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A group of farm workers hoe a large field along California's central coast.In the past few years we have seen amazing advances in the fight for expansion of medical coverage. With the Affordable Care Act in effect, California has taken a step that no other state in the union has ever done, expanding restricted scope Medi-Cal for the undocumented, giving them access to basic, preventive services. The state budget includes money to give full-scope Medi-Cal to dreamers who benefitted from the Deferred Action for Childhood Arrivals program as well as others who have a valid visa and Social Security number.

In this last few years certain counties including Santa Cruz have had some form of county-wide relief for undocumented children. This created a ripple effect where more and more counties were expanding their services to undocumented children, and in this past budget cycle Gov. Brown included in the budget the expansion of full-scope Medi-Cal for undocumented children under 19.

Monterey County has not been left behind. Also in this past budget cycle the county, pushed by Communities Organized for Relational Power in Action (COPA), pushed forward a one-year pilot program that would include $500,000 to give the undocumented access to medication, x-rays, and lab services.

This last program is of particular importance because if someone who undocumented can only apply for restricted-scope Medi-Cal, he or she can go to a doctor and get checked but further visits and specialized services are not included. People in that situation may find they have high blood pressure or diabetes and be left on their own to pay for the high cost of medication.

I’ve worked in enrolling people into Medi-Cal and the Affordable Care Act since the Affordable Care Act rolled out. I have come to see what many of us know, that there is an inherent injustice in allowing a certain sector of the population the right to take care of their health and denying access to health care to a different section of the population. What we also see is that even in the same household certain people can have insurance while others do not. This affects the Central Coast because of the high stress that comes from being a farmworker, the number one job classification in the county.

Many of those that I had the privilege of helping were farmworkers, including Carmen, an undocumented farmworker who has been injured from so many years of hard labor and cannot get access to a doctor to help her ease the pain and get back to work.

Carmen was proud to say that she worked in agriculture and had great health insurance that covered her thanks to working in one of the few agricultural companies that has a labor union. And then she got hurt. Years of working 10-hour days bending over swiping lettuce, packing it in a box, lifting that box over her head to put it into a machine, swooping back down to cut more lettuce, walking bent over, packing bent over, picking up, lifting, pushing and shoving boxes, left her unable to work and thus, left her without insurance.

After her injury her insurance covered the medical costs for a brief time period, so she doesn’t have too much debt; but she can no longer work.

José, her husband, qualified for the Medi-Cal expansion thanks a combination of ACA and a California policy that extended Medi-Cal to people with a valid Social Security number and work permit. Jose’s permit comes from his Temporary Protective Status (TPS), granted to certain immigrants whose home country suffered a natural disaster. For José, this means the 7.7 magnitude earthquake that shook El Salvador in 2001. Their two U.S.-born children have insurance through Medi-Cal; Carmen is the only one in the family left out of insurance.

Like millions of other farmworkers who come to the United States, Carmen and Jose came with high hopes of getting ahead after their home country became inhospitable.

But what one quickly learns as an undocumented immigrant is that there is little access to many of the most fundamental things that we all need to survive, including health care.

“Why do some people get benefits and others don’t,” Carmen asks, “We are all equal and if there are opportunities for someone, there should be opportunities for everyone.”

“The way that she is feeling,” says Jose, “there are many more people feeling the same. We want to have the same opportunities as everyone else. That the government sees that people that don’t have a Social Security number should get a permit and can also have [insurance].

“When someone is over there (El Salvador), one doesn’t know how much one is going to suffer. It’s hard because one has big dreams of entering this country. But it’s hard when one comes here and has no money or work and one would like to have the opportunities that other have but it’s hard.

Jose left El Salvador in 1997 because of the gangs. The civil war was ending and violence lingered on. Carmen left in 2003 because of domestic violence she suffered from her previous husband. Her journey was a month-long odyssey that began when she escaped from her home and crossed through Guatemala into Mexico. She was locked in a house for 15 days by the people who promised to take her north. She felt immense fear that if these coyotes wanted to, they could abandon her and the others and leave them locked in the house to starve.

UnknownEventually, she was able to ride in a van with 25 others for days and nights, afraid, barely able to breathe, only to be dropped off to face the most terrifying portion of her journey – the four-day walk through the desert from Chihuahua into Arizona. She walked to survive and she took that fighting spirit for survival into the fields with knife in hand, bandana covering her face. She did it for her children but years of intense labor took its toll.

“Near the end of 2008 my back began to hurt a lot. I got hurt and since then I haven’t been able to work. It’s hard because one came to get their family ahead. This is a good country; it’s the nation of opportunities. But then these things happen. One feels bad because, well, in one’s mind one wants to do so many things but as you know sometimes the body doesn’t react that one would like. And I feel bad.”

Her injury is very common to farmworkers. The long hours, the many days, the repetitive nature of the work, the nature of the labor, union or no union, is hard. At times Carmen attempts to get back to work but the pain is too much. It’s been almost two years since she was able to work full time.

Carmen now faces the realities that millions of Americans face; they got hurt on the job, they don’t have employer-based insurance, going to the hospital is expensive, and therefore, they don’t get the attention necessary to regain their health. And, in Carmen’s case, she can’t purchase insurance through Covered California because of federal regulations.

 When we begin to speak about the possibility for immigration reform and DAPA (President Obama’s executive action that is currently caught up in the court system), Carmen smiles. She has been active for years in the fight for her rights. She has gone to Sacramento to advocate for farmworker rights, she has attended immigration reform rallies, and she is hungry for more information on how she can get involved to make DAPA a reality. It would provide work permits for parents of children who are U.S. citizens or to legal permanent residents. That would give her access to a Social Security number, which would give her access to full-scope Medi-Cal.

What can be proudly said is that California has gone above and beyond any other state in the nation. Monterey County is now being added to the list of counties that are giving some services to the undocumented. And while there is much work to do to expand health coverage for everyone, the cost of doing so will probably fall on the county until either the state or the federal governments push forth greater measures. And while the cost of expanding health insurance for all is high at first, there is a growing movement that argues that this will save millions in the long run. While the state now paying for undocumented children is a positive thing, too many adults are still left out of the equation.

Jesús Valenzuela is a Salinas resident who has worked on health equity issues for the Central Labor Council.

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医療スタッフTensions will remain high at Salinas Valley Memorial Hospital until the directors understand the role of the unions and recognize that hospital employees are already contributing as much as the board and the CEO.

As expressed in a recent column by board Chairman Harry Wardwell, the leadership seems surprised that the union isn’t simply acquiescing to a plan to lay off as many as 120 people, including 54 registered nurses. They seem surprised even though the CEO, Pete Delgado, received a $177,000 raise just two months ago.

“Unfortunately, the unions representing some of the employees at SVMHS are using this time of difficult decisions to criticize the administration rather than helping to be a part of the solution,” Wardwell wrote in the Salinas Californian.

“It is my hope that everyone will work together to determine the best way forward. It is in the best interest of Salinas Valley Memorial, and it is in the best interest of our community.”

Wardwell can hope all he wants but it won’t lead anywhere until he understands the situation from the perspective of the employees and the unions. Of course the employees want what is best for the hospital, the community and the patients. That’s because it’s the right thing and because that’s in their best interest. Every day, most of the employees go above and beyond on behalf of the patients. But they cannot be expected to meekly let the administration put all the budget-cutting burden on their backs, something that has happened year after year.

Of course the employees and the unions resent Delgado’s raise, especially coming right before another round of painful belt tightening. Of course the unions are complaining. Their job is to protect the employees, not to help undo years of bad management and reckless spending. To suggest that the employees are letting down the hospital and the community is another example of tone deafness at the top.

The story of the previous CEO, Sam Downing, is well known. He left the hospital in shaky financial shape but retired with a $150,000 annual pension and a special supplemental pension fund of $3.9 million. The hospital board repeatedly denied the existence of that fund, which only came to light because of a Los Angeles Times investigation. Were Downing’s pension and other perks in the best interest of the hospital and the community?

Now, the hospital is following the lead of thousands of short-sighted corporations that manage to meet annual profit goals principally by cutting employees and expenses. The top executives receive raises or generous bonuses merely by eliminating people, which is considerably easier than finding ways to increase revenues by improving or expanding services. The hospital, like so many comatose corporations, could be setting itself on a course of declining expectations and results.

At the same time, the hospital also plans to convert most of its patient rooms from doubles to singles, which would reduce patient load and allow staff cuts while enabling the facility to charge higher room rates.

One special problem for Salinas Valley is that many of its part time nurses receive full-time benefits, a function of the time not long ago when hospitals were having a hard time finding nurses. The administration proposes to end that by converting most of the part-time jobs to full time. There’s nothing wrong with that as long as their union has a real say in how it works.

The economy, the advent of the Affordable Care Act and numerous other factors make these tough times for the hospital industry. Wardwell, Delgado and everyone else at Salinas Valley face large challenges. It very likely is true that downsizing is necessary because of the economic realities. If so, the administration should focus on making the process as painless as possible, starting with the recognition that the employees and the union should be partners in the process. To marginalize them or cast them as villains is not in the best interests of the hospital or the community.

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