Obamacare in action: how access to the health care system contributes to immigrants’ sense of belonging

ABSTRACT

The Affordable Care Act (ACA) aimed to reduce stark health inequalities by providing universal health insurance to all Americans and long-term authorised immigrants. Later regulations, however, gave the 50 U.S. states latitude to choose the degree of coverage for their constituencies. In this paper, we explore how interactions with these diverse systems of care contribute to the incorporation of immigrants into America, especially among the most likely to remain uninsured: the working poor. We uncovered a process in which immigrants’ access to health coverage and care was informed by the procedural justice embedded in their interactions with representatives of the health care system. These interactions signalled to immigrants their deservingness in American society, operating as a system of incorporation in the most inclusive states and as a barrier to incorporation in the most exclusive ones. Repealing the ACA may exacerbate differences across states in access to health care among eligible immigrants and end the incipient transformation of the U.S. health care system into an agent of immigrant incorporation.     

Immigrant access in the Affordable Care Act: legacies of the Confederacy

ABSTRACT

During its first five years, the Affordable Care Act (ACA) built upon previous categorical distinctions among immigrants to solidify some inequalities and partially redress others. To analyse these changes, we build upon Tilly’s theory of durable inequalities by adding the concepts of redress and retrenchment, reflecting the dynamics of change among countervailing powers in a policy field. We employ this theoretical framework to investigate the ways the ACA has selectively reduced barriers for certain categories of immigrants, but not others. Some of these strategies date back to the ways the white power elite in Confederate states set out to regain control as Congress acted after 1865 to grant freed slaves full citizen’s rights. These barriers became blueprints for political strategies to block or subvert federal reforms. Additionally, we describe the ACA effort to reduce the legacy of de facto barriers for immigrants. We also detail how the federalist nature of the Act continued to allow wide-ranging forms of retrenchment and redress at state and local levels. Through this theoretical and historical analysis, we show how the ACA sought to redress certain historical inequalities of immigrant health care access but also solidified others, particularly in the case of undocumented immigrants.     

Nativity and citizenship status affect Latinos’ health insurance coverage under the ACA

ABSTRACT

The 2010 Patient Protection and Affordable Care Act (ACA) aimed to increase health insurance access for the over 47 million uninsured people in the U.S.A., among whom ethnoracial minorities had the highest uninsured rates before the ACA. Studies have shown that Latinos have had the greatest improvements in health coverage under the ACA, but many may be at a significant disadvantage, specifically due to their nativity and immigration status, as the ACA explicitly excludes unauthorised immigrants from most of its provisions. Using the 2015 Latino National Health and Immigration Survey, a nationally representative sample of Latinos (n?=?1493), we find that variation in health insurance access among Latinos can be traced to immigration status. This study finds no differences among U.S.-born versus foreign-born Latinos in the likelihood of being uninsured in 2015. However, among foreign-born Latinos, unauthorised immigrants are five times more likely than naturalised citizens to be uninsured and less likely to visit a primary care provider or clinic, even after controlling for other factors including language, income and education.     

Labour migration brokerage and Dalit politics in Andhra Pradesh: a Dalit fabric of labour circulation

ABSTRACT

Why and how do labour migrant brokers engage with henchmen of bosses, small-time criminals and violent politicians? What significance do labour brokers’ political relations have in the fabric of labour circulation? This article argues for migration brokerage to be examined along a broad continuum of brokerage to explore the local fabric of labour circulation in the Indian construction sector. Considering migration brokerage as part of a broader landscape of brokerage firstly allows look at how migration brokers concretely navigate the worlds of labour and politics to pursue their activities and to further their own agendas. It secondly offers insight into how the everyday relations between migrant brokers and henchmen of bosses shape the lives of migrant labourers in the urban construction sector. Based on a detailed ethnography of the relation between a Dalit labour maistri and a Dalit henchman of a boss in a context of violent criminal political economy, this article explores the roles of Dalit politics in shaping the Dalit fabric of labour circulation and labour broker’s trajectories in South India. It further looks at the ambivalent production and mobilisation of Dalit identities in the making of an ideal Dalit migrant labourer.     

Is coverage enough? Persistent health disparities in marginalised Latino border communities

ABSTRACT

What has been the fate of those living in the place once dubbed the ‘county that needs the Affordable Care Act the most’? This article presents results from a longitudinal, five-year ethnographic study of healthcare access in the Rio Grande Valley of Texas. It explores reasons why this region along the U.S./Mexico border has the highest rate of uninsured persons in the country and remains among the most medically underserved, despite some increases in coverage accompanying the Affordable Care Act (ACA). It argues that the convergence of healthcare and immigration policy, framed by a unique regional history and social environment, has had multiple direct and indirect impacts on health and healthcare access. It examines the impact of the ACA on access for Latino immigrants and mixed-status households, which contain a mix of citizens, legal residents, and undocumented persons. It argues that the ACA aided in shifting the conversation to promoting private insurance coverage and away from more fundamental access barriers for low-income working populations ineligible for its benefits. This has eclipsed discussions about fundamental causes of persistent and highly racialised health disparities.     

Immigration Policies and Social Determinants of Health: Is Immigrants’ Health at Risk?

The purpose of this study was to examine the impact of immigration legislation on Latino immigrants within the social determinants of health framework to understand the impact of such legislation on the immigrant’s health. While the socio-political climate in California is geared towards more pro-integration immigration policies, findings indicate that immigrants still experiences poor treatment in the form of microaggressions, horizontal discrimination, and institutional discrimination. This poor treatment may be an indication of residual anti-immigrant sentiment that remains in the state as well as a spillover effect from the anti-immigrant legislation being passed in neighboring states or national rhetoric. The findings overlap with four domains of the social determinants of health framework including economic stability, education, health and access to care, and social and community context. Implications for practice, policy and research are discussed.     

Living a Deportation Threat: Anticipatory Stressors Confronted by Undocumented Mexican Immigrant Women

Previous sociological research shows that exposure to stress varies by individuals’ social statuses and is a central mechanism in producing mental health disparities. This line of research suggests that ethnoracial groups are more exposed to racial discrimination, thus negatively impacting their mental health. There has also been a growing literature showing how legal status impacts the mental health of immigrants and their families. However, the sociology of mental health and migration literature has largely remained disparate. This paper bridges these literatures to highlight how living a deportation threat manifests itself as an anticipatory stressor that negatively impacts undocumented Mexican migrant women’s access to resources, social relationships, and social roles. Based on 30 semi-structured in-depth interviews with undocumented Mexican immigrant women from Houston, Texas, my findings reveal living a deportation threat is a perpetual anticipatory stressor that intensifies the effects of avoiding authorities, family fragmentation, and economic uncertainty. I argue this anticipatory stressor transforms into a chronic stressor that undocumented Mexican women confront daily. By situating this study within an anti-immigrant social context, it highlights the social processes and mechanisms that exacerbate the stressors undocumented Mexican immigrant women confront.     

Activism of immigrants in vulnerable conditions and radical-left allies: a case study of Italy’s Struggle of the Crane

As interest in immigrant mobilisations in hostile national environments grows among migration scholars, the reasons why immigrants in vulnerable conditions engage in radicalised mobilisation at the local level and why they make alliances with controversial non-institutional radical-left actors need to be further explained. This study examines the conditions of mobilisation and radicalisation by undocumented immigrants in Brescia (a mid-sized city in Northern Italy) through the lens of a contentious moment that took place for two months in 2010, known as the Struggle of the Crane (Lotta della gru). It addresses two questions: why have undocumented immigrants in Brescia been mobilised to contentious political activism? And, why have they created partnerships with non-institutional radical-left organisations, rather than institutional non-state organisations, such as the Church and traditional trade unions? In addition to the hostile national context, discrimination and repression by local authorities triggered the motivation for mobilisation and nourished the radicalisation of the struggle and its endurance. Additionally, competing discourses and practices over immigrants’ access to rights and deservingness by multiple non-state actors played a key role in shaping alliances. The long-lasting alliance with the radical left since the 1990s was renewed and reinforced in 2010 by immigrants’ growing distrust towards institutional non-state actors.     

“My Life was Filled with Constant Anxiety”: Anti-Immigrant Discrimination,Undocumented Status,and Their Mental Health Implications for Brazilian Immigrants

Immigration reform and the various costs associated with undocumented immigration have been in national headlines in the past few years. The growth of Latinos as the US’ largest ethno-racial minority has sparked debates about the “browning” of the United States and led to an increase in anti-immigrant discrimination. While some researchers have documented the effects of racial discrimination on the mental health of ethno-racial minorities in the United States, less has explored how anti-immigrant discrimination and undocumented status influence the mental and psychological well-being of Latino immigrants, more specifically Brazilian immigrants, in the United States. Relying on data from in-depth interviews conducted with 49 Brazilian return migrants who immigrated to the United States and subsequently returned to Brazil, this paper will examine how their experiences living as racialized and primarily undocumented immigrants in the United States influenced their mental health. Specifically, I demonstrate that respondents experienced ethno-racial and anti-immigrant discrimination and endured various challenges that had negative implications for their mental health. This paper will also discuss additional factors that researchers should take into account when examining immigrants’ mental health and the challenges immigrants encounter in a racialized society with increasing anti-immigrant sentiment.     

Trust among recent immigrants in Canada: levels,roots and implications for immigrant integration

ABSTRACT

Generalised trust promotes social interactions and may well be a crucial component of immigrant integration. Recent immigrants in particular are likely to be viewed by themselves and others as ‘outsiders’ who are unfamiliar with the expectations and norms that structure day-to-day social interactions in the host country. This study relies on a unique combination of three sources of data all derived from World Values Surveys to examine levels of trust, and its sources, among newcomers in one country with a large immigrant population, Canada. The evidence indicates that recent immigrants to Canada make a clear distinction between trust in other people in general, and trust in Canadians in particular: the former is grounded in pre-migration cultural influences, while the latter is grounded in immigrants’ experiences in the new host country. Moreover, the evidence suggests trust in Canadians is a crucial component of immigrant integration.     

Searching for belonging and confronting exclusion: a person-centred approach to immigrant settlement experiences in Canada

ABSTRACT

Drawing on an analysis of three immigrant narratives, this paper employs a person-centred approach to immigrant integration in Canada. It examines how immigrants interpret the inclusions/exclusions that mark their integration experience and the consequences these experiences have on their social identities and sense of belonging. Analysis demonstrates that for immigrants a sense of belonging does not grow in a linear fashion; rather, it grows, stalls, dissipates and/or flourishes in relation to the ties and identifications that immigrants are enabled to forge. Broader structural and historical forces prefigure immigrant inclusion and exclusion in Canada in ways that reflect a hierarchy of migration and belonging. We argue that a recognition of Canada’s ‘hierarchies of belonging’ and the multidimensional nature of social inclusion/exclusion complicate integration metaphors that flatten the uneven social terrain of immigrant belonging.     

Formal determinants of informal arrangements: housing and undocumented immigrants in Rotterdam

"Using data on undocumented immigrants in the city of Rotterdam, it is argued that peculiarities of the Dutch housing market, especially the large degree of decommodification of the housing stock, lead to a specific housing situation and housing career of illegal immigrants.... The housing situation of undocumented immigrants in Rotterdam clearly shows how formal arrangements create conditions for informal practices.... A comparison between Dutch and U.S. data shows that differences in formal arrangements have substantial effects on the potential of ethnic solidarity within immigrant communities."     

Who has Housing Affordability Problems? Disparities in Housing Cost Burden by Race, Nativity, and Legal Status in Los Angeles

Housing costs are a substantial component of US household expenditures. Those who allocate a large proportion of their income to housing often have to make difficult financial decisions with significant short-term and long-term implications for adults and children. This study employs cross-sectional data from the first wave of the Los Angeles Family and Neighborhood Survey collected between 2000 and 2002 to examine the most common US standard of housing affordability, the likelihood of spending 30 % or more of income on shelter costs. Multivariate analyses of a low-income sample of US-born Latinos, whites, African Americans, authorized Latino immigrants, and unauthorized Latino immigrants focus on baseline and persistent differences in the likelihood of being cost burdened by race, nativity, and legal status. Nearly half or more of each group of low-income respondents experience housing affordability problems. The results suggest that immigrants’ legal status is the primary source of disparities among those examined, with the multivariate analyses revealing large and persistent disparities for unauthorized Latino immigrants relative to most other groups. Moreover, the higher odds of housing cost burden observed for unauthorized immigrants compared with their authorized immigrant counterparts remains substantial, accounting for traditional indicators of immigrant assimilation. These results are consistent with emerging scholarship regarding the role of legal status in shaping immigrant outcomes in the United States.     

Racial and Structural Discrimination Toward the Children of Indigenous Mexican Immigrants

My research examines the role of patron saint celebrations in how the children of indigenous Oaxacan immigrants living in Los Angeles, California form ethnic, community, and national identities. Religious practices among immigrants have been characterized as a reterritorialization of religious practices (McAlister in Gatherings in diaspora: Religious communities and the new immigration, 1998). Importantly, legal status may influence transborder movement for undocumented immigrants thereby affecting the extent and character of immigrants’ transnational activities, including their religious practices (Menjívar in J Ethn Migr Stud 28:531–552, 2002). In cases when immigrants may be unable to return their country of origin, rituals figuratively transport immigrants between the sending and receiving community (Tweed in J Am Acad Religion 70:253–277, 2002). Thus, religious identities and practices also enable immigrants to sustain membership in multiple locations, allowing them to affirm continued attachments to a particular sending community or nation even if they are unable to return to their home country (Levitt in Int Migr Rev 37:847–873, 2003). Playing in village-based bands, performing traditional dances, or attending patron saint festivities facilitate indigenous youths’ social integration into the U.S. by fostering a strong sense of ethnic pride in the face of anti-indigenous discrimination from within the Latino population or anti-immigrant hostility from mainstream society. This article explores the racism at structural and individuals levels the children of indigenous immigrants contend with, as well as the effects of these on patterns of identity formation for the children of undocumented indigenous immigrants and on their children’s transnational practices.     

Deconstructing Immigrant Illegality: A Mixed-Methods Investigation of Stress and Health Among Undocumented College Students

Research has established that being undocumented is a risk factor for mental and physical health conditions. Much of this work emphasizes undocumented immigrants’ chronic stress, yet key questions about pathways to health remain. The mere state of being undocumented is viewed as a general stressor, without considering actual levels of stress or identifying dimensions of documentation status that contribute to overall stress levels. Drawing on surveys and interviews with undocumented students at the University of California, we uncover the everyday manifestations of four dimensions of immigrant “illegality”: academic concerns, future concerns, financial concerns, and deportation concerns, and their association with reported stress levels and self-rated health. Survey data establish undocumented students’ high levels of stress and poorer health, in comparison to previous research on other national samples. In a structural equation model, we found academic and future concerns to be significantly associated with higher stress, which was in turn, associated with poorer self-rated health. Financial concerns were not associated with higher perceived stress but were directly associated with poorer self-rated health. Notably, deportation concerns did not have any significant independent associations with stress or health. We use our qualitative data to identify specific stressors embedded within these four dimensions. Our findings inform understandings of the health risks arising from documentation status.     

Model (undocumented) minorities and “illegal” immigrants: centering Asian Americans and US carcerality in undocumented student discourse

As the numbers of immigrant apprehensions, detentions, and deportations increase, and in context of anti-immigrant sentiment, education scholars must better contend with the way that carcerality affects undocumented student experiences. Carcerality refers to social and political systems that formally and informally promote discipline, punishment, and incarceration. Guided by Critical Race Theory, I examine interview data from 15 undocumented Asian Americans to show that the portrayal of undocumented student exceptionalism that typically characterizes the discourse on their experiences obscures the centrality of carcerality in shaping how young people with undocumented status navigate their lives. The narratives of undocumented Asian Americans represent a shift in undocumented discourse as these students de-emphasized their academic mobility, demonstrated a hyper-awareness of punitive immigration policies, and were traumatized by and practiced nondisclosure in response to deportation threats. However, while these students developed resistance strategies that they believed would both physically and psychologically protect their presence in the US, some reinforced white supremacist perceptions of the illegality of other undocumented immigrants. Undocumented Asian American experiences illuminate the nuanced relationship between the criminalization of undocumented immigrants, race, and education, and how a legacy of carcerality is vital to deciphering the contemporary educational experiences of undocumented students in the US.     

The paradox of integration and isolation within immigrant organisations: the case of a Latin American Association in Israel

Most immigrant organisations aim to facilitate the integration of immigrants into the host society while seeking to preserve their cultural heritage. In order to explore the tension between these two apparently opposite processes within immigrant organisations, a case study was carried out on the Organization of Latin American Immigrants in Israel (OLEI). The research question focuses on how, and to what extent, OLEI contributes to the integration of Latin American immigrants into Israeli society and how, and to what extent, it contributes to their isolation. The findings indicate that while individual services promote the integration of Latin American immigrants into Israeli society, communal services both isolate and integrate them simultaneously. To address this paradox, I suggest an interpretation of this process as ‘integration through isolation’, since OLEI socially isolates immigrants, but at the same time integrates them into the host society by providing Israeli culture in Spanish.     

Gender,migration and care deficits: what role for the sustainable development goals?

ABSTRACT

This article explores migration to higher income countries in light of collective commitments to the Sustainable Development Goals (SDGs) and argues that domestic social protection and labour market policy will need to be modified to meet these commitments. We look primarily at women in care work, using a broad definition of care that includes home help, domestic work and health care. We argue that the failure to recognise and value unpaid care work has created a sustained labour demand for women migrant care workers in many of these labour-importing countries. Increasingly, immigrant women are being imported into host economies to care, often in informal settings, and frequently engaged by private households, without full access to social protection and labour rights. The consistent application of SDG goals 5 and 8 and their linking to existing labour rights norms and conventions could simultaneously address care deficits in home and host countries and protect the rights of care workers in labour-importing countries and ensure that migrant workers are able to claim these rights.     

Hiding within racial hierarchies: how undocumented immigrants make residential decisions in an American city

In the United States, the residential segregation of Latinos from whites has persisted but has fallen between Latinos and blacks. Demographers offer the size of the Latino population that is undocumented as one potential explanation for these patterns. However, little work has examined undocumented immigrants’ first-hand accounts of residential decision-making. Drawing on interviews with undocumented-headed, Latin American-origin families in Dallas, Texas, we explore how lacking legal status relates to residential selection. We find that some undocumented families perceive certain neighbourhoods to be ‘off-limits’, not only because of financial constraints, explicit legal impediments to their tenure, or individual racial preferences, but also because they perceive them as high-risk: Most sample households agree that law enforcement patrols areas with white majorities in order to exclude Latinos and, specifically, the undocumented. As a strategy to minimise the perceived risk law enforcement poses to their families’ stability, some undocumented families in the study report opting into neighbourhoods with Latino majorities in order to ‘blend in’, whereas others describe feeling safe in neighbourhoods with black majorities where they can ‘hide in plain sight’. We demonstrate how undocumented families’ perceptions of law enforcement in neighbourhoods with differing racial compositions may partly underlie trends in residential selection and stratification.     

Scapegoat citizens in times of austerity: the impact of the crisis on the immigrant population in Spain

The economic crisis has not yet produced alarming cases of racism and social conflict in Spain. However, as we shall analyse, there are indications that ‘immigrants’ are considered one of the first populations to be disposed of in times of crisis. A preference for nationals is increasing among traditional parties, alongside the rise of political parties with anti-immigrant agendas. Unemployment rates among the foreign born population are disproportionate in comparison with those of the native population. Migration policies that link residence permits to the possession of an employment contract have resulted in disturbing rates of irregularity. Health regulations have been amended to prevent irregular immigrants from accessing ‘universal’ health care. Police raids occur in public places to detain and expel undocumented immigrants, and ‘hospitality’ towards irregular immigrants is considered a criminal offence by a new reform in the Penal Code. As a parallel trend that is repeated in other European countries in times of austerity, we shall identify a depletion of universal rights, detention, and deportation as alienating strategies and technologies that are used to redefine the relations between citizens and ‘others’ within the contemporary citizenship regime. Leaning on Engin Isin's critical perspective on citizenship, this article argues that under the circumstances of crisis and austerity that harry Spain, the ‘immigrant’ is constructed as a disposable category, not only to balance the labour market and welfare state, but also to reinforce the notion of the national citizen as a subject of rights.