Buffering the Uneven Impact of the Affordable Care Act: Immigrant‐serving Safety‐net Providers in New Mexico

Abstract

We conducted a study in early 2014 to document how the initial implementation of the Affordable Care Act (ACA) affected health care provision to different categories of immigrants from the perspective of health care providers in New Mexico. Though ACA navigators led enrollment, a range of providers nevertheless became involved by necessity, expressing concern about how immigrants were faring in the newly configured health care environment and taking on advocacy roles. Providers described interpreting shifting eligibility and coverage, attending to vulnerable under/uninsured patients, and negotiating new bureaucratic barriers for insured patients. Findings suggest that, like past efforts, this recent reform to the fragmented health care system has perpetuated a condition in which safety-net clinics and providers are left to buffer a widening gap for immigrant patients. With possible changes to the ACA ahead, safety-net providers' critical buffering roles will likely become more crucial, underscoring the necessity of examining their experiences with past reforms.

Occupational health within the bounds of primary care: Factors shaping the health of Latina/o immigrant workers in federally qualified health centers

“…Studies have found that in recent decades the cost of work‐related injuries and illnesses has shifted away from workers' compensation to workers and their families, private health insurance, and the government 15,49–51 . Clinicians' observations regarding the delivery of care to injured Latina/o workers suggests some community clinics are also taking on the financial burden of providing care to injured workers and buffering against the gaps in care for Latina/o immigrants stemming from the current structure of the workers' compensation system and lack of a universal healthcare policy 52,53 …”

DACA Recipient Health Care Workers’ Barriers to Professionalization and Deployment of Navigational Capital in Pursuit of Health Equity for Immigrants

“…Studies have demonstrated how community health workers (CHWs) in particular deploy CCW to improve community health and well-being through advocacy and research [25,26] However, these studies do not elaborate how health care workers deploy their CCW specifically in health care settings. A separate literature on health care brokerage examines how immigrants and coethnics serve as intermediaries in facilitating immigrants' interface with the health care system [27][28][29][30][31]. Brokers are prized for their ability to flex to meet community needs and performing tasks that often extend beyond their envisioned or funded positions [32,33].…”

A Eulogy for Jane Robinson: A Social Autopsy of Uncare Policies

“…Medical anthropologists have produced important insights into the geography of care in the rural United States. Ethnographers have repeatedly found that safety net institutions and the health care providers who work at them fill gaps created by the privatization of health care services (Boehm 2005;Horton et al 2001) as well as the categorical exclusion of many immigrants from coverage (Getrich et al 2017). Thurka Sangaramoorthy (2018) argues that safety net care is improvisational and incomplete, forcing dedicated care providers to employ multiple informal strategies to deliver care such as bartering, rationing, hoarding, willful noncompliance, and goodwill.…”