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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 and “Universality”

Stratification and “Universality”

Immigrants and Barriers to Coverage in Massachusetts

Chapter:
(p.79) 3 Stratification and “Universality”
Source:
Unequal Coverage
Author(s):

Tiffany D. Joseph

Publisher:
NYU Press
DOI:10.18574/nyu/9781479897001.003.0004

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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