Cautious Citizenship: The Deterring Effect of Immigration Issue Salience on Health Care Use and Bureaucratic Interactions among Latino US Citizens

Abstract

Research shows that health care use among Latino immigrants is adversely affected by restrictive immigration policy. A core concern is that immigrants shy away from sharing personal information in response to policies that expand bureaucratic monitoring of citizenship status across service-providing organizations. This investigation addresses the concern that immigration politics also negatively influences health care utilization among Latino US citizens. One implication is that health insurance expansions may not reduce health care inequities among Latinos due to concern about exposure to immigration law enforcement authorities. Using data from the 2015 Latino National Health and Immigration Survey, we examine the extent to which the politics of immigration deters individuals from going to health care providers and service-providing institutions. Results indicate that Latino US citizens are less likely to make an appointment to see a health care provider when the issue of immigration is mentioned. Additionally, Latino US citizens who know someone who has been deported are more inclined to perceive that information shared with health care providers is not secure. We discuss how cautious citizenship, or risk-avoidance behaviors toward public institutions in order to avoid scrutiny of citizenship status, informs debates about reducing health care inequities.

Spillover Effects: Immigrant Policing and Government Skepticism in Matters of Health for Latinos

“…What mattered to Latinos in the opening anecdote was whether they could trust the specific assurances that President Obama was giving about immigration policy not being connected to health insurance programs. Concerns among Latinos about immigrant policing are sufficiently salient to forgo enrollment in health insurance (Fix and Passel 1999;Watson 2014) and at times, medical attention (Beniflah et al 2013;Pedraza, Cruz Nichols, and LeBrón 2017;Rhodes et al 2015;Toomey et al 2014). The Obama administration's concern was sufficiently acute to stress on the HealthCare.gov website, as well as through a formal statement of "agency policy" for ICE (2013), that "[y]our information will never be used for enforcement purposes when you apply to HealthCare.…”

“…However, as one observer remarked, "[Latino families] hear [the President's] assurance, but because of the level of deportations that have happened, there's a lot of families that don't know whether they can trust that assurance" (Easley 2014). This example suggests that Latinos draw lessons from immigrant policing experiences that, in turn, inform their trust in government-sponsored efforts to court potential health insurance enrollees (Condon, Filindra, and Wichowsky 2015;Pedraza 2018a, 2018b;Fix and Passel 1999;Pedraza, Cruz Nichols, and LeBrón 2017;Watson 2014).…”

“…that is obtained for the purposes of determining eligibility for [health insurance] coverage as the basis for pursuing civil immigration enforcement actions against such individuals or members of their household.” However, as one observer remarked, “[Latino families] hear [the President's] assurance, but because of the level of deportations that have happened, there's a lot of families that don't know whether they can trust that assurance” (Easley ). This example suggests that Latinos draw lessons from immigrant policing experiences that, in turn, inform their trust in government‐sponsored efforts to court potential health insurance enrollees (Condon, Filindra, and Wichowsky ; Cruz Nichols, LeBrón, and Pedraza , ; Fix and Passel ; Pedraza, Cruz Nichols, and LeBrón ; Watson ).…”

Restrictive ID Policies: Implications for Health Equity

“…Consequently, PRWORA induced a “chilling effect,” or a reduction in utilization of social and health care services to which individuals and families were entitled, which spilled over to prevent US-born Latino children of immigrants from accessing social services and resources for which they were eligible [18]. By prohibiting access to these resources for immigrants who arrived after the law was passed and enforcing a wait period for recent immigrants, PRWORA reinforced and exacerbated citizenship and nativity-based privileges and racial inequalities [18–20]. Like PRWORA, by restricting access to health care to persons who can provide the requisite IDs, the Deficit Reduction Act of 2005 expands inequities in rights and access to resources between citizens and non-citizens and children of immigrants, and between those who have a current government-issued ID and those who do not.…”

“…The early twenty-first century has been characterized by several federal-, state-, and local-level restrictive immigration policies and practices, such as collaboration between federal immigration enforcement agencies and local law enforcement agencies, immigration raids, and state-level policies such as Arizona’s SB 1070 that criminalize the failure to present immigration documents [24–27]. A growing evidence base links restrictive immigration policies with racialized stressors [7, 28–30], restricted access to health-promoting resources [7, 20, 29–33], and adverse health outcomes [28, 34] for immigrant and US-born Latinos, the racial group that has been disproportionately burdened by restrictive immigration policies [26, 35]. …”