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Migrant health care study in bureaucratic limbo

WASHINGTON—Migrant farm workers face life-and-death questions about elusive health care.

So far, though, the Bush administration is keeping potential answers close to the chest.

Four years ago, eager for solutions, Congress ordered a study of farm worker health care. Three years ago, the study was done. It's been buried ever since, caught in a bureaucracy working at a pace of its own.

"We have been kind of frustrated," said Wenceslao Vasquez, a California health activist who chairs the Bush administration's National Advisory Council on Migrant Health. "If we had the study, we would have the basis for pointing out our concerns."

An immigrant from El Salvador and former farm worker in California's Yuba and Colusa counties, Vasquez now runs a restaurant in Chico, Calif.

Another advisory council member is Dr. Rogelio Fernandez. They have different expertise—Fernandez as a physician, Vasquez as a businessman and board member of local community health centers—but they agree about farm worker health woes.

"First of all, there's a problem with financial access," Fernandez said, speaking by phone from the United Health Centers office in Parlier, Calif., "and there are also issues of transportation. In our rural areas, getting to any kind of care can be costly."

Advisory council members also include Robert Nimmo, a former family farmer from North Carolina's Greene County, and Rosita Castillo Zavala, who serves on the board of the Yakima Valley Farmworkers Clinic in eastern Washington state.

"She is an advocate who knows she can always return to pick apples if she needs to," the minutes of one advisory council meeting note.

The nation's estimated 3 million migrant and seasonal farm workers are generally poor. Three out of four earn less than $10,000 a year. Few are insured. By some estimates, only about 5 percent are covered by employer-provided health insurance. Their work is dangerous. Thirteen percent of U.S. occupational deaths during the 1990s occurred in farming, though farm workers made up only 2 percent of the nation's workforce.

Congress picked up on the problem in 2002 when it passed a diverse package of health care amendments. The legislation includes a requirement that the Department of Health and Human Services conduct a solutions-oriented study of farm worker health care.

It seemed controversy-free, as lawmakers agreed better health care would pay off.

"Oftentimes if we can catch their illnesses early, we can actually save society a great deal of money," then-Rep. Mark Foley, R-Fla., declared during brief House debate. "The sicker a person becomes ... the more expensive it is and typically will be treated in an emergency room where the cost is that much greater for Medicaid."

Congress directed the Bush administration to consult widely and answer specific questions. The study was to examine the barriers to farm workers enrolling in Medicaid and the State Children's Health Insurance Program. The barriers might include language, complicated applications or lack of outreach personnel. It was to examine lack of "portability"—when farm workers obtain health care in one state but not another. It was to evaluate different solutions, including interstate compacts, public-private partnerships and establishing a new national program serving migrants.

"The study is very important," Vasquez said.

It is also very, very late.

The Centers for Medicare and Medicaid Services completed the study in 2003. Since then, researcher William Clark informed the migrant advisory council last January, the study has remained "in clearance." This bureaucratic limbo means the study can't be made public, nor can the recommendations incite congressional debate.

Last spring, the advisory council formally urged Health and Human Services Secretary Michael Leavitt to release the study.

"(We) are working very diligently to accelerate the review of the farm worker access study," Leavitt said on May 31.

Nearly six months after that reassurance, the study remains in clearance. Health and Human Services officials could not be reached to comment on when the clearance ends.

"They say it's coming soon," Vasquez said Wednesday, "but we never know."


(c) 2006, McClatchy-Tribune Information Services.

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