A Working Class

Part 1, continued: Undocumented and Uninsured – A Health Care Challenge

[Editor’s Note: Click this link for an overview of the series and an interview with the author.]

Tammy Worth — Special correspondent to The Hale Center for Journalism

Anna is a 17-year-old living in Mission, Kan. She is a well-spoken, pretty young woman who seems like a typical high school senior. But if you look closer, there are some subtle distinctions.

Though she wanted to, she couldn’t take part in an exchange trip this past summer to China. She doesn’t have a job or a driver’s license, and she won’t be getting student loans next fall for college.

She’s unable to do many of the things her friends do because she doesn’t have a U.S. passport or a Social Security number. Anna and her family are undocumented immigrants.

Anna talks intently about her inability to understand why people think individuals like she and her family “don’t belong here.” She came to the states from Mexico City with her mother when she was three. The only life she has ever known is one in this country, and the fact that she is different than her peers has only come to the fore in the past couple of years.

“I always knew I was undocumented – my mother never hid it from me – but it has just recently hit me,” she said. “I can’t travel and get a (driver’s) license like my friends have.”

And her 42-year-old mother has started having health problems. Her family goes downtown to Cabot Westside Medical and Dental Center for primary care. When they found blood in her urine and a potential problem with her heart, all the doctors could do was recommend she see a specialist.

A urologist at Shawnee Mission Medical Center ran basic tests, but said she needed more. Anna said they were going to cost thousands of dollars. Because they are undocumented, Anna’s mother doesn’t qualify for a payment plan or financial assistance. It was also recommended that she see a cardiologist, but her mother was unable to go to the University of Kansas Hospital because they don’t provide any kind of financial aid without documentation.

So along with focusing on prom, graduation and college, Anna worries about her mother’s health and how to pay off exorbitant, but necessary, medical bills. And what happens if her mother becomes too sick to work?

Both of her parents work; their employers know they are undocumented, and while health insurance is offered, her parents are ineligible without documentation.

Her family talked with a health care navigator at El Centro Inc., a Kansas City nonprofit, who told them their best bet would be to go to Mexico to get care. They know that going to Mexico means not coming back to the states.

“How could she go back to somewhere she doesn’t know anymore?” Anna asks. “We’ve been here so long; this is where we call home.”

Immigrant workforce 

Immigrants come to the United States to work. Thirty-five percent of the undocumented population are men aged 18 to 39 compared with 14 percent of U.S. citizens, according to 2008 numbers by the Pew Research Center. There are also dramatically fewer elderly undocumented immigrants: 1.2 percent of the total undocumented population is aged 65 or older as opposed to 12 percent of U.S. citizens.

Some work as doctors, scientists and software engineers – a 2012 study released by the Kauffman Foundation found that nearly 25 percent of high-tech companies nationwide are founded by immigrants. But this is the minority of immigrant workers; a majority of them work in low-wage, physically demanding jobs.

Audé Negrete-Banos, director of community services at El Centro, Inc. in Olathe, sees at least 100 people lined up most mornings at the labor company adjacent to her office.

“There are a lot of immigrants working at landscaping companies in Olathe,” she said. “Look at how pretty Lenexa is. Who do you think is doing all of that work?”

Studies looking at the economic impact of immigrants in Kansas and Missouri found that more than 70 percent of butchers and meat cutters in Kansas are immigrants. In Missouri, the industries that employ the highest numbers of immigrants are animal slaughtering and processing, food service, construction and health care.

Judy Ancel, director of the Institute for Labor Studies at the University of Missouri-Kansas City, said the meatpacking industry in particular “has been a real cash cow for employers, and for both Mexican and American laborers its been a disaster.”

Dangerous progress: the meatpacking industry

Problems in the meatpacking industry began in the 1980s, Ancel said. New industrial processes sped up work and reduced safety, making it one of the most dangerous industries in which to work.

The U.S. Bureau of Labor Statistics found that the industry reported 262.3 injuries per 100,000 workers in 2012. Those rates are more than four times that of other injury-prone manufacturing businesses. A 2008 article in the Journal of Agromedicine looked at three-years of injuries reported in a Midwest meatpacking plant. They found the rate of injury to be 22.76 for every 100 full-time employees. Even with the high numbers, the study authors contend that injuries in this sector are greatly underreported, particularly by Hispanic workers.

While the industry was becoming more mechanized, unions were moving out, wages were lowering and plants were relocating from urban centers to rural communities.

No one wanted to work these dangerous, low-paying jobs, so employers turned to immigrant laborers. Many of these were Mexicans moving to the country to escape a debt crisis in the early 1980s.

“It is clear this industry has survived for decades now by employing undocumented laborers,” Ancel said. “If they are here and have no papers, they are condemned to do low-wage jobs no one else wants to do for that amount of pay.”

Erik is an employee of Mossberg Sanitation, the Great Bend, Kan.-based group contracted to clean the Farmland facility in Milan. He used to work at a plant in Virginia, but when the company lost its contract, Erik and the other workers followed their employer to Milan.

That was five years ago, and he is the last person from his group still cleaning the plant. Because of the arduousness of the labor, turnover is high; most people only stay on the job for a couple of months before moving on. Erik stays so he can send money home to his wife and four children.

“Work is really difficult and there is not enough time to do it, but you have no choice,” he said. “I have to make money for my family.”

I speak with Erik via Axel Fuentes, an employee of the Center for New Community, a Chicago-based organization dedicated to racial justice. For the past five years, Fuentes has split his time between Milan and other Midwestern towns working with immigrants as a translator, chauffeur, advocate, friend and community organizer.

Fuentes acts as a go-between for the plant’s employees and the community, focusing most of his time on health care. He has pushed to make the plant a safer place for its employees and made midnight emergency room runs with injured immigrants. He has rushed pregnant women to the hospital and ridden with them in the ambulance while they labor.

In spite of his dedication to the immigrants in the community, he is not a medical professional. He translates as best he can, but during our conversation it is easy to see how things can get missed. Terms like gestational diabetes and sciatica are not part of his everyday vocabulary. A few of the providers in and around Milan have translators on staff, but when they don’t, the task is left to Fuentes. When he is not there, immigrants pay people to translate or go without.

Not long ago, Erik hurt his back and was unable to sleep because of the pain. He went with Fuentes to a health clinic in Kirksville, about a half hour east of Milan. The bill was $700, and for that, he got very little. He didn’t understand his treatment because everything was in English. Fuentes said they provided some muscular manipulation and a prescription, but no diagnosis, save returning for a follow-up visit. Erik never went back because he couldn’t afford another visit or more medication.

This scenario is endemic for many of the immigrants Fuentes helps. The bills are too high, they don’t understand instructions and they get little to no resolution for their conditions.

“I wish I could go again, but I can’t go,” Erik said. “A lot of my co-workers want to go but they decide not to because they have families, too, and it is too expensive to go. Everyone just stands their own pain.”

Worth reported this special series during a year-long Association of Health Care Journalists Reporting Fellowship on Health Care Performance supported by The Commonwealth Fund.

Major Funding for Health coverage on KCPT provided by Assurant Employee Benefits and the Health Care Foundation of Greater Kansas City.