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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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PRINTED FROM NYU Press SCHOLARSHIP ONLINE (www.nyu.universitypressscholarship.com). (c) Copyright University of NYU Press, 2022. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in NYSO for personal use.date: 25 June 2022

Increasing Access, Increasing Responsibility

Increasing Access, Increasing Responsibility

Activating the Newly Insured

(p.254) 10 Increasing Access, Increasing Responsibility
Unequal Coverage

Mary Alice Scott

Richard Wright

NYU Press

Mary Alice Scott and Richard Wright’s chapter explores the intersections of seemingly opposing understandings of health—as a “right” or a “responsibility”—in health care professionals’ commentaries on ACA implementation in a formerly free clinic in southern New Mexico. The concepts of co-responsibility and of patient engagement—increasingly central to health care and other social programs globally— were reflected in staff framing of health care problems, clinic activities, and conceptualizations of patients. Patient engagement requires motivating patients to increase participation in their own health care and empowering them to develop self-efficacy. As this chapter shows, there is often a mismatch between provider expectations of shared responsibility and the highly constrained actions of patients, who in this study confronted structural barriers including being homeless, lack of regular transportation, and undocumented immigration status.

Keywords:   co-responsibility, patient engagement, ACA, New Mexico, implementation, structural barriers, undocumented immigration, homeless

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