(Not) All In: Race, Ethnicity, and Healthcare Exclusion in America's City on a Hill - PROJECT SUMMARY Despite legislative efforts to extend health insurance through the 2010 Affordable Care Act (ACA), there have been recent reductions in insurance coverage in the overall population amid ACA repeal attempts. Being Latinx, limited English proficient (LEP), and lower and middle- income compound health disparities for some groups relative to white, English-proficient, and higher-income Americans. Yet, less is known about how the intersection of Latinx ethnicity, limited English proficiency, and lower socioeconomic status influence individuals’ experiences with the healthcare system even in states that fully implemented the ACA. To address these gaps, the proposed G13 will support writing a book manuscript that explores how heterogeneity in ethnicity, English proficiency, and socioeconomic status shaped Latinxs’ insurance eligibility and healthcare access in Boston, MA from 2012-2019 amid significant health policy changes. The book draws upon 207 interviews conducted with Latinxs (Brazilians, Dominicans, and Salvadorans), healthcare professionals with Latinx patients, and employees from health and Latinx advocacy organizations in Boston. Boston is the ideal locale as it is home to a sizeable Latinx population and capital of the first state to implement health reform: the lauded 2006 MA reform became the model for the ACA. As Latinxs are racialized as people of color, this book argues that they experience two types of discrimination that negatively shape their healthcare access: 1) de jure or legally-sanctioned discrimination based on income-level and legal status and 2) de facto discrimination that happens in practice based on their race and ethnicity. The proposed book will explore how this intersection of de jure and de facto discrimination contributes to and perpetuates stratification in the healthcare system among diverse Latinxs and what implications such discrimination has for other marginalized groups’ healthcare access. Significantly, this book will capture how the original MA health reform, ACA implementation in Massachusetts, and ACA repeal attempts reconfigured Boston Latinxs’ experiences with the healthcare system in this “best-case” healthcare scenario. The proposed book manuscript is a timely and relevant exploration of the micro-level consequences of macro-level policies that shape people’s lives and their encounters navigating our complex healthcare system.
