Excluded and Frozen Out: Unauthorized Immigrants’ (Non)Access to Health Care after Health Reforms

• In Event: 281 - Section on International Migration Paper Session. Hard Times for Immigrants in America

Abstract

The Affordable Care Act (ACA) of 2010 expressly excludes unauthorized immigrants from its expansions in access to insurance and care. Though the ACA extends public and private insurance to 32 million individuals, it restricts unauthorized adult immigrants from participating in the federally-subsidized state health exchanges and the Medicaid expansion. In this article, we draw on the sociological literature on boundaries to show that the ACA intentionally increases the “brightness” of unauthorized immigrants’ symbolic and social exclusion within the U.S. healthcare system. We contribute to the boundary literature by arguing that the intersection of immigration and health policy as exemplified in the ACA yields this “brightening” via two main processes : a boundary expansion for U.S. citizens and long-term legal immigrants, and a boundary contraction for unauthorized (and some authorized) immigrants. Next, we discuss how two subnational governments in San Francisco (city) and Massachusetts (state) have played more promising roles in the effort to “unfreeze” this “frozen-out” population. We demonstrate commonalities in the extent to which these two entities have successfully reduced unauthorized immigrants’ access to care and health vulnerabilities. At the same time, we highlight their mutual limitations, which signal an ongoing need for federal inclusion that is currently out of sight.

Authors

• Helen B. Marrow, Tufts University

• Tiffany D. Joseph, State University of New York-Stony Brook