In the United States, exclusionary public policies generate inequalities within and across labor, financial, and legal status hierarchies, which together undermine immigrant well-being. But can inclusive public policies improve immigrant health? We examine whether and how an immigrant-inclusive federal program, Federally Qualified Health Centers (FQHCs), shaped health care access and use among farmworkers over nearly three decades, paying particular attention to disparities at the intersection of nativity and legal status. Linking historical administrative data on the location and funding of FQHCs with the National Agricultural Workers Survey from 1989–2017, we first document trends in farmworkers’ county-level proximity to FQHCs and identify a steady increase in FQHC access among undocumented farmworkers following the Affordable Care Act. Next, using time-series cross-sectional regressions with a battery of fixed effects, we find that living in a county where FQHCs are available and better resourced is associated with increased health care use among undocumented farmworkers, but not among U.S.-born or documented immigrant farmworkers. We also find that county-level access to FQHCs is associated with reduced reports of language barriers to care among both documented and undocumented foreign-born farmworkers. These findings suggest that FQHCs may improve access for immigrants who are typically excluded from U.S. health care institutions. Still, county-level FQHC infrastructure is not associated with cost-related barriers to care for any nativity or legal status groups. Taken together, our study highlights both the potential and constraints of inclusive public policies for promoting health equity in a welfare state context characterized by commodification and stratification.

中文翻译：

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包容性公共政策的承诺和局限性：美国联邦安全网诊所和移民获得医疗保健的机会


在美国，排他性公共政策在劳工、财务和法律地位等级制度内部和之间造成不平等，这共同破坏了移民的福祉。但是，包容性的公共政策能否改善移民的健康？我们研究了近三十年来包容移民的联邦计划，即联邦合格健康中心 （FQHC） 是否以及如何影响了农场工人的医疗保健获取和使用，特别关注出生和法律地位交叉点的差异。将 FQHC 位置和资金的历史行政数据与 1989 年至 2017 年的全国农业工人调查联系起来，我们首先记录了农场工人县级接近 FQHC 的趋势，并确定在《平价医疗法案》之后，无证农场工人获得 FQHC 的机会稳步增加。接下来，使用具有一系列固定效应的时间序列横断面回归，我们发现生活在 FQHC 可用且资源更好的县与无证农场工人的医疗保健使用增加相关，但与美国出生或有记录的移民农场工人无关。我们还发现，县级获得 FQHC 的机会与有证和无证的外国出生的农场工人在护理方面的语言障碍报告减少有关。这些发现表明，FQHC 可能会改善通常被排除在美国医疗保健机构之外的移民的机会。尽管如此，县级 FQHC 基础设施与照顾任何出生或法律身份群体的成本相关障碍无关。 综上所述，我们的研究强调了包容性公共政策在以商品化和分层为特征的福利国家背景下促进健康公平的潜力和限制。