Navigating health care: brokerage and access for undocumented Latino immigrants under the 2010 Affordable Care Act

ABSTRACT

Brokerage is a prominent mechanism that explains access for Latino immigrants to many American institutions. However, few studies examine the dual nature of brokerage in answering questions on access to health care for undocumented Latino immigrants. The growing importance of Federally Qualified Health Centers (FQHCs) and ethnic navigators connecting immigrants to health care under the 2010 Affordable Care Act calls attention to the duality of brokers and its role in access. The study draws from 44 in-depth interviews with providers, clinic directors, navigators, and immigrant patients and two years of fieldwork in FQHCs in California’s San Francisco Bay Area (2011–2013). Results show that brokers enable access through coaching and myth-busting but they also hinder it through scrutiny and bureaucratic filtering. The widespread dependence on brokerage, I argue, leads to ersatz brokerage, such as when providers navigate the health-care system for the undocumented without the appropriate linguistic resources or coordination. Furthermore, the study shows that the duality in brokerage generates misinformation, churning, and alienation. Understanding the relational processes that both include and exclude vulnerable populations from needed services enhances theories of immigrant integration and can help design more efficient policies and address inequalities related to documentation status.     

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.     

The ecology of immigrant naturalisation: a life course approach in the context of institutional conditions

Traditionally, immigrants’ propensity to naturalize is attributed to individual characteristics and the origin country. Recently scholars increasingly recognise that naturalisation decisions do not take place in a vacuum: they are conditioned both by the individual life course of immigrants, such as the age at migration and family situation, as well as the opportunity structure set by citizenship policies of the destination country. Yet it is less clear what impact specific policy changes have, and to whom these changes matter most. In this paper we address these questions by analysing citizenship acquisition among first generation immigrants in the Netherlands in light of a restriction in citizenship policy in 2003. We employ unique micro-level longitudinal data from Dutch municipal population registers between 1995 until 2012, which allow us to track naturalisation among different immigration cohorts. We find evidence that indeed naturalisation is part of a larger life course trajectory: immigrants who arrive at a younger age in the Netherlands naturalise more often and so do immigrants with a native partner, or a foreign-born partner who also naturalises. Policy also matters: migrants naturalise later and less often under more restrictive institutional conditions, especially migrants from less developed and politically unstable countries of origin.     

Immigrant life satisfaction in Europe: the role of social and symbolic boundaries

The cross-national investigation of immigrant subjective well-being remains an understudied field, especially with regard to the link between institutional settings and individual outcomes. We approach this gap by investigating the role of policies regulating immigrant integration for life satisfaction. Immigrants’ status and life chances depend on the inclusiveness of integration policies in forms of rights given to immigrants in the receiving country. These policies differentiate immigrants from natives: exclusionary integration policies understood as social boundaries should result in lower levels of well-being. We also consider an alternative policy type (i.e. multicultural policies) as well as symbolic boundaries (i.e. natives’ attitudes towards immigrants). We distinguish between national citizens, EU citizens and third-country nationals (TCNs). Results based on up to five rounds of data from the European Social Survey indicate that in terms of life satisfaction only TCNs profit from inclusive integration policies. Furthermore, while political multiculturalism does not play a role, we find that EU migrants appear more susceptible to the negative impact of natives’ anti-immigrant attitudes. Policy-making is more important for TCNs, while a migrant-friendly opinion climate is more important for EU migrants. These findings are robust to controlling for unobserved time-constant country heterogeneity via country fixed effects.     

民族地区基本公共服务均等化研究述评:基于公共政策的视角

随着基本公共服务均等化的提出,研究者们展开了对民族地区基本公共服务均等化问题的研究。从本质上说,基本公共服务均等化是一项公共政策,所以文章试图从公共政策的视角出发,以政策价值取向、政策系统、政策过程为分析维度,对研究者们的成果进行归纳和述评,以期对民族地区基本公共服务均等化问题的研究现状有更加全面的认识和把握。     

重大公共卫生事件中应如何作为:来自医学人类学哈佛学派的启示

聚焦人类学者在针对重大公共卫生事件的跨学科研究中应该有何作为这一议题,通过借鉴来自医学人类学哈佛学派的民族志洞见和研究经验,为当下2019新型冠状病毒疫情危机中所进行的田野观察和分析,以期获得灵感和启示,并探索有可行性和操作性的研究策略和方法。     

Nevertheless,They Persist: American and European Muslim Immigrants in the Era of Trump

This paper reviews the consequences of Donald J. Trump’s anti-Muslim rhetoric and policies vis-à-vis his travel ban on Muslim immigration experiences. The paper looks at the impact of Trump’s and like-minded European leaders’ Islamophobic rhetoric and policies on dominant cultures, public policies, and assimilation of Muslims in the U.S. and in Europe. The review correlates said rhetoric and policies with public attitudes about Muslims, the rise of hate crimes and violence against Muslims, public policy changes, and assimilation (including civic engagement) of Muslims. The paper contrasts the differences in attitudes and responses of Muslim and non-Muslim communities in the U.S. and Europe. It concludes that U.S. and European Muslims retain overall positive attitudes about their new home countries and institutions and are politically engaged against the rise of anti-Muslim xenophobia, which varies between America and Europe, based on their respective histories, cultures and economies.