States with fewer criminalizing immigrant policies have smaller health care inequities between citizens and noncitizens
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RESEARCH ARTICLE
Open Access
States with fewer criminalizing immigrant policies have smaller health care inequities between citizens and noncitizens Maria-Elena De Trinidad Young1* , Hiram Beltrán-Sánchez2 and Steven P. Wallace2
Abstract Background: In the last thirty years, major shifts in immigrant policy at national and state levels has heightened boundaries among citizens, permanent residents, and those with other statuses. While there is mounting evidence that citizenship influences immigrant health care inequities, there has been less focus on how policies that reinforce citizenship stratification may shape the extent of these inequities. We examine the extent to which the relationship between citizenship and health care inequities is moderated by state-level criminalization policies. Methods: Taking a comparative approach, we assess how distinct criminalization policy contexts across US states are associated with inequitable access to care by citizenship status. Utilizing a data set with state-level measures of criminalization policy and individual-level measures of having a usual source of care from the National Health Interview Survey, we use mixed-effects logistic regression models to assess the extent to which inequities in health care access between noncitizens and US born citizens vary depending on states’ criminalization policies. Results: Each additional criminalization policy was associated with a lower odds that noncitizens in the state had a usual source of care, compared to US born citizens. Conclusion: Criminalization policies shape the construction of citizenship stratification across geography, such as exacerbating inequities in health care access by citizenship. Keywords: Immigration, Citizenship, Health care access
Background In the US, immigrants who lack citizenship face significant barriers to accessing health care [1]. Citizenship constitutes a system of social stratification that inequitably positions individuals in a hierarchy of social and legal belonging - from US born citizens to naturalized citizens to those with various documentation statuses (e.g., lawful permanent residents, temporary resident statuses) to those who are undocumented [2]. Research shows a pattern in which inequities in access to health * Correspondence: [email protected] 1 Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, USA Full list of author information is available at the end of the article
care align with the hierarchy of citizenship statuses. Undocumented immigrants, for example, are less likely to have insurance, a usual source of care, and receipt of timely preventative services compared to documented immigrants and US born citizens [3–7]. Those with temporary statuses, such as Deferred Action for Childhood Arrivals, similarly, are ineligible for federallyfunded public insurance and face institutional barriers to establishing a source of care [8]. While more likely to have access to care than the undocumented, lawful permanent resid
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