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

项目总结 尽管立法努力通过2010年《平价医疗法案》延长医疗保险 (ACA)，最近总人口的保险覆盖面有所减少，原因是 ACA废除尝试。作为拉丁裔，英语水平有限(LEP)，以及中下级- 一些群体的收入与白人、英语熟练者和 收入较高的美国人。然而，关于拉丁裔种族的交集是如何， 有限的英语水平和较低的社会经济地位影响了个人的经历 即使在全面实施ACA的州，医疗体系也是如此。要解决这些问题 由于存在差距，拟议的G13将支持撰写一本探讨异质性如何 在种族、英语熟练程度和社会经济地位方面，拉美裔美国人的保险资格 在医疗政策发生重大变化的情况下，2012-2019年马萨诸塞州波士顿的医疗保健服务。 这本书引用了207次对拉丁裔(巴西人、多米尼加人和 萨尔瓦多人)，拉丁裔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 拉丁裔人口和第一个实施医疗改革的州的首府：备受赞誉的2006年MA 改革成为ACA的典范。由于拉丁裔被种族歧视为有色人种，这本书 辩称他们经历了两种类型的歧视，这两种歧视对他们的医疗保健产生了负面影响 获得：1)基于收入水平和法律地位的法律或法律认可的歧视 2)实际上发生的基于种族和族裔的歧视。这个 拟议的书将探讨这种法律上和事实上的歧视是如何相交的 有助于并永久保持医疗保健系统中不同拉丁裔和 这种歧视对其他边缘群体的医疗保健服务有何影响？ 值得注意的是，这本书将捕捉到最初的MA医疗改革、ACA实施 在马萨诸塞州，ACA废除尝试重新塑造了波士顿拉丁裔人与 在这个“最好的”医疗方案中的医疗系统。建议的书稿是一本 及时和相关地探索宏观层面政策的微观后果 在我们复杂的医疗保健系统中塑造人们的生活和他们的遭遇。

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.