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Unequal CoverageThe Experience of Health Care Reform in the United States$
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Jessica M. Mulligan and Heide Castañeda

Print publication date: 2017

Print ISBN-13: 9781479897001

Published to NYU Press Scholarship Online: September 2018

DOI: 10.18574/nyu/9781479897001.001.0001

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Stratification by Immigration Status

Stratification by Immigration Status

Contradictory Exclusion and Inclusion after Health Care Reform

(p.37) 1 Stratification by Immigration Status
Unequal Coverage

Heide Castañeda

NYU Press

Heide Castañeda’s chapter highlights the fact that immigrant groups in the United States are not monolithic, but instead stratified by many chaotic bureaucratic categories. Using three case studies derived from longitudinal research in Texas, this chapter illustrates the unanticipated and contradictory effects of the Affordable Care Act (ACA) by examining how immigration categories influenced eligibility and participation. The ACA explicitly excluded more than 11 million undocumented immigrants from coverage and distinguished between “qualified” and “non-qualified” immigrants among those who were considered “lawfully present.” This chapter illustrates the impacts of these exclusions and inclusions. We see how these distinctions produced ripple effects on U.S. citizen children in mixed-status families. In addition, the exclusion of youth holding deferred action for childhood arrivals (DACA) status—produced through an unusual case of administrative rollback—created a new pattern of formal disenfranchisement, while a loophole allowed some immigrants to qualify for insurance subsidies that U.S. citizens living in the same state could not.

Keywords:   immigration, deferred action for childhood arrivals (DACA), undocumented immigrant, lawfully present, exclusion, inclusion, insurance subsidies, Affordable Care Act, Texas

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