University of California, Merced, Merced.
University of California, ANR, Davis.
Med Care. 2023 Jul 1;61(7):431-437. doi: 10.1097/MLR.0000000000001806. Epub 2022 Dec 12.
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.
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.
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.
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.
States should consider funding a farmworker-specific Medicaid program to provide health insurance coverage and care coordination across counties and states.
由于《患者保护与平价医疗法案》（ACA）的出台，2011-2012 年至 2015-2016 年，农业工人的医疗保险覆盖范围有所扩大。本研究旨在探讨 ACA 对 2018 年农业工人保险覆盖范围的持续影响，并确定进一步扩大保险覆盖范围的障碍。
采用混合方法。对 2011-2012 年、2015-2016 年和 2017-2018 年的全国农业工人调查（NAWS）数据进行加权统计分析。对农业雇主、医疗保健提供者和社区组织进行定性访谈，以研究 ACA 对农业工人医疗保险覆盖范围的影响。
尽管 ACA 出台后，加州农业工人的医疗保险覆盖率有所提高（从 2011-2012 年的 37.3%增加到 2015-2016 年的 56.5%），但 2015-2016 年至 2017-2018 年期间，覆盖率增长幅度较小（64.8%）。有记录的工人（2011-2012 年为 43.0%，2017-2018 年为 77.7%）的覆盖率高于无记录的工人（2011-2012 年为 26%，2017-2018 年为 46.8%）。定性访谈的结果表明，增加覆盖率的障碍包括种植者保险成本高、工人自付额和共付额高，以及对政府机构的不信任。
尽管 ACA 实施后，加州农业工人的医疗保险覆盖范围有了显著改善，但农业工人寻求保险和种植者寻求提供保险仍存在重要障碍。
各州应考虑为农业工人提供特定的医疗补助计划，以在县和州之间提供医疗保险覆盖和护理协调。
