Thanks to what is believed to be first of its kind legislation, legal minimum wages and worker protections may be on the horizon for California’s professional cheerleaders.
A bill proposed by State Rep. Lorena Gonzalez (D) in January, and approved by the Senate on Monday, requires California sports teams to adhere to state and federal minimum wage requirements and to provide overtime pay and sick leave to professional cheerleaders.
Despite the athletic skill and training required for participation in professional-level cheering — plus the branding and visual expectations that come along with acting as the public face of a sports team — cheerleaders are often considered independent contractors and therefore are not protected by minimum wage and other labor standards.
This is particularly jarring considering professional cheerleaders act as some of the most public symbols for leagues like the NFL, which is worth over $33 billion, according to recent estimates.
“A.B. 202 would explicitly require that professional sports teams provide cheerleaders with the same rights and benefits as other employees, protecting against the sort of financial and personal abuses that have been reported throughout the country,” said Gonzalez, who is a former college cheerleader herself, in an April press release. “A.B. 202 simply demands that any professional sports team — or their chosen contractor — treat the women on the field with the same dignity and respect that we treat the guy selling beer.”
A similar bill has been proposed in New York State, but Gonzalez’s will be the first to hit a governor’s desk. Both measures come as a response to a string of lawsuits brought against NFL teams over the last two years. The first suit was brought by a former Oakland Raiders cheerleader who claims that she and other members of the cheer team were paid less than $5.00 an hour and were denied overtime and other benefits associated with standard labor laws.
In bringing the lawsuit against the Raiders, attorney Sharon Vinik dismissed the team’s justification for the contractor status of the cheer squad, stating that the NFL team dictated the choreography and music used by the cheerleaders among other strict limitations. The defense also rejected the common claim that the opportunity to cheer for a professional team opened up other doors such as endorsements and modeling, and therefore acted as a career stepping stone.
“If you are a young starting quarterback, you get lot of notoriety for that, but you also get paid for that work,” said Vinik at the time. “The fact that the women might get some opportunities doesn’t justify not paying them.”
According to the Associated Press, Vinik thinks the new California legislation is a good step, but one that may not be big enough to actually change the payment culture surrounding professional cheerleading.
The Raiderette’s lawsuit was followed by similar legal complaints from other teams, including cheerleaders from the Buffalo Jills cheer squad, who claim that they were not paid for up to 20 hours of their weekly work with the Buffalo-based NFL team.
While the new California legislation may be a step in the right direction, the vast majority of professional sports teams and states have yet to address the significant wage gap and labor violations associated with the professional cheerleading industry.
This blog was originally posted on July 1, 2015 on Think Progress. Reprinted with permission.
About the Author: The author’s name is Katelyn Harrop. Katelyn Harrop is a summer intern at ThinkProgress. She is a rising senior at Ithaca College, where she is pursuing a B.A. in journalism and a minor in international politics. Katelyn is an editor for Buzzsaw Magazine, Ithaca College’s independent, student-run publication, and a staff writer for the community radio station in Ithaca, New York. Katelyn is originally from McMinnville, Oregon.
Uber must pay its drivers benefits, overtime, working expenses, and other standard compensation that the company has thus far avoided providing, the California Labor Commission has ruled.
The decision is not self-executing across the state and can only be directly applied in one specific driver’s case. But it signals to the company’s other employees that the body charged with adjudicating California labor law views Uber to be an employer with all the obligations that come with the label. Uber notes in a statement that the same commission had ruled the opposite way in a 2012 case, and that neither of those rulings would be binding in any other individual lawsuit over similar complaints by other drivers.
The ridesharing start-up, whose market value recently hit $50 billion, has relied upon paying drivers as though they were independent contractors rather than employees. Classifying a worker as a contractor negates most provisions of federal labor law, saving an employer thousands of dollars per year for each person they treat as a contractor.
If a company treats a contractor like an employee by exerting substantial control over day-to-day job activities, though, it risks being found guilty of misclassifying workers. Misclassification is a widespread problem, with complaints popping up everywhere from trucking to strip clubs to beauty parlors.
In California, Uber argued that its relationship with drivers is not controlling enough to constitute an employer-employee relationship, pointing out that they don’t set drivers’ hours or require a minimum number of trips in a shift. But California’s definition of the line between employment and contract work is primarily based on whether the worker is providing a service that’s integral to the main line of business of the company paying her. Labor commission lawyers examined Uber’s policies for drivers and overall business model and found the company’s argument weak.
“Defendants hold themselves out as nothing more than a neutral technological platform, designed simply to enable drivers and passengers to transact the business of transportation. The reality, however, is that defendants are involved in every aspect of the operation,” the commission ruled. By vetting would-be drivers, requiring them to register their vehicles with Uber, and terminating them if their approval ratings dip too low, the state found, Uber positioned itself as an employer rather than a non-controlling party to a contract.
The case that generated the ruling will only cost Uber about $4,000 in reimbursement payments to a driver named Barbara Ann Berwick. But its consequences could be much grander. If it cannot successfully appeal the finding, it will have to choose between fielding further individual lawsuits or reclassifying all its California drivers as regular employees to pre-empt the suits. That means paying unemployment insurance and other payroll taxes that aren’t triggered for contractors, as well as potentially being subject to overtime rules and made to reimburse drivers for work expenses like gas, tolls, and some traffic tickets.
Any multi-billion-dollar corporation should theoretically be able to absorb such costs. But they threaten to turn Uber into a much smaller-margin enterprise, one more akin to the traditional taxi company business model that the firm has made so much money disrupting. And because Uber’s market value is a fluid, on-paper number that depends on investor confidence and market analyst’s reading of the economic tea leaves, the California ruling could lead to some shrinkage in the car service’s worth and ability to raise private funds.
The ruling isn’t the end of the story, either. There are other civil cases outstanding in California and elsewhere that touch on similar issues and could be decided differently. And the sheer variety of different driver experiences, from people who drive a few hours a week for supplementary income to those who log long hours in vehicles leased from the company itself, suggests that it’s hard to pin down the entire category of workers with either the “employee” or “contractor” label that the law provides.
This blog was originally posted on Think Progress on June 17, 2015. Reprinted with permission.
About the Author: The author’s name is Alan Pyke. Alan Pyke is the Deputy Economic Policy Editor for ThinkProgress.org. Before coming to ThinkProgress, he was a blogger and researcher with a focus on economic policy and political advertising at Media Matters for America, American Bridge 21st Century Foundation, and PoliticalCorrection.org. He previously worked as an organizer on various political campaigns from New Hampshire to Georgia to Missouri. His writing on music and film has appeared on TinyMixTapes, IndieWire’s Press Play, and TheGrio, among other sites.
Last week, New York Gov. Andrew Cuomo (D) announced that he is taking advantage of a state law to raise minimum wages without the involvement of the legislature. He’s not the only governor with that power; others could also follow suit.
New York State law gives the labor commissioner the authority to convene a wage board to investigate whether the minimum wage in a specific job — or even all of the jobs in the state — are adequate, and to issue a “wage order” to increase it without the involvement of state lawmakers. On Wednesday, Cuomo announced that he would direct the commissioner to investigate wages in the fast food industry. New York was the home to the first strike in the fast food industry demanding a $15 minimum wage and has been home to them as they continued to spread across the country.
But Cuomo isn’t the only governor with the power to set a higher minimum wage without approval from a state legislature. According to an analysis from the National Employment Law Project (NELP), state laws in California, Massachusetts, New Jersey, and Wisconsin all empower their governors in similar ways. “There was a time when the minimum wage was less politicized and there was a sense that it should be at a level adequate to deliver decent incomes for workers,” explained Paul Sonn, general counsel at NELP. “These laws are still on the books in a number of places.”
States have already been raising their own minimum wages, to the point that the majority have a higher wage than the federal level of $7.25. But some state lawmakers haven’t been taking action. “Where the legislative process won’t deal adequately with the minimum wage, governors should dust [these laws] off and use them aggressively to deliver the wages that workers need,” Sonn argued. “Governors in states with this authority should be using them more frequently and more creatively to address the problem of low wages.”
One example could be California, which has a Democratic governor, Jerry Brown, who already signed a minimum wage increase to $10 by 2016 back in 2013. “Cuomo is saying, ‘I’m going to make New York a progressive leader with the strongest minimum wage in the nation,’” Sonn said. “Jerry Brown could do the same thing.” A spokesman for the governor’s office told ThinkProgress he wasn’t aware of similar options to what Cuomo did in California, but noted that there are other new bills and proposals to raise the wage.
The authority can also be used against governors who aren’t supportive of higher minimum wages. That’s already happened in Wisconsin. There, a state statute says that all wages in the state have to amount to no less than a living wage and that any member of the public can file a complaint saying the minimum wage fails that standard. Last year, low-wage workers and worker organizing groups submitted 100 complaints to Gov. Scott Walker (R) alleging that the state’s $7.25 minimum wage violates the statute, although his administration rejected the complaints.
A similar fight could start brewing in New Jersey, where Gov. Chris Christie (R) has voiced his opposition to increasing the minimum wage. “The Governor of New Jersey has the power to raise wages for hundreds of thousands of workers,” Analilia Mejia, executive director of New Jersey Working Families, told ThinkProgress. “We will absolutely be calling on Gov. Christie to follow in the footsteps of Gov. Cuomo, who Christie has called his ‘separated at birth twin brother.’” She also said the issue would be brought up beyond Christie’s administration. “Over the coming year Working Families activists [will] be asking every potential gubernatorial contender in New Jersey’s 2017 election where they stand on using the state’s wage board to end poverty wages,” she said.
This blog was originally posted on Think Progress on May 11, 2015. Reprinted with permission.
About the author: The author’s name is Bryce Covert. Bryce Covert is the Economic Policy Editor for ThinkProgress. She was previously editor of the Roosevelt Institute’s Next New Deal blog and a senior communications officer. She is also a contributor for The Nation and was previously a contributor for ForbesWoman. Her writing has appeared on The New York Times, The New York Daily News, The Nation, The Atlantic, The American Prospect, and others. She is also a board member of WAM!NYC, the New York Chapter of Women, Action & the Media.
To explain the contrast between the trend in California and the United States as a whole—where union membership dropped last year by 400,000—Semuels turned to some credible sources, including Steve Smith of the state labor federation who cited “an appetite among these low-wage workers to try to get a collective voice to give themselves opportunity and a middle-class lifestyle.”
Quoting Smith and others, Semuels finds that, “After working hard to get here, many Latino immigrants demand respect in the workplace and are more willing to join unions in a tough economic environment, organizers say.”
True enough: Immigrant workers have been particularly important for unions in California and Latino organizing has helped reignite the state’s labor movement. But that’s only part of the story.
Many California unions, allied with progressive groups up and down the state, have dedicated enormous resources to community and economic organizing. This has influenced California’s political culture. Union-friendly city councils, boards, commissions, a democratic legislature and statewide office holders produce a relatively pro-worker political and economic atmosphere.
Though employer resistance to unions can be as fierce in California as in other states, there is also a growing sense that a cooperative relationship with labor can be good business (note the expedited permitting for the construction of downtown L.A.’s Farmers Field).
California unions were ahead of the curve in recognizing the power of Latino workers and voters and then led other states in building diverse constituencies around progressive economic development strategies. The number of “living wage” districts around the state testifies to that.
There is no pro-union state in the United States. But California (with 18.4 percent of the workforce unionized) may be pointed in that direction.
Despite its failure to offer context, the Los Angeles Times piece draws the same conclusion.
“Labor’s more optimistic proponents say that California could serve as a blueprint for unions across the country as they seek to stem membership declines,” writes Semuels. “The trend comes amid forecasts that the Latino population in the United States is likely to double in two decades.”
AFL-CIO President Richard Trumka said Solis “brought urgently needed change to the Department of Labor, putting the U.S. government firmly on the side of working families.”
Under Secretary Solis, the Labor Department became a place of safety and support for workers. Secretary Solis’s Department of Labor talks tough and acts tough on enforcement, workplace safety, wage and hour violations and so many other vital services. Secretary Solis never lost sight of her own working-class roots, and she always put the values of working families at the center of everything she did. We hope that her successor will continue to be a powerful voice both within the Obama administration and across the country for all of America’s workers.
This afternoon, I submitted my resignation to President Obama. Growing up in a large Mexican-American family in La Puente, California, I never imagined that I would have the opportunity to serve in a president’s Cabinet, let alone in the service of such an incredible leader.
Because President Obama took very bold action, millions of Americans are back to work. There is still much to do, but we are well on the road to recovery, and middle class Americans know the president is on their side.
Together we have achieved extraordinary things and I am so proud of our work on behalf of the nation’s working families.
This post was originally posted by AFL-CIO NOW on January 9, 2012. Reprinted with Permission.
About the Author: Donna Jablonski is the AFL-CIO’s deputy director of public affairs for publications, Web and broadcast. Prior to joining the AFL-CIO in 1997, she served as publications director at the nonprofit Children’s Defense Fund for 12 years. She began my career as a newspaper reporter in Southwest Florida, and since have written, edited and managed production of advocacy materials— including newsletters, books, brochures, booklets, fliers, calendars, websites, posters and direct response mail and e-mail—to support economic and social justice campaigns. In June 2001, she received a B.A. in Labor Studies from the National Labor College.
Some 450 office clerical workers—members of the International Longshore and Warehouse Union (ILWU) Local 63—are back on the job this morning in the ports of Los Angeles and Long Beach, Calif., after the ILWU and port employers reached a tentative agreement Tuesday night that will prevent the outsourcing of jobs.
ILWU International President Robert McEllrath said the unity and solidarity of the workers, members, their families and thousands of community supporters played a major role in the workers’ win. When the workers struck Nov. 27, ILWU dockworkers and other port workers refused to cross the picket lines.
“This victory was accomplished because of support from the entire ILWU family of 10,000 members in the harbor community.”
The key elements in the tentative agreement are new protections that will help prevent jobs from being outsourced to Texas, Taiwan and beyond. Union spokesman Craig Merrilees said:
“Really, it was getting control on the outsourcing…ensuring that the jobs are here today, tomorrow and for the future.”
The port workers had been without contract for more than two years and employers were threatening to outsource jobs from the nation’s busiest port complex—some 40 percent of all containerized cargo is handled in the Los Angeles and Long Beach ports.
Details of the agreement that still must be ratified have not been released, but news reports say it is a six-year deal that is retroactive to June 30, 2010.
The workers don’t have ordinary clerk and secretarial jobs. The Los Angeles Times describes them as “logistics experts who process a massive flow of information on the content of ships’ cargo containers and their destinations….They are responsible for booking cargo, filing customs documentation and monitoring and tracking cargo movements.”
This post was originally posted on AFL-CIO NOW on November 6, 2012. Reprinted with Permission.
About the Author: Mike Hall is a a former West Virginia newspaper reporter, staff writer for the United Mine Workers Journal and managing editor of the Seafarers Log. He came to the AFL- CIO in 1989 and has written for several federation publications, focusing on legislation and politics, especially grassroots mobilization and workplace safety. When his collar was “still blue,” he carried union cards from the Oil, Chemical and Atomic Workers, American Flint Glass Workers and Teamsters for jobs in a chemical plant, a mining equipment manufacturing plant and a warehouse.
For the third time in the past 14 years, California voters rejected an attempt—fueled by millions of out-of-state dollars—to shut working people out of the political process when they soundly defeated Proposition 32. California Labor Federation Executive Secretary-Treasurer Art Pulaski said working families:
Rejected a blatant power play by corporate special interests to silence the voice of working people. Despite weeks of misleading advertisements backing Prop. 32 paid for by billionaires and out-of-state super PACs, the margin of defeat was decisive. Prop. 32 backers spent more than $50 million in an effort to fool voters.
The San Jose Mercury News reports that $11 million of that war chest came from “a shadowy Arizona group that became entangled with the state’s Supreme Court over where it got its money.”
Ultimately, that money was traced back to two outside groups with ties to the billionaire oil tycoon brothers, David and Charles Koch, as well as to Karl Rove, the former top strategist to former President George W. Bush, whose web of super PACs and non-profit groups spread hundreds of millions of dollars in campaigns across the nation.
Prop. 32 would ban the use of voluntary payroll deductions by union members who want to contribute to their union’s political activity. It would do nothing to stop the campaign spending by secret corporate-backed PACs and the wealthy. Pulaski says:
Prop. 32 had the effect of driving millions of firefighters, electricians, nurses, teachers, plumbers and other working people to the polls today. This measure was nothing less than an attack on working people; an attack we took personally.
More than 40,000 union volunteers made more than 3 million voter contacts and distributed more than 5.1 million worksite leaflets.
As of this morning, Prop. 32 was losing by more than eight percentage points. Working families defeated similar measures in 2005 and 1998.
Working families also rallied to help pass Prop. 30 that will raise $6 billion to put the state’s education system back on track by ending cuts to schools and providing funds to rehire teachers, reduce class sizes and update textbooks. It’s paid for by asking the state’s wealthiest to pay their fair share. Learn more about Prop. 30.
This post was originally posted on AFL-CIO NOW on November 7, 2012. Reprinted with permission.
About the Author: Mike Hall is a former West Virginia newspaper reporter, staff writer for the United Mine Workers Journal and managing editor of the Seafarers Log. I came to the AFL- CIO in 1989 and have written for several federation publications, focusing on legislation and politics, especially grassroots mobilization and workplace safety.
This year, it’s called Prop. 32 and it’s a near-clone of 2005’s Prop. 75 and 1998’s Prop. 226, which voters defeated by 53% to 47%. Both times, huge mobilizations by working families turned back the millions of dollars from Republican PACs and corporate and anti-worker extremists. These are the same groups that are behind Prop. 32.
Deceptively titled, “Stop Special Interest Money Now Act,” Prop. 32 would ban the use of voluntary payroll deductions by union members who want to contribute to their union’s political activity. It would do nothing to stop the campaign spending by secret corporate-backed PACs and the wealthy.
Prop. 32 exempts secretive super PACs and corporate front groups, which can raise unlimited amounts of money from corporate special interests and billionaire businessmen, to support their candidates or defeat their enemies. The measure does nothing to prevent anonymous donors from spending unlimited amounts to influence elections.
Prop. 32 is NOT campaign finance reform, as its backers claim. The wealthy supporters of this initiative created exemptions for Wall Street hedge funds, real estate investors, insurance companies and other well-heeled special interests, allowing them to continue contributing directly to the coffers of political candidates.
Prop. 32 would severely restrict union members in both the public and private sectorfrom having a voice in our political process. As a result, teachers, nurses, firefighters, police officers and other everyday heroes would be unable to speak out on issues that matter to us all—like cuts to our schools and colleges, police and fire response times, patient safety and workplace protections.
This measure would give corporate CEOs and their lobbyists even greater influence over our political system. Corporations already outspend unions 15-1 in politics. This measure would effectively clear the playing field of any opposition to big corporations’ agenda, which includes outsourcing jobs, gutting homeowner protections, slashing wages and health benefits and attacking retirement security.
This post originally appeared in AFL-CIO Now on October 17, 2012. Reprinted with permission.
About The Author: Mike Hall is a former West Virginia newspaper reporter, staff writer for the United Mine Workers Journal and managing editor of the Seafarers Log. He came to the AFL- CIO in 1989 and have written for several federation publications, focusing on legislation and politics, especially grassroots mobilization and workplace safety.
As two critical bills waited quietly on California Governor Jerry Brown’s desk last weekend, immigrants across the state held their breath, hoping that the progressive legislation could affect the national immirgation debate. By Sunday night, the anticipation gave way to disillusionment with two stunning vetoes.
The highly anticipated Domestic Workers Bill of Rights would have enacted major protections for tens of thousands of housekeepers, nannies and other caregivers and closed loopholes ignored by federal labor law. It would have extended California’s policies for overtime pay and workers’ compensation, and helped ease in-house workers’ arduous, sometimes-abusive work routines by providing for a set amount of sleep and the ability to cook one’s own food.
Above all, the Bill of Rights would place California alongside New York (where similar legislation has already passed) in formally recognizing the rights and unique needs of this burgeoning, cross-cutting sector. The bill won support from a huge array of groups, from labor unions to celebrities, precisely because of the myriad social issues that domestic work braids together: the changing demographics of the workforce, the challenges of securing affordable childcare or elder care for families, and the struggles of immigrant workers, particularly women of color, in a largely unregulated industry.
But Brown scrapped the bill (sadly following an earlier veto by former Gov. Arnold Schwarzenegger) andaligned himself with the business lobby, led by the California Chamber of Commerce, which had complained that the provisions of the bill would be unworkable and overly burdensome for employers.
The California Domestic Workers Coalition will continue its campaign (with plans to deploy sponge bombs to help Brown “clean up his act”) by building on its growing network of allies, including women’s rights, labor and faith groups. Looking ahead, Katie Joaquin, a Filipino community activist with the California Domestic Workers Coalition, tells Working In These Times, “We’re going to continue to build upon those relationships. And the first step is to hold Governor Brown accountable for what we view as a blatant lack of leadership.”
Inspired by the New York example, Joaquin says, the California bill is part of a movement for what the National Domestic Workers Alliance calls “an alternative vision of care,” which is based on sustainable working conditions and better training in the care industries, in order to meet the growing need for caregivers as the population ages. “We need to have a vision for training and caring for caregivers at the same time that we’re making care accessible for families,” Joaquin says.
Immigration policy complicates the labor struggle. Brown delivered a one-two punch to California’s migrant communities by also vetoing the Trust Act, which would have restrained the power of local police to route arrestees suspected of immigration violations into the custody of Immigrations and Customs Enforcement (ICE). That means that the mass deportation of undocumented immigrants, including domestic caregivers and other low-wage workers, will continue.
Immigrant rights activists had pushed the Trust Act to counter the Obama administration’s enforcement regime, particularly the Secure Communities program, which encourages federal and local police to collaborate to nab undocumented immigrants. The program mirrors Arizona’s infamous SB1070 law and other state initiatives that threaten to expand racial profiling of Latinos and feed the federal deportation machine (which hasn’t significantly eased up in spite of the administration’s slippery claims of refraining from deportating “low priority” cases, such as students with clean records).
Still, aside from the painful vetoes, Brown managed to approve more modest pro-immigrant measures, such as allowing driver’s licenses for some undocumented immigrants (a move apparently aimed at the youth who would qualify for temporary immigration relief and work permits under the White House’s new “deferred action” policy).
The problem is that making it easier for undocumented workers to drive isn’t going to prevent them from being pulled over and ensnared in deportation proceedings. A young man named Juan Santiago told the Associated Press:
he was pleased he would be able to get from his home in Madera to his college classes 30 miles away once his work permit application is approved. But he said the measure does little for his mother, who brought him across the Arizona desert into the U.S. when he was 11.
“It was a happy and a sad day for us,” Santiago said. “The fact that the governor vetoed the TRUST Act, it means there’s nothing to protect the rest of my family members.”
The legislative changes that immigrants most need now are those that protect the whole neighborhood–at work, in school and at home. In an email to Working In These Times, Chris Newman, legal director of California-based National Day Laborer Organizing Network (NDLON), one of the leading advocates for the Trust Act, says:
Equality demands that all Californians have faith in law enforcement, and the vetoes send a message that whether it’s civil rights, labor rights, or public safety, Jerry Brown does not respect the interests of immigrant workers in California.
Building political savvy and leverage on the street level is critical, with or without supportive legislation. As NDLON activist Pablo Alvarado wrote on the group’s blog, the governor “can veto a bill but he cannot veto a movement.” Ultimately, it’s the community’s power, not the letter of the law, that defines justice.
About the author: Michelle Chen work has appeared in AirAmerica, Extra!, Colorlines and Alternet, along with her self-published zine, cain. She is a regular contributor to In These Times’ workers’ rights blog, Working In These Times, and is a member of the In These Times Board of Editors. She also blogs at Colorlines.com. She can be reached at michellechen @ inthesetimes.com.
LOS ANGELES—At a conference convened by the organization Reporting on Health at the University of Southern California this week, doctors and health care experts shed light on labor-related aspects of the health care field as the sweeping health care reform legislation is set to take effect after being upheld by the U.S. Supreme Court.
They provided a window into the workplace stresses and challenges doctors themselves have faced in our tumultuous and trouble-plagued health care system, and also the health care needs and challenges of low-income workers.
Marcia Sablan, a doctor in the tiny northern California town of Firebaugh, embodies both of these narratives. Marcia is one of many doctors who depended on a federal program that helps people afford medical school in exchange for working in under-served rural districts. After her residency at the University of Hawaii, she was assigned to Firebaugh, in the agricultural valley of Fresno County, with a population then of just over 3,000. She was accompanied by her husband, also a doctor and the first native of Saipan to graduate from a U.S. medical school.
Panelists at the conference noted that such programs will be increasingly important if the government wants to encourage more doctors to go into general primary care rather than becoming specialists. Specialists make an estimated $3.5 million more over their lifetimes, yet there will be an estimated shortage of 30,000 primary care doctors in coming years especially as more people become insured under the new health care law.
Sablan arrived in Firebaugh in 1981 and eventually founded her own private practice there, where she primarily serves low-income Latino farmworkers, about half of them immigrants, including many uninsured people who may or may not end up insured under the health care bill reforms. Doctors and experts at the USC conference echoed the widespread concern that due to the way the health care reform bill and Supreme Court decision played out, people living under the poverty line may not get insurance under the new law. That’s because the insurance exchanges and subsidies the law mandates are designated for people who make more than the poverty line, while people making below the poverty line (including childless adults —a change from the past) are all supposed to be covered by Medicaid.
States are ordered to expand their Medicaid programs to cover people making up to 133 percent of the poverty line, but the mandate doesn’t have strong teeth since it is unclear if or how the federal government can punish states that don’t expand their Medicaid programs to cover the newly eligible people. Many states say they cannot afford their share of the expansion plus the extra costs expected when currently eligible but un-enrolled people “come out of the woodwork” thanks to the publicity around the reform law.
Sablan notes that she never asks her patients about immigration status—she is not required to under California’s Medicaid law—and she typically charges a $50 fee which most patients pay out of pocket.
“Undocumented workers know not to leave a trail, not to leave bills,” she said.
But when her patients need specialty care, the seasonal nature of farm work can cause serious problems. Many of them do have insurance during the months they are employed, but not during the off-months, she said. In her early years in Firebaugh, many of the locals were migrant workers living in labor camps who returned to Mexico or otherwise left Firebaugh for half the year. But the labor camps have been demolished and now many farmworkers have bought homes and live year-round in the town with their families, even as they continue to depend on seasonal agricultural wages. Hence an illness or injury that keeps them away from work for days or weeks during the crucial seasonal employment period is especially devastating financially.
“What does an agricultural-based seasonal economy mean to a doctor practicing there?” Sablan asked, noting that Firebaugh’s population now numbers 6,741: 88 percent Latino, 22 percent living below the poverty line, more than a third unemployed and almost two-thirds without a high school diploma. “It means people have insurance and Medi-Cal (California’s version of Medicaid) at certain seasons of the year. But we know diseases don’t work like that. So this is a huge problem for us—seasonal workers have a very difficult time keeping up with chronic diseases.”
From a health perspective, Sablan is glad to see the valley’s once-thriving cotton industry decline, she said, since it involves heavy pesticide use that raised serious health problems for workers and other residents. Once she treated victims of what was known as the worst pesticide-poisoning case in state history—28 workers critically poisoned after being ordered to return to a field too soon after it had been sprayed with phosphates. Now almonds and pistachios are the main crops in the area, grown mostly by huge industrial farms. (Meanwhile a sustainable cotton projecthas been in the works.)
Sablan hopes the health care reform law will indeed result in better preventative care for low-income and currently uninsured people. She cites the case of one patient, a 54-year-old farmworker who had a heart attack and was prescribed medication which, at $400 a week, he could never afford. Also suffering from diabetes and lacking medication, he eventually had another heart attack and ending up needing permanent dialysis by age 60.
“When you think about the Obama plan, think about [the farmworker] – do we want to be upstream or downstream?” in health care spending, she asked. “Someone paid for him to be in the hospital two times and on dialysis, which costs about a million dollars a year. He’s totally disabled now, unable to work, from what should have been a preventable situation.”
Despite such challenges, Sablan and her husband feel lucky to work in an environment where they have treated three generations of patients —it gives them a sense of personal connection and continuity that other doctors say they lack when forced to see up to 30 patients a day, in the common “fee for service” health care model.
Dr. Ken Kim described the challenges of working in a typical profit-driven, urban system. He and other internists were disgusted to see how badly many of their patients were faring under the standard health care model. He described multiple diabetic patients with legs amputated because they were shuffled between specialists, waiting for months for appointments, while a “pin-sized” wound became infected and festered. And he described elderly patients unable to comply with a doctor’s orders because they lacked a ride to the clinic or couldn’t open medicine bottles with arthritic hands or ate high-sodium meals as shut-ins. Doctors and nurses want to help such patients with personalized care, he indicated, but the fee-for-service model and other aspects of the traditional insurance system create so much time pressure that patients fall through the cracks.
So Kim and other doctors formed an “accountable care organization” (ACO) wherein insurance companies like Blue Cross pay the organization a flat fee to provide care for a certain group of the insurance companies’ enrollees. Kim said that after floundering at first, the company, CareMore, where he now serves as chief medical officer, was able to provide holistic, preventative care to a patient base of mostly ailing senior citizens by subverting the fee for service model, focusing on prevention and making sure the various nurses and doctors working with a given patient communicate and develop a cohesive plan. He said that under their organization rates of hospital readmissions, amputations, mortality and other indicators have decreased drastically. Many hope this type of accountable care organization will become more common under the health reform law.
While the general public is obviously confused about the implications of the health care reform bill, doctors and health care experts are also uncertain about how the law will play out and what it will mean for their own work lives and those of their patients.
About the author: Kari Lydersen, an In These Times contributing editor, is a Chicago-based journalist writing for publications including The Washington Post, the Chicago Reader and The Progressive. Her most recent book is Revolt on Goose Island.