Uninsured in Chicago: How the Social Safety Net Leaves Latinos Behind

230 Pages·2022·1.779 MB·English

by  Robert Vargas

Uninsured in Chicago
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Latina/o Sociology Series
General Editors: Pierrette Hondagneu- Sotelo and Victor M. Rios
Family Secrets: Stories of Incest and Organizing While Undocumented:
Sexual Violence in Mexico Immigrant Youth’s Political Activ-
Gloria González- López ism Under the Law
Kevin Escudero
Deported: Immigrant Policing,
Disposable Labor, and Global Front of the House, Back of the
Capitalism House: Race and Inequality in the
Tanya Maria Golash- Boza Lives of Restaurant Workers
Eli Revelle Yano Wilson
From Deportation to Prison: The
Politics of Immigration Enforce- Building a Better Chicago:
ment in Post- Civil Rights America Race and Resistance to Urban
Patrisia Macías- Rojas Redevelopment
Teresa Irene Gonzales
Latina Teachers: Creating Careers
and Guarding Culture South Central Dreams: Finding
Glenda M. Flores Home and Building Community in
South L.A.
Citizens but Not Americans: Race
Pierrette Hondagneu- Sotelo and
and Belonging among Latino
Manuel Pastor
Millennials
Nilda Flores- González Latinas in the Criminal Justice
System: Victims, Targets, and
Immigrants Under Threat: Risk and
Offenders
Resistance in Deportation Nation
Edited by Vera Lopez and Lisa
Greg Prieto
Pasko
Kids at Work: Latinx Families
Uninsured in Chicago: How the
Selling Food on the Streets of Los
Social Safety Net Leaves Latinos
Angeles
Behind
Emir Estrada
Robert Vargas
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Uninsured in Chicago
How the Social Safety Net Leaves Latinos Behind
Robert Vargas
NEW YORK UNIVERSITY PRESS
New York
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NEW YORK UNIVERSITY PRESS
New York
www.nyupress.org
© 2022 by New York University
All rights reserved
References to Internet websites (URLs) were accurate at the time of writing. Neither the au-
thor nor New York University Press is responsible for URLs that may have expired or changed
since the manuscript was prepared.
Library of Congress Cataloging-in-Publication Data
Names: Vargas, Robert, 1985– author.
Title: Uninsured in Chicago : how the social safety net leaves Latinos behind / Robert Vargas.
Description: New York : New York University Press, [2022] | Series: Latina/o sociology |
Includes bibliographical references and index.
Identifiers: LCCN 2021039791 | ISBN 9781479807130 (hardback ; alk. paper) | ISBN
9781479807147 (paperback ; alk. paper) | ISBN 9781479807161 (ebook) | ISBN
9781479807260 (ebook other)
Subjects: LCSH: United States. Patient Protection and Affordable Care Act. | Hispanic
Americans—Medical care—Illinois—Chicago—Case studies. | Hispanic Americans—
Health and hygiene—Illinois—Chicago—Case studies. | Health insurance—Illinois—
Chicago—Case studies. | Medical care—Illinois—Chicago—Case studies.
Classification: LCC RA412.475 .V37 2022 | DDC 368.38/200977311—dc23
LC record available at https://lccn.loc.gov/2021039791
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Also available as an ebook
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Contents
Introduction 1
1. How the Uninsured Are Criminalized 19
2. Who Deserves Health Care? 44
3. Why Latina Women Sacrifice Their Coverage 79
4. The Role Gender Plays in Access to Health Care 116
5. The Power of Social Networks to Secure Insurance 137
Conclusion 163
Acknowledgments 177
Methodological Appendix 179
Notes 189
References 199
Index 211
About the Author 223
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Introduction
“I’m sorry if you can’t hear me well,” said soft-s poken Nick Rodriguez.
A 28- year- old uninsured Mexican American, Nick suffered from severe
asthma, and his voice was faint in our first interview. It was January 2013,
and we sat in an otherwise empty McDonald’s in Chicago’s Little Village
neighborhood. The Affordable Care Act (ACA) had gone into effect just
a few weeks earlier.
“I’ve been in the emergency room a couple times,” Nick said. “Some-
times I just wake up purple, like I can’t breathe, can’t even talk. So, my
girl would have to call the ambulance for me and that’s scary.”
“Have you ever tried to get health insurance?” I asked.
“Yeah,” Nick responded, clarifying, “It’s where they give you benefits
and help to get medicine— stuff like that?”
“Yeah. Have you applied for it?” I asked again.
“Yeah, I’ve applied for health insurance before, but I’ve gotten denied.
In the past they’ve said that asthma is not . . . how do you call it . . .
covered.”
“So, what do you do when you have an asthma attack?”
“I end up going to the University Hospital emergency room.”
“Have they been charging you?”
“Yeah, I got all my bills. It’s ridiculous. A lot of money.”
“Roughly how much?”
“Oh my god, probably more than $60,000. Pretty sure more than
that.”
“Did you ever think about going to Stroger hospital [the county hospi-
tal], whenever you’ve had your asthma attacks? It might be cheaper there.”
“Yes, I did, but to be honest, I don’t go there because there is a wait
there. I wait a lot there. And once I go to my hospital, once I get there, I
1
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2 | Introduction
get a room right away. I don’t even have to wait five, ten minutes. If I go
over here, I have to wait at least four, five hours.”
“What do you know about the Affordable Care Act?”
“Is that the Obama?”
“It is. It’s also called Obamacare. Yeah. Do you think you’ll try to get it?”
“Right now, I don’t trust them. I just want to see what happens. I want
to hear people saying, ‘Oh, they’re helping me with my bills, with my
medicine.’ I want to see somebody who got it.”
* * *
In 2013, roughly half of US Latino young adults between the ages of
18 and 34 were uninsured, a problem the ACA was supposed to help
fix. The ACA represented an enormous shift in health care governance,
and its provisions opened unprecedented opportunities for Latinos
to acquire health insurance. Among its best- known effects, the ACA
allowed young adults to stay on their parents’ health insurance until age
26, prevented insurers from denying coverage to people with preexisting
conditions, expanded Medicaid eligibility to single able- bodied adults
between 18 and 64 who earned under 138% of the federal poverty level,
and created state marketplaces in which uninsured individuals (ineli-
gible for Medicaid) could purchase private insurance with the help of
a government subsidy. Modeled after Republican governor Mitt Rom-
ney’s health care reform in Massachusetts, the ACA treated health care
as a commodity and not a human right. Thus, like car insurance, the
ACA mandated citizens to purchase private health insurance or enroll
in Medicaid.
So why didn’t millions of uninsured Latinos like Nick actually enroll?
This troubling trend has puzzled scholars, policymakers, and health care
providers. Of the ACA’s many provisions, Medicaid expansion was key
for Latinos, the highest percent uninsured group in the nation.1 Millions
of previously ineligible Latinos could apply for this government health
insurance program for low- income people.2 Six years after implementa-
tion, they hadn’t: Latinos turned out to be the racial group least likely to
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Introduction | 3
enroll.3 Enormous sums were poured into advertising campaigns, and
the percentage of uninsured Latinos decreased from 15.7% in 2013 to
9.1% in 2019, yet a total of 10.1 million now-e ligible US Latinos remained
uninsured (half of them millennials aged 18 to 35 years old, 59% male
and 41% female).4
This is, to put it mildly, a major problem. Health insurance brings
enormous benefits that many Latinos need. In addition to facilitating ac-
cess to medical services, health insurance protects individuals and fami-
lies from financial ruin.5 In 2013 alone, 2 million personal bankruptcy
filings were attributed to unpaid medical bills, outpacing both credit
card debt and unpaid mortgages.6 For Latino families just one medical
emergency away from financial disaster, health insurance coverage has
the potential to foster economic well-b eing. Lacking such coverage is a
major driver of Latinos’ economic precarity.
The brutal four-y ear presidency of Donald J. Trump significantly
worsened the problem. President Trump’s racist caricatures of Latinos
expanded and hardened immigration enforcement, and the detention
of migrant adults and children at the US– Mexico border has had a chill-
ing effect on Latino Medicaid enrollment. The concurrent resurgence
of anti- Latino racism underscored the imperative to improve Latino
participation in health insurance programs and government programs
more generally,7 yet scholars and industry experts agree that fewer Lati-
nos, particularly those who lived in counties with stricter immigration
enforcement policies, sought enrollment under the Trump administra-
tion.8 Trump’s four invective- filled years in office are over; still, the con-
sequences of his anti- immigrant and anti- Latino postures and policies
will prove difficult for any future administration to remedy.
Even more troubling, Latinos’ low participation rates in government
programs are not limited to Medicaid or health insurance programs. De-
spite higher levels of poverty, Latinos also have the lowest rates of partic-
ipation in public assistance programs such as Temporary Assistance for
Needy Families and Supplemental Nutrition Assistance Program.9 This
matters tremendously for policy efforts aimed at expanding the nation’s
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4 | Introduction
social safety net. For example, a group led by Latina congresswoman
Alexandria Ocasio- Cortez has introduced the “Green New Deal,” a mas-
sive federal reinvestment act aimed at addressing climate change that
would create higher- paying jobs and improve access to food, health care,
and housing. Without a deeper understanding of Latinos’ low participa-
tion rates, those seeking to strengthen the social safety net are unlikely
to bring Latinos into the fold. The logic of “If you build it, Latinos will
come” does not apply to social policy.
The scant social science on Latinos’ low program participation rates
has pointed to a number of possible explanations; however, none is suffi-
cient. Some surveys and interview studies suggest that Latinos are often
unaware of their eligibility or believe “they don’t need” such supports.10
Other studies point to immigration status, with fearful Latino immi-
grant families describing a desire to avoid potentially disclosing their
undocumented status to any government agency—a nd reaping disas-
trous consequences.
* * *
This book tells the stories of uninsured Latinos’ experience with the
ACA in Chicago. I aim to answer what seems, on the surface, a straight-
forward question: Why did some uninsured Latino millennials enroll in
Medicaid while others did not?
I engaged in a longitudinal ethnographic study of the uninsured,
shadowing 25 Latinos, nine African Americans, and six whites during
the first three years of ACA implementation (2013– 16). I observed my
participants as they lived their daily lives, messaged with them on social
media, and accompanied them as they sought information about the
ACA or interacted with the health care system. Chicago proved an ideal
site for this study: 44% of the Chicagoland area’s total Medicaid- eligible
population— some 681,000 individuals— remained uninsured from 2014
to 2016.11 This was one of the most Democratic and pro-O bama areas
of the country, yet 40% of African Americans and 30% of Latinos who
became eligible for Medicaid here did not enroll.12
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