FRAGMENTED HEALTH AND IMMIGRATION SYSTEMS in the United States
My work bridges a research gap to show how health and immigration policies exacerbate inequities between social groups whose memberships are often outside individual control: genders, races/ethnicities, and family structures.
US Health System
To achieve gender equity at home and work, access to health insurance should not depend on employment. Health insurance benefits can influence divorce rates among women, and people married to spouses with full-time employment better weathered economic downturns in 2001 and 2008. The gendered findings reinforced the literature on women’s greater management of health-related risk, higher utilization of health services, and reliance on marriage for economic resources.
Universal health coverage in early life builds a healthier and a more equitable adult population for decades to come. The introduction of the Medicaid program—a means-tested public insurance option—in the 1960s reduced the racial gap in infant mortality and improved the efficiency of public health screening programs. The lowered infant mortality risk associated with Medicaid at birth gave dividends in adulthood even as adult chronic illness emerged as leading causes of death. Ensuring health care for the youngest is even more important as screening technology becomes increasingly sophisticated.
Reducing bouts without insurance and prioritizing coverage stability must be a critical component of health policy. Insurance continuity was a driving factor in racial/ethnic disparities in coverage. Since its inception, Medicaid has expanded its eligibility criteria considerably, consequently improving insurance coverage among children. Maintaining and demonstrating eligibility can become obstacles, however. Black and Latinx children, more likely to use public insurance than non-Hispanic White children, had greater churning with frequent coverage gaps.
US Immigration System
Immigrants arriving in the U.S. join the population via segregated pathways that define their legal rights, access to public programs, and societal participation. Immigration policies with strict eligibility rules, mandatory waiting periods, and high application costs can take people decades to become naturalized U.S. citizens.
Researchers must ensure representation of immigrants with liminal status in their work while protecting privacy. Non-US citizens are underrepresented in national censuses and surveys, and their experiences and well-being are not sufficiently documented despite their large numbers. People living in the U.S. with expired visas or those who entered the country without authorization are particularly difficult to study. They are less likely to respond to state-sponsored surveys, and surveys are careful not to ask for information on their legal status.
Indirect methods can capture better the health and well-being of an increasingly diverse immigrant population in the U.S. while obscuring individual immigration status. Harnessing the strengths of multiple datasets into one study can reveal hidden patterns. To identify risk factors for deportation and voluntary return migration throughout the Bush, Obama, and Trump administrations, a project straddled the US-Mexico border by combining U.S. Census data (Current Population Survey) with Mexican survey data (La Encuesta sobre Migración en la Frontera Norte de México).
Policy must consider immigrants’ unique vulnerabilities in the wake of natural disasters and public health crises. Family support among undocumented immigrants in California mitigated their socioeconomic disadvantage, but dense living and working conditions made them particularly vulnerable to infectious diseases during the COVID-19 pandemic.