Access to the Health Care Safety Net for Hispanic Immigrants in Established Gateways and New Destinations

• In Event: 4411 - Challenges and Barriers in Health Care Delivery

Abstract

Across nearly every measure of health care access, immigrants lag behind. Although immigrants are excluded from many federal welfare policies and major health care institutions such as Medicaid, Federally Qualified Health Centers (FQHCs) are one program that immigrants are able to use regardless of financial resources, health insurance, or legal status. This study contends that proximity to FQHCs – the primary care safety net that serves many migrant communities – is a crucial yet underexplored mechanism in understanding immigrant health. Despite serving millions of people and receiving substantial funding from the federal government to help medically underserved populations, little is known about the reach of FQHCs into immigrant communities. I review the political and institutional context undergirding this primary care safety net program and situate the study in theoretical frameworks on “health-related deservingness” and boundary-making. Using novel, historical datasets joined with Census data, this study documents how Hispanic immigrants are differentially exposed to FQHCs depending on where they live. I use spatial demographic techniques to assess the densities of FQHCs across “New” and “Established” Hispanic immigrant destinations. I then examine the spatial and temporal evolution of FQHCs across Hispanic immigrant destinations. Finally, I explore the variation in Hispanic immigrants’ proximity and exposure to FQHCs at the tract-level, relative to the native-born population. Preliminary findings show that Hispanics settling in New Destinations had less access to FQHCs than those in Established Gateways during the major migration waves of the 1990s and 2000s. The results suggest an uneven distribution of affordable, culturally competent health care for Hispanic immigrants.

Author

• Emily Anne Parker, Cornell University