Navigating Health Care: Brokerage and Access for Unauthorized Latino Immigrants under the 2010 Affordable Care Act

12-1 pm

PSTC Seminar Room 205

Laura López-Sanders, Assistant Professor of Sociology, Brown University

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Brokerage is a prominent mechanism that explains access for Latino immigrants to many American institutions. However, few studies examine the dual nature of brokerage in answering questions on access to health care for unauthorized Latino immigrants. The growing importance of Federally Qualified Health Centers (FQHCs) and ethnic navigators connecting immigrants to health care under the 2010 Affordable Care Act calls attention to the duality of brokers and its role in access.

López-Sanders' study draws from 44 in-depth interviews with providers, clinic directors, navigators and immigrant patients and two years of fieldwork in FQHCs in California’s San Francisco Bay Area (2011-2013). Results show that brokers enable access through coaching and myth-busting but they also hinder it through scrutiny and bureaucratic filtering. The widespread dependence on brokerage, she argues, leads to ersatz brokerage, such as when providers navigate the health care system for the unauthorized without the appropriate linguistic resources or coordination. Furthermore, the study shows that the duality in brokerage generates misinformation, churning and alienation. Understanding the relational processes that both include and exclude vulnerable populations from needed services enhances theories of immigrant integration and can help design more efficient policies and address inequalities based on documentation status.

López-Sanders was a Robert Wood Johnson Post-doctoral Scholar in Health Policy Research at UC Berkeley and a Ford Foundation Fellow at Duke University. She holds an M.Ed. in International Education Policy from Harvard University, and an M.A. in Social Sciences and Education and a PhD in Sociology from Stanford University. Her research interests are in the fields of immigration, social inequality, and race and ethnic relations. She is currently working on a book that examines the influence of employment practices on the integration of unauthorized immigrants in new destinations.

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