(Not) All In: Race, Ethnicity, and Healthcare Exclusion in America's City on a Hill

项目摘要 尽管通过2010年《平价医疗法案》（Affordable Care Act）， (ACA)，最近整体人口的保险覆盖面有所减少， ACA试图废除。作为拉丁裔，有限的英语熟练（LEP），低和中等- 收入使某些群体相对于白色、英语熟练和 高收入的美国人。然而，人们对拉丁裔的交叉点知之甚少， 有限的英语水平和较低的社会经济地位影响个人的经验 即使在完全实施ACA的州，医疗保健系统也是如此。解决这些 差距，拟议的G13将支持写一本书的手稿，探讨如何异质性 种族、英语水平和社会经济地位决定了拉丁裔的保险资格 在重大的卫生政策变化中，2012-2019年马萨诸塞州波士顿的医疗保健服务。 这本书借鉴了207次采访拉丁美洲人（巴西人，多米尼加人， 萨尔瓦多人），与拉丁美洲患者的医疗保健专业人员，以及来自卫生和 波士顿的拉丁裔倡导组织。波士顿是理想的地点，因为它是一个相当大的家庭， 拉丁裔人口和第一个实施卫生改革的州的首府：备受赞誉的2006年MA 改革成为ACA的模式。由于拉丁裔被种族化为有色人种，这本书 认为他们经历了两种类型的歧视，对他们的医疗保健产生了负面影响。 （1）基于收入水平和法律的地位的法律上或法律认可的歧视 （2）实际上发生的基于种族和民族的歧视。的 拟议的书将探讨这种法律上和事实上的歧视如何交叉 在不同的拉丁美洲人中，有助于并延续医疗保健系统的分层， 这种歧视对其他边缘化群体获得医疗保健的影响。 值得注意的是，这本书将捕捉如何原来的马健康改革，ACA的实施 在马萨诸塞州，ACA的废除尝试重新配置了波士顿拉丁人的经验， 在这种“最佳情况”的医疗保健系统。这本书的手稿是一个 及时和相关地探讨宏观政策的微观后果， 塑造人们的生活和他们在我们复杂的医疗保健系统中的遭遇。

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.