Beyond welfare reform: Reframing undocumented immigrants鈥?entitlement to health care in the United States, a critical review

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• 作者：Anahí ; Viladrich ; ^{anahi.viladrich@qc.cuny.edu}
• 关键词：U.S.A. ; Immigrants ; Undocumented ; Welfare reform ; Deservingness ; Framing ; Health care ; Health services ; Review
• 刊名：Social Science and Medicine
• 出版年：2012
• 期刊代码：242_02779536
• 类别：med
• 出版时间：March, 2012
• 卷：74
• 期：6
• 页码：822-829
• 文件大小：182 K

摘要

This article addresses the main scholarly frames that supported the deservingness of unauthorized immigrants to health benefits in the United States (U.S.) following the passage of the Personal Responsibility Work Opportunity Reconciliation Act (PRWORA), known as the Welfare Reform bill, in 1996. Based on a critical literature review, conducted between January 1997 and March 2011, this article begins with an analysis of the public health rhetorics that endorsed immigrants鈥?inclusion into the U.S. health safety net. In this vein, the 鈥渃ost-saving鈥?and 鈥渢he effortful immigrant鈥?frames underscore immigrants鈥?contributions to society vis-脿-vis their low utilization of health services. These are complemented by a 鈥渟urveillance鈥?account that claims to protect the American public from communicable diseases. A 鈥渕aternalistic鈥?frame is also discussed as a tool to safeguard families, and particularly immigrant mothers, in their roles as bearers and caretakers of their American-born children.

The analyses of the 鈥渃hilling鈥?and the 鈥渋njustice鈥?frames are then introduced to underscore major anthropological contributions to the formulation of counter-mainstream discourses on immigrants鈥?selective inclusion into the U.S. health care system. First, the 鈥渃hilling effect,鈥?defined as the voluntary withdrawal from health benefits, is examined in light of unauthorized immigrants鈥?internalized feelings of undeservingness. Second, an 鈥渋njustice鈥?narrative highlights both the contributions and the limitations of a social justice paradigm, which advocated for the restoration of government benefits to elderly immigrants and refugees after the passage of PRWORA. By analyzing the contradictions among all these diverse frames, this paper finally reflects on the conceptual challenges faced by medical anthropology, and the social sciences at large, in advancing health equity and human rights paradigms.