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：联邦安全网诊所和移民在美国获得医疗保健的机会


在美国，排他性公共政策造成了劳动力、金融和法律地位等级内部和之间的不平等，这些不平等共同损害了移民的福祉。但包容性公共政策能否改善移民健康？我们研究了近三十年来包容移民的联邦计划——联邦合格健康中心 (FQHC) 是否以及如何影响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上的差异。将有关 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在县级接近 FQHC 的趋势，并发现在平价医疗之后，无证农场工人获得 FQHC 的机会稳步增加行为。接下来，使用具有一系列固定效应的时间序列横截面回归，我们发现，居住在有 FQHC 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农场工人的医疗保健使用增加相关。移民农场工人。我们还发现，县级获得 FQHC 的机会与有证和无证外国出生农场工人的护理语言障碍报告减少有关。这些发现表明，FQHC 可以改善通常被排除在美国医疗保健机构之外的移民的获取机会。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。 总而言之，我们的研究强调了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包容性公共政策的潜力和局限性。