- Colorado’s 2021 Agricultural Labor Rights and Responsibilities Act (ALRRA) guarantees farmworkers access to healthcare providers but does not specify funding.
- In Colorado, 63% of primary care shortage areas are rural (HRSA, 2025) and spending on emergency room visits translates into an estimated $800 million a year in avoidable costs (CIVHC, 2015).
- CSU students developed a Harvest Health Initiative proposal to increase funding to rural clinics already serving farmworkers with a focus on finding healthcare solutions while capturing economies of scale.
Introduction
In 2021, Colorado passed the Agricultural Labor Rights and Responsibilities Act (ALRRA), which extended a range of workplace protections to farmworkers, including a right of access to healthcare providers and to transportation to off-site services (Colorado General Assembly, 2021). The law guaranteed that workers could reach care, but it did not fund the clinics, programs, or capacity needed to ensure that care was available when they arrived.
This gap between a right on paper and the capacity to provide it was the focus of CSU’s entry to the University of Chicago’s 2026 Policy Challenge Super Bowl, which asked teams to identify a healthcare issue in their state and to design a program to address it. A multidisciplinary team of Colorado State University students developed a “Harvest Health Initiative” in response. The Initiative is a proposal to increase funding to rural health clinics already serving farmworkers rather than building a new program from scratch. The summary presented in this REDI Report presents background research and analysis behind that solution: why the gap exists, why the initiative is a funding model, and how the proposed solution could work.
The Cost of Emergency Care
Across the country, healthcare costs continue to balloon. In Colorado, costs rose by 139% from 2013 to 2022, with the total burden of healthcare at $30 billion statewide (Fortier, 2024). One of the main drivers of this cost is the high burden of acute care when compared to preventative care. A 2015 study found that Coloradans spend an average of $1,150 more on an emergency department visit when compared with a regular doctor’s visit, costing Coloradans more than $800 million in unnecessary care (CIVHC, 2015). Burdens of uncompensated care are worse for rural communities, driven by a lack of access to primary care, and the unaffordability of care (Cerutti, 2025). This type of uncompensated care then puts a burden on healthcare systems and can cause rural hospitals and clinics to go under, thus reducing access for the public (Keesee et al., 2023; U.S. Government Accountability Office, 2021).
Why Farmworkers and ALRRA
The gap between preventive and emergency care is widest for populations without consistent access to a regular provider, and Colorado’s farmworkers are among the clearest examples. The Colorado farmworker population is largely uninsured, often seasonal, and is concentrated in rural areas where primary care is limited. National survey data show only 28% of crop workers have access to employer-offered health insurance (Fung et al., 2023), and in Northeastern Colorado, geographic distance to community and migrant health centers compounds that gap (Deka, 2020).
A legal framework already exists. ALRRA establishes farmworkers’ right of access to care (Colorado General Assembly, 2021), so the question is not whether workers should be able to reach care, but why the capacity to provide it is still missing.
Investing in Existing Care, Not a Mobile Model
With farmworkers and the ALRRA gap in focus, the next question is what kind of intervention would actually reach them. An early version of the proposal centered on a mobile healthcare model, bringing care directly to workers in the field. Two interviews reshaped that direction: conversations with Aidan Hettler, CEO of Sedgwick County Health Center, and Dr. Mary Ann Queen, Interim Pediatrician-in-Chief at Children’s Mercy Kansas City, both pointed toward investing in the rural healthcare centers already serving these communities rather than building a parallel system.
The reasoning is one of cost and capacity. Building a new program would mean paying for every component of care delivery from zero, while providers already serving this population have absorbed those costs. Salud Family Health Centers, for example, already operates a mobile unit for migratory and seasonal agricultural workers in rural Northern Colorado, and is tied into a full network of clinics for follow-up care. Table 1 compares what each approach must provide.
How the Harvest Health Initiative Could Be Funded and Conclusion
Rather than rely on short-term grants, the Initiative could be financed through a recurring per-employee fee on agricultural employers, paid into a dedicated fund for farmworker care. A standing revenue source lets the fund support existing clinics year over year rather than in one-time cycles, and it places the cost with the industry whose workforce generates the need. The Policy Challenge team recommended that the fee be tiered rather than flat, because agricultural operations are not uniform and ALRRA already recognizes that. Senate Bill 21-087 defines an “Agricultural Employer” as any operation that “regularly engages the services of one or more” workers (Colorado General Assembly, 2021, § 8-3-104(1)(a)) and treats operation types differently based on their wage structures and labor practices. The proposed fee follows those existing categories, summarized in Table 2. This keeps it proportional to each operation’s circumstances rather than placing an equal burden on operations with very different capacities.
By strategically supporting the funding of existing rural clinics, the Harvest Health Initiative and/or similar proposals could transform healthcare access from a legal right on paper into a practical reality for Colorado’s farmworkers and agricultural communities.
References
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