Field Actions Science Reports (Oct 2010)
Access Not Denied? The Role American Localities Can Play
Abstract
San Francisco represents a unique case in the United States in that it has enacted a set of inclusive policies at the local level to increase unauthorized immigrants’ access to and utilization of health care. Based on interviews conducted with 36 primary care providers working in the city’s public safety net in 2009, I examine how this inclusive local policy environment both reinforces and constrains their aspirational views of unauthorized immigrants as morally “deserving” patients, and how it operates to help provide care to unauthorized immigrants. On one hand, this environment reinforces safety-net providers’ aspirational views by creating a more legal-status-blind environment that encourages unauthorized immigrants to come in for care, and by facilitating their abilities to offer key services to and advocate for unauthorized immigrant patients. At the same time, this environment constrains their aspirational views by operating through an institutional structure whose bureaucratic rules effectively deter some unauthorized immigrants from accessing care, and by explicitly delimiting unauthorized immigrants’ access to care to the realm of select primary medical services. These results highlight the great potential of, but also the limitations and internal dilemmas constituting, local “right to care” strategies that seek to ameliorate unauthorized immigrants’ health vulnerability in what is still a hostile U.S. federal context.
