Stratification and “Universality”
Stratification and “Universality”
Immigrants and Barriers to Coverage in Massachusetts
Tiffany D. Joseph’s chapter examines how stratification of access by immigration status effectively undermined a “universal” health policy. While the ACA only extended coverage to U.S. citizens and eligible documented immigrants, Massachusetts pursued a universal health care system at the state level and offered coverage to all residents, regardless of documentation status. Despite this policy that aimed for inclusion, immigrants in Massachusetts were still more likely than non-immigrants to remain uninsured. Joseph interviewed Brazilian and Dominican immigrants, health care professionals, and immigrant/health organization employees to find out why immigrants remained uninsured. She identified immigration-related, health care system, and bureaucratic barriers that prevented individuals from effectively accessing care. Massachusetts serves as both a model and a cautionary tale for ACA implementation, with barriers exacerbated for immigrant, low-income, and minority populations.
Keywords: stratification, Massachusetts, ACA, immigrants, documentation status, bureaucratic barriers, minority populations, uninsured
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