Health Insurance Coverage for Farmworkers in California After the Introduction of the Affordable Care Act: A Mixed-methods Study.

Background: Previous studies have found that health insurance coverage expanded for farmworkers from 2011-2012 to 2015-2016 due in part to the introduction of the Patient Protection and Affordable Care Act (ACA). This study examines the continued impact of the ACA on insurance coverage for farmworkers to 2018 and identifies barriers to further expansion.

Methods: A mixed-methods approach was utilized. Weighted statistical analyses were conducted on the National Agriculture Worker Survey (NAWS) data for 2011-2012, 2015-2016, and 2017-2018. Qualitative interviews conducted with agricultural employers, health care providers, and community-based organizations examined the impact of the ACA on health insurance coverage for farmworkers.

Results: Though health insurance coverage for farmworkers in California increased after the introduction of the ACA (from 37.3% in 2011-2012 to 56.5%% in 2015-2016), coverage rates grew only modestly between 2015-2016 and 2017-2018 (64.8%). Coverage rates were higher for documented (43.0% in 2011-2012 and 77.7% in 2017-2018) than for undocumented workers (26% in 2011-2012 and 46.8% in 2017-2018). The results from the qualitative interviews suggested that barriers to increased coverage include the high cost of insurance for growers, high deductibles and copays for farmworkers, and distrust of government agencies.

Conclusions: While the period after the ACA was associated with notable improvements in health insurance coverage for farmworkers in California, important barriers remain for farmworkers seeking to obtain insurance and for growers seeking to provide coverage.

Policy Implications: States should consider funding a farmworker-specific Medicaid program to provide health insurance coverage and care coordination across counties and states.