chapter  6
Structural violence and compassionate compatriots: immigrant health care in South Florida
ByLisa Konczal, Leah Varga
Pages 15

As interest in health care reform moved to the forefront during Barack Obama’s first year as president, some have speculated how US immigrants will fare under the new plan. While approximately fifty million Americans struggle to gain access to health care, immigrants face their own unique set of challenges. Immigrants without citizenship status are far more likely to be uninsured; face barriers under federal law that prevent them from receiving Medicaid and State Children’s Health Insurance Program (SCHIP) coverage; and receive significantly

less health care than US citizens (Kaiser Commission on Medicaid and the Uninsured 2008). Arguments that took place in town hall meetings across the nation during the summer of 2009 debated immigrant exclusion from a free ‘public option’ health care plan, while other debates centred upon the filling of presumed bureaucratic loopholes that would allow access to those allegedly ‘undeserving’ of medical care. Discussions uncovered deep-rooted preconceptions about immigrants and US policy: that offering benefits to immigrants is bait that lures them into the country, and that taxpayers would be overburdened with the cost of supporting them. Can (and do) immigrants jump through loopholes to get health care designed for US citizens? What factors permit access and what factors restrain immigrant access to health care? This paper attempts to answer these questions by focusing on

immigrants seeking health care in Miami-Dade County, Florida, the county with the highest percentage of foreign-born residents in the nation (US Census 2003). It starts with a review of writings that demystify common misconceptions about immigrants and health care and frames the issue within the theoretical context of symbolic and structural violence: concepts we found relevant to the relationship between immigrants and US health care institutions on several levels. The findings section of this paper broaches the questions above using data from in-depth interviews with health care professionals throughout Miami-Dade County. In 2004, more than half a million Miami-Dade County residents

under the age of sixty-five lacked health care coverage, representing between 26.7 and 29 per cent of the county’s population (Alliance for Human Services 2007; Healthy Start Coalition of Miami-Dade County 2006). This percentage is higher than the state’s (20.9 per cent) and the nation’s (17.7 per cent). Miami-Dade County in South Florida is an ideal place to study immigrant health care. Florida ranks fourth among states in terms of numbers of immigrants (3,391,511) and fifth when it comes to share of immigrants (18.5 per cent of Florida’s population are foreign born) (Terrazas and Batalova 2009). Florida’s immigrant population continues to grow: the state has added more than 720,683 immigrants since 2000 (highest growth in the US, after Texas and California). Over thirtyfive per cent of Florida’s immigrants live in Miami-Dade County (1,196,000). When classified by the share of immigrants in total county population, Miami-Dade County is ranked number one in the nation: 49.9 per cent of the county’s people are foreign born (Terrazas and Batalova 2009).