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Structural Exclusion and Administrative Burden within the Affordable Care Act: An Exploratory Study of Latinos in Arizona

Author: KARINA MORENO and LAUREN BOCK MULLINS
Published in JHHSA, Vol. 40 No. 3

This paper is based on an exploratory study that collected original data in 2016 from Latino and Latino immigrant communities in Arizona to examine the most important policy issues and challenges they encounter. The findings showed, surprisingly, that Latino respondents considered health care and the Affordable Care Act among the top challenges Latinos face today, just as important as the overall economy of the United States and even more important than immigration reform. This was surprising because Arizona has increasingly and expansively securitized its immigration sector, which disproportionately targets Latinos and Latino immigrants. In light of this puzzle, this study examines the discrepancies of the health care system from a federalist point of view, and synthesizes existing research on the outcomes of the Affordable Health Care Act across lines of race, ethnicity, gender, national origin, and immigrant status. We connect these findings to academic literature on administrative exclusion and administrative burdens, a crucial intersection within the field of public administration and social policy. We then found another interesting item from the survey data: there is an increased likelihood of perceiving the ACA and health care as a pressing challenge if Latinos perceive discrimination, particularly on the basis of language. This paper adds to existing work on the disparities in health that arise out of lack of cultural competency, an issue that the public health community must address. Implications of this paper are critical in understanding contextual issues that are imperative to community building. In the context of Latinos and Latino immigrants who have repeatedly expressed feeling disenfranchised from formal political structures in the U.S., this research is especially important to facilitate their political assimilation and incorporation, in order to further establish social equity perspective.

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