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.     

Detection of multiple undocumented change-points using adaptive Lasso

The problem of detecting multiple undocumented change-points in a historical temperature sequence with simple linear trend is formulated by a linear model. We apply adaptive least absolute shrinkage and selection operator (Lasso) to estimate the number and locations of change-points. Model selection criteria are used to choose the Lasso smoothing parameter. As adaptive Lasso may overestimate the number of change-points, we perform post-selection on change-points detected by adaptive Lasso using multivariate t simultaneous confidence intervals. Our method is demonstrated on the annual temperature data (year: 1902–2000) from Tuscaloosa, Alabama.     

Exploring parent–child communication in the context of threat: immigrant families facing detention and deportation in post-9/11 USA

This paper explores whether and how documented and undocumented migrant parents communicate with their children about the threats posed by the intensified enforcement of 1996 and 2001 US immigration reforms; whether parents facing potential detention and deportation plan for the care of their children; and whether their children learn from other sources about detention and deportation. The focus of this paper emerged in the context of a multiyear participatory and action research (PAR) process as one effort to understand the multiple meanings and divergent perspectives on parental–child communication that arose among and between participants and coresearchers. The aim is to better understand, in parents' own voices, their embrace of and resistance to direct communication with their children about the threat of deportation. Data are triangulated from in-depth interviews with 18 Central American immigrant coresearchers (Study 1), responses of 132 Latino/a immigrant parents to a survey with open-ended questions (Study 2), and conversations in a series of community meetings and workshops. Findings confirm the importance for advocates, service providers, and researchers to understand migrant parents' decisions about communication within the context of family and community values; gender expectations; lived and psychological experiences of being criminalized; and strategies to manage daily challenges of living without documents while parenting US-citizen children.     

Moral or civic ties? Deservingness and engagement among undocumented Latinas in non-profit organisations

As alternatives to mainstream institutions, local non-profit organisations (NPOs) are important sites for immigrant civic engagement; yet, there is little research on how immigrants negotiate the benefits of NPOs. We use ethnographic fieldwork and multiple in-depth interviews with 39 NPO staff and Latina immigrants in San Francisco, California. We offer new insights about how undocumented, low-income, Latina mothers – a group constrained by multiple barriers – negotiate direct assistance and civic engagement in NPOs. Although NPOs provide both direct services and civic engagement opportunities, we find that moral judgments within the broader anti-immigrant and anti-welfare climate impact how Latinas feel the need to ‘give back’ or ‘ration’ services in NPOs. Additionally, the expectation that direct services are an entrée for civic engagement has consequences for how Latinas negotiate deservingness and work to preserve their self-worth. For some, these expectations depress further engagement or drive intergroup divisions.     

Abused Latina Women's Perceptions of Their Postdivorce Adjustment

This qualitative study explores the postdivorce adjustment of battered Latina immigrants. Three focus groups were conducted. Data were analyzed utilizing a grounded theory approach. Five conceptual themes were unearthed including: (a) intimate partner violence (IPV) as the precipitator for divorce; (b) motivations for leaving; (c) the impact of the Latino culture on marriage, separation, and postdivorce; (d) immigration and other legal and social issues; and (e) postdivorce/post-IPV experiences. Implications for practice are drawn.     

“They Treat us Like Pests:” Undocumented Immigrant Experiences Obtaining Health Care in the Wake of a “Crackdown” Ordinance

This article presents findings from a qualitative study of Latino immigrant experiences seeking health care services in the wake of an anti-immigrant “crackdown” ordinance similar to Arizona's SB 1070. Prince William County, Virginia's 2007 “Rule of Law” ordinance escalated law enforcement efforts that targeted this population for deportation and ordered staff to ensure that no one receive social services other than those required by federal law. This article sought to answer the questions: (1) Were undocumented immigrants able to obtain health care? (2) How do immigrants characterize their experiences with health providers? Data were gathered via semi-structured interviews (n = 57) with Latinos in a low-income neighborhood. Analysis of Spanish-language narratives found that many were dissuaded from seeking care because of high costs as well as lack of familiarity with the health care system. Others perceived that they were treated with insensitivity or outright hostility—and believed this treatment was a deliberate effort to discourage them from seeking help.     

Undocumented Acts: Migration,Community and Audience in Two Chicana Plays

Abstract

The 1980 Refugee Act endeavoured to provide effective settlement for refugees entering the United States. But most South American refugees escaping from dictatorships and civil wars were denied political asylum. This article explores the representation of migration and border crossing in Latina (1980 Sánchez-Scott, Milcha, with Jeremy Blahnik. 1980. “Latina.” In Necessary Theatre Six Plays about the Chicano Experience, edited by Jorge Huerta, 85–141. Houston: Arte Publico Press. [Google Scholar]), a play by Milcha Sánchez Scott that stages the difficulties associated with this journey. In 2010 Senate Bill 1070, one of the strictest anti-immigration legislative acts to be enforced, encouraged racial profiling in the identification of border crossers in the state of Arizona. Detained in the Desert (2011), a play by Josefina L?pez, is a Chicana response to the passing of SB 1070, and contributes to a deeper understanding of the fraught experiences of migrant women’s lives. The study of the plays places an emphasis on transnational community building and audience engagement and builds on a range of recent critical work by border theorists and scholars such as Alicia Schmidt Camacho and Deborah Boehm, and theatre and performance critics such as Diana Taylor.     

Christian Zionists in the Holy Land: Evangelical Churches,Labor Migrants,and the Jewish State

In this article we trace the creation of Evangelical churches created by and for Latin American undocumented migrants in Israel. First, we relate to the social significance of religious practices and beliefs for migrants' individual and collective identity in the host society and the ways through which non-Jewish labor migrants in Israel are creating alternative spaces that operate simultaneously as a new community of belonging. We consider the possibilities latent in the churches as “free spaces” for foreigners in the Jewish State, along with the limitations that participation in such a church entails for the migrant community. The second theme involves the universe of meanings through which believing migrants interpret their existence and place in the Jewish State. Here we probe how religion becomes a way of legitimizing the migrants' presence in a Jewish state and a means of channeling their claims for inclusion in the host country. We delve into the modes whereby the theological position of Christian Zionism is translated into a sociological position of Christian migrants in a Jewish state.     

Latino Immigrants

Abstract

The Latino population continues to increase dramatically with some of the increase due to continuous immigration, both documented and undocumented. This article examines some of the demographic within group diversity that exists. The immigration experience is highlighted for the particular stresses that occur. The unique issues related to living in the United States without legal papers are noted. For those immigrants who are refugees, the impact of civil war and violence on their ability to adapt to this new culture is underscored. The consequences of immigration are noted in how children are affected. An Ecological Perspective illustrates how their adaptations can be classified into such specific areas as identity, relatedness, competence and autonomy. Some of the resources to support viable adaptation are delineated.