting a filling paid for by the Healthy Kids program.Juan Carlos' father works at an upscale vacation spa nearby, the boy and his mother said, but the spa's medical insurance covers only employees.Clinic Ole was built with a $9 million donation from vintners and continues to receive hundreds of thousands of dollars a year from the industry. Over 25 years, the vintners' annual charity auction has raised almost $70 million, mostly for health care provided at sliding-scale fees to the uninsured.Since the Children's Health Initiative began, Clinic Ole has seen a surge in newly insured children coming for teeth cleanings and checkups. Kids used to show up only when their teeth were already aching, said Dale Barry, dental clinic administrator.Across the state, outreach workers for similar health initiatives have been surprised to find that about 75 percent of the uninsured kids actually qualify for Healthy Families or Medi-Cal. Their families had never applied.As a result, Napa County expects to be reimbursed at least $1 million in Medi-Cal funds. To Diel, that reality contradicts assumptions that immigrants rush to sign up their U.S.-born children for Medi-Cal."People don't risk their lives to get across the border so they can sit on a sofa to live off public assistance," Diel said. "Almost any child that we serve, one or more of their parents works."Among those parents is Nohemi Sanchez, who arrived in the United States at age 9 as an undocumented immigrant and, at 21, is a legal resident.In October, Sanchez's uninsured infant son Alan fell seriously ill, and a doctor at Napa's private Queen of the Valley hospital emergency room thought he should be tested for leukemia.Sanchez makes $10 an hour supervising developmentally disabled adults in Napa. She currently has no job-linked insurance because she can't afford to pay her portion of the premiums. Her husband is an undocumented vineyard worker, who qualified for private employer-sponsored insurance coverage after six months on the job but only to cover himself and only when seasonal work is in full swing.When Sanchez took Alan to the hospital for the blood tests, she was worried she would be turned down -- at the time, she owed about $2,000 for hospital visits related to the baby's respiratory problems. But Queen of the Valley hospital dipped into funds it reserves for indigent care to pay for Alan's tests for leukemia.The blood tests came back negative, and today Sanchez says, "I'm waiting for my tax return right now so I can pay (the earlier) bills."Scared by the experience, Sanchez decided it was time to make sure Alan had health insurance. Through the Napa health initiative group, she enrolled him in Medi-Cal.Diel's goal of insuring 4,000 kids in Napa is modest, he said, compared with tackling the more than 6 million uninsured people statewide -- about 2.4 million of them noncitizens. More than half of California's uninsured are Latinos, including legal and undocumented immigrants, according to the California HealthCare Foundation.The daunting statistics are less surprising given that for a decade, one in three new workers in California has been Mexican.The demographic shift has prompted alarm that immigrants are consuming disproportionate amounts of public health funds. But a study released in November suggests otherwise.Based on research in Los Angeles County, the Rand Corp. found that illegal immigrants cost about $11 in public health money a year per U.S. household compared with overall public health costs of $843 per household.Former Orange County pediatric oncologist Geni Bennetts, who is on the board of Napa's Children's Health Initiative, suggested businesses follow the vintners' lead and contribute to local efforts to deal with uninsured workers. Around the state, her counterparts agree.The Los Angeles health care coalition to insure children raised $141 million, enough to continue its program for three years, through April 2007. So far, it has financed Healthy Kids insurance for 42,000 children. As the money runs low, the advocates are considering approaching the industry around which much of Los Angeles revolves, Hollywood.In Orange County, where anti-immigrant sentiment runs high, program coordinator Mary Jo Hooper is trying to get local businesses that employ illegal immigrants to contribute.In Fresno, health advocate Norma Forbes hopes the Fresno County Farm Bureau will help extend insurance to an estimated 26,000 children and, next year, help organize subsidized insurance for about 2,000 adult farm workers.Fresno County Farm Bureau president Ryan Jacobsen said lots of employers can't afford insurance or can't figure out how to structure it with a migrant labor force. But Jacobsen said growers are committed to finding ways to increase preventive health care."These are our workers," he said, "and we need them."