Coverage Isn't the Whole Story: Insurance, Gender, and Access to Care in Colorado's Fields

Access to healthcare can look very different depending on a worker’s immigration status. Agricultural workers on H-2A visas face a unique set of pressures: employer-tied housing, fixed-length contracts, and now, wage rules that are actively changing. Nearly 400,000 workers now enter the country each year on H-2A visas, and that number keeps growing as farms rely more on the program to fill labor shortages. Whatever policy changes come out of Congress this year will affect a workforce that size directly. The Securing Agriculture’s Workforce Act would overhaul how H-2A contracts and wages work, and a recent Department of Labor rule change has already cut take-home pay for many H-2A workers by letting employers charge for housing that used to be free. These debates focus almost entirely on wages and program costs. Wages and housing costs shape a worker’s life, but they say nothing about whether that worker can see a doctor when they need one. Healthcare access for H-2A workers has largely stayed outside this policy conversation. Project Protect’s 2025 HDCGP Preventative Healthcare Survey offers a different angle: H-2A status may also predict if a worker can get health care when they need it. This week, we looked at whether workers experienced a barrier to needed health care in 2025, and whether gender, H-2A status, or insurance coverage predicted who ran into one. 

We started with the question at the center of this debate: does H-2A status predict whether a worker runs into a barrier to needed health care in 2025? Among 530 respondents with valid answers to both questions, only 23.4% of H-2A workers (15 of 64) reported being unable to get needed health services, compared to 43.1% of non-H-2A workers (201 of 466). This gap is statistically significant (p=0.003), meaning H-2A status can predict who runs into a barrier in this sample. Among H-2A workers who did report a barrier, the type also differed. Barriers were sorted into two types: economic barriers covered cost and lack of insurance, while logistical barriers covered scheduling conflicts, transportation, and lack of time off work. Among the H-2A respondents, 10 of 15 described it as logistical (scheduling, transportation, hours), compared to just 2 who called it economic. Non-H-2A workers split closer to evenly between the two. Research on transportation barriers to care finds that inconvenient hours and lack of personal transportation are among the most common reasons patients delay or skip care, which lines up with what H-2A workers are describing here. The lower overall barrier rate for H-2A workers is driven largely by one response: 52.3% of H-2A workers said they had no need to go or did not get sick, compared to 25.5% of non-H-2A workers. Reports of never having had issues with health care services were similar across both groups (18.5% vs. 24.9%). This suggests the gap is not about H-2A workers navigating the health care system more successfully. It may instead reflect a workforce that is younger, healthier on average, or less likely to seek care even when something comes up. 

Next, we checked whether having insurance keeps workers from hitting a barrier to care. Among 535 respondents, 40.3% of currently insured workers (77 of 191) and 40.7% of uninsured workers (140 of 344) reported a barrier in 2025. This difference is not statistically significant (p=0.931), meaning insurance status alone does not explain who runs into trouble getting care. This is the most important null result in this week's data. A common assumption in health policy is that getting someone insured solves their access to care. A worker with coverage and a worker without it are equally likely to report being unable to get care when they need it. But the type of barrier tells a different story: among workers who did report one, those with insurance were more likely to describe it as logistical (48.1%) than economic (27.3%), while uninsured workers showed the opposite pattern, citing economic barriers (47.1%) far more than logistical ones (27.1%), a difference that is itself statistically significant (p=0.004). Expanding coverage without addressing scheduling and transportation is unlikely to close the gap this survey found. Coverage affects what care costs once a worker is already in the door. It does little to affect whether they get in the door at all. 

Gender shaped last week's findings on healthcare awareness. This week, we asked whether it shapes something more immediate: who gets left without care. Among 547 respondents, 42.6% of men (147 of 345) and 37.1% of women (75 of 202) reported a barrier in 2025. This difference is not statistically significant (p=0.208), meaning gender alone does not predict who runs into an access problem in this workforce.This result rules out gender as a driver of who hits a barrier once a worker seeks care. Last week’s data showed real gender differences in awareness of employer coverage and financial assistance programs. That gap does not carry over into whether a worker actually gets the care they need. Appointments, time off, and transportation hit men and women in this workforce at close to the same rate. 

Taken together, these findings complicate the current H-2A policy debate rather than fit neatly into it. Congress is considering the Securing Agriculture’s Workforce Act, a bill with 50 co-sponsors that would rewrite H-2A wage formulas and remove the program’s seasonal requirement, while the Department of Labor has separately changed how H-2A wages are calculated, cutting take-home pay for many workers. Both efforts are about money, wages going up or down, and who pays for housing. Neither touches the problem this survey is picking up: workers who cannot leave the field to make an appointment, cannot reach a clinic, or cannot find clinic hours that match a farm schedule. Insurance status does not predict who hits these barriers, and neither does gender. H-2A status does, and the type of barrier H-2A workers describe skews logistical rather than financial. One existing model points toward a real solution: the community health worker, known in Latino communities as a promotora, someone from the same community who bridges workers to a healthcare system that would otherwise be out of reach. The Rural Health Information Hub’s toolkit on this workforce finds the model works because the health worker shares the same social, cultural, and economic background as the people they serve, not just professional training. Project Protect’s own Promotora Network is built on that same design. This week’s findings show why that design works: the barriers workers face are logistical, and a promotora is positioned to help close exactly that kind of gap.