DUNN, N.C.-Seasonal agricultural workers were just finishing a meal after a long day of planting sweet potato seeds when Julie Pittman pulled up to their camp.
Pittman, a paralegal with the Farmworker Unit of Legal Aid of North Carolina, worked to get their attention.
The health care law that passed in 2010 requires you to have health insurance, she said, speaking in Spanish. If you don't get it, she said, you could be fined.
"Cunto cuesta?" asked a worker, wanting to know the cost.
In the United States legally through the H-2A visa program, these farmworkers, like most American citizens and legal residents, must be insured. But reaching them is an uphill battle.
The majority come from Mexico to work in Florida, Georgia and North Carolina. The deadline for getting insurance starts when they enter the country. They have 60 days to learn about coinsurance and copayments, and decide whether to purchase a high- or low-deductible plan.
Alexis Guild, a migrant health policy analyst at Farmworker Justice, an advocacy in Washington, D.C., said a yearslong partnership among various nonprofits and health centers in North Carolina has been working to enroll the workers.
In the camp near Dunn, Pittman told the workers that the cost of health insurance depends on the type purchased, income and family size. Some people don't have monthly payments, others could pay $40 per month. Consider, she added, that this year's fine is $695 or 2 percent of wages, whichever is greater.
"Would I need to pay the fine?" said Antonio Flores, 29, who like other farmworkers based in North Carolina, makes $10.72 per hour.
It's a difficult question because some workers qualify for an exemption or are offered insurance through their employer.
Mackenzie Mann, a health educator with North Carolina Farmworkers Project, said the only way to be sure is to fill out a form.
The group has signed up about 150 workers since February.
In a camp in Angier, Apolinar Castillo, of Zacatecas, Mexico, said he didn't think twice about paying $10.55 per month for health insurance. "I feel confident that, if there is an emergency, I can dial 911 and use my (insurance) card," said Castillo, 44.
Workers under the H-2A visa program are a small minority of the nation's more than 2.4 million farmworkers, many of whom are in the country illegally and don't have access to health insurance.
Their jobs are among the most dangerous, according to the Occupational Safety and Health Administration. Farmworkers face exposure to pesticides, and risk heat exhaustion and heatstroke.
Outside of emergencies, farmworkers can use community health centers, which receive federal funding to care for the poor and uninsured.
Dr. Eugene H. Maynard, of the Benson Area Medical Center, said many procedures can be done at his office, where fees are based on a sliding scale. But some require specialists, whose steep prices are out of the reach to most workers.
Often, Maynard said, he places workers on waiting lists for charity care, but they are so long that workers return to Mexico before seeing a specialist.
"Insurance makes that process a lot easier," Maynard said.
Some are skeptical that access to health insurance would translate into better health care.
Thomas Arcury, director of the Center for Worker Health at Wake Forest Baptist Medical Center, said farmworkers work long hours, don't have access to transportation or accumulate paid sick days, which is why many ignore their illnesses.
"There are a lot of roadblocks," Arcury said.
Large farmworkers are required to offer health insurance to their workers. They have raised the issue of cost, arguing that already provide workers' compensation, which covers work-related injuries.
U.S. Rep. Renee Ellmers, a Republican from North Carolina, has twice introduced a bill to exclude farmworkers under the H-2A visa program from the employer mandate. In a statement, she said the cost would put many farmers out of business.
Steve Davis of Greene County Health Care, a community health center that enrolled nearly 800 workers last year, said most farmworkers know of workers who were injured or became ill and landed in the emergency room.
Last October, for example, Feliciano Gonzalez went to the ER with an unbearable pain in his arm and chest. He said doctors kept him overnight and told him to take a couple days off.
The hospital billed $14,900. It wasn't a work injury, so his health insurance paid most of the bill and he owed $750.
"We need to be protected," Gonzalez said.