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Stratified citizenship, stratified health: Examining latinx legal status in the U.S. healthcare safety net

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  • Van Natta, Meredith
  • Burke, Nancy J.
  • Yen, Irene H.
  • Fleming, Mark D.
  • Hanssmann, Christoph L.
  • Rasidjan, Maryani Palupy
  • Shim, Janet K.

Abstract

Our paper explores how legal status stratification shapes the health and health care of low-income patients with chronic illnesses in the U.S. healthcare safety net. Drawing on data from over two years of ethnographic fieldwork at urban safety-net clinics, we examine efforts by Complex Care Management (CCM) teams to stabilize patients with uncontrolled chronic illnesses through primary care-integrated support. We show that stratified citizenship and geographic variability correspond to different possibilities for health care. We suggest an approach to immigration as a structural determinant of health that accounts for the complex, stratified, and changing nature of citizenship status. We also highlight how geographical differences and interactions among local, state, and federal policies support the notion that citizenship is stratified across multiple tiers with distinctive possibilities and constraints for health. While county-based health plans at each of the study sites include residents with varying legal status, lack of formal legal status remains a substantial obstacle to care. Many immigrants are unable to take full advantage of primary and specialty care, resulting in unnecessary morbidity and mortality. In some cases, patients have returned to their country of origin to die. While CCM teams provide an impressive level of support to assist immigrant patients in navigating healthcare and immigration bureaucracies, legal and geographic stratification limit their ability to address broader aspects of these patients’ social context.

Suggested Citation

  • Van Natta, Meredith & Burke, Nancy J. & Yen, Irene H. & Fleming, Mark D. & Hanssmann, Christoph L. & Rasidjan, Maryani Palupy & Shim, Janet K., 2019. "Stratified citizenship, stratified health: Examining latinx legal status in the U.S. healthcare safety net," Social Science & Medicine, Elsevier, vol. 220(C), pages 49-55.
    • Handle: RePEc:eee:socmed:v:220:y:2019:i:c:p:49-55
    DOI: 10.1016/j.socscimed.2018.10.024
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    References listed on IDEAS

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    1. Viruell-Fuentes, Edna A. & Miranda, Patricia Y. & Abdulrahim, Sawsan, 2012. "More than culture: Structural racism, intersectionality theory, and immigrant health," Social Science & Medicine, Elsevier, vol. 75(12), pages 2099-2106.
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    4. Tara Watson, 2014. "Inside the Refrigerator: Immigration Enforcement and Chilling Effects in Medicaid Participation," American Economic Journal: Economic Policy, American Economic Association, vol. 6(3), pages 313-338, August.
    5. Morey, Brittany N. & Gee, Gilbert C. & Muennig, Peter & Hatzenbuehler, Mark L., 2018. "Community-level prejudice and mortality among immigrant groups," Social Science & Medicine, Elsevier, vol. 199(C), pages 56-66.
    6. Cathy Zimmerman & Ligia Kiss & Mazeda Hossain, 2011. "Migration and Health: A Framework for 21st Century Policy-Making," Working Papers id:4174, eSocialSciences.
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    8. Marrow, Helen B., 2012. "Deserving to a point: Unauthorized immigrants in San Francisco’s universal access healthcare model," Social Science & Medicine, Elsevier, vol. 74(6), pages 846-854.
    9. Fleming, Mark D. & Shim, Janet K. & Yen, Irene H. & Thompson-Lastad, Ariana & Rubin, Sara & Van Natta, Meredith & Burke, Nancy J., 2017. "Patient engagement at the margins: Health care providers' assessments of engagement and the structural determinants of health in the safety-net," Social Science & Medicine, Elsevier, vol. 183(C), pages 11-18.
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    Citations

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    Cited by:

    1. Nakphong, Michelle K. & De Trinidad Young, Maria-Elena & Morales, Brenda & Guzman-Ruiz, Iris Y. & Chen, Lei & Kietzman, Kathryn G., 2022. "Social exclusion at the intersections of immigration, employment, and healthcare policy: A qualitative study of Mexican and Chinese immigrants in California," Social Science & Medicine, Elsevier, vol. 298(C).
    2. Young, Maria-Elena De Trinidad & Perez-Lua, Fabiola & Sarnoff, Hannah & Plancarte, Vivianna & Goldman-Mellor, Sidra & Payán, Denise Diaz, 2022. "Working around safety net exclusions during the COVID-19 pandemic: A qualitative study of rural Latinx immigrants," Social Science & Medicine, Elsevier, vol. 311(C).
    3. Thoa V. Khuu, 2024. "Mapping Immigrant Health Trajectories: Investigating the Implications of Institutional Selection and Post-arrival Support Across Legal-Entry Pathways," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 43(1), pages 1-28, February.
    4. Jimenez, Anthony M., 2021. "The legal violence of care: Navigating the US health care system while undocumented and illegible," Social Science & Medicine, Elsevier, vol. 270(C).
    5. Joseph, Tiffany, 2020. "The Documentation Status Continuum: Citizenship and Increasing Stratification in American Life," SocArXiv 2x6hq, Center for Open Science.

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