When deservingness policies converge: US immigration enforcement, health reform and patient dumping

Abstract

As immigration and health policy continue to be contentious topics globally, anthropologists must examine how policy creates notions of health-related deservingness, which may have broad consequences. This paper explores hidden relationships between immigration enforcement laws and the most recent health reform law in the United States, the Patient Protection and Affordable Care Act (ACA), which excludes immigrants from certain types of health services. Findings in this paper show how increasingly harsh immigration enforcement efforts provide health facilities a 'license to discriminate' against undocumented immigrants, resulting in some facilities 'dumping' undocumented patients or unlawfully transferring them from one hospital to another. Due to changes made through the ACA, patient dumping disproportionately complicates public hospitals' financial viability and may have consequences on public facilities' ability to provide care for all indigent patients. By focusing on the converging consequences of immigrant policing and health reform, findings in this paper ultimately show that examining deservingness assessments and how they become codified into legislation, which I call 'deservingness projects', can reveal broader elements of state power and demonstrate how such power extends beyond targeted populations. Exercises of state power can thus have 'spillover effects' that harm numerous vulnerable populations, highlighting the importance of medical anthropology in documenting the broad, hidden consequences of governmental actions that construct populations as undeserving of social services.

Keywords: EMTALA; Immigrant policing; Latino health; affordable care act; undocumented immigrants.