New Publication: Inclusion and Exclusion of Latinos in the Affordable Care Act

The Harvard Journal of Hispanic Policy has published my analysis of the Affordable Care Act (ACA) and its potential for improving access to care for the Latino population in its Spring 2014 issue.

The article, Inclusion and Exclusion of Latinos in the Affordable Care Act: Challenges and Opportunities for Achieving Health Equity, examines outreach strategies and various components of the health law to assess its ability to reduce and prevent the exacerbation of health inequities. The inclusive and exclusionary aspects of some of the ACA’s provisions and implementation is explored within the context of the nation’s commitment to the elimination of health disparities and international consensus on a right to medical care regardless of race, ethnicity, religion, age, income, or legal status.

Some key points I make in the article include:

While the Affordable Care Act moves the nation closer to achieving universal health coverage, the United States has yet to fully embrace a right to health framework guaranteeing access to health care for all residents. As a result, millions of individuals and families will remain on the margins of our health care system. Given disparities in health and health care among communities of color, racial and ethnic minorities are particularly disadvantaged by the absence of a universal health care program. The devolution of federal responsibility for health care and other social welfare programs to state governments, antigovernment rhetoric, and anti-immigrant sentiment have contributed to a “social context of exclusion” that undermines efforts to achieve health equity.

This article explores how this social context has restricted access to health care and its impact on insurance coverage for the Latino population under the Affordable Care Act.

I conclude that:

Notwithstanding the Affordable Care Act’s many benefits, variations in the states’ expansion of Medicaid and the continuation of the 1996 welfare reform policy making some legal immigrants ineligible for the program will limit the extent to which Latinos gain access to quality, affordable, and culturally appropriate care and treatment…Given the fierce opposition to the Affordable Care Act and a political environment in which Democrats and Republicans appear to accept the premise that some groups should not have access to health care outside of a medical emergency, the idea of a right to health care in the United States may be implausible in the near future. Reform advocates must be willing to challenge the assumption that certain groups should be excluded from health insurance coverage. It may not be politically expedient, but just as the opponents have beat the drum against “big government” health care, progressives should speak more loudly and clearly about the moral obligations and the potential benefits in productivity and reduced costs with a guaranteed right to health care.

The full text of the article can be downloaded from the Social Science Research Network’s website:


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