Borders of Care

Probes the relationship between the immigration and health care systems in the United States.

For the roughly ten million undocumented immigrants living in the United States, federal health care coverage is out of reach. Barred from Medicare, Medicaid, and the Affordable Care Act, most rely on hospital emergency rooms when they get sick, or clinics that don’t inquire about immigration status. Further obstacles to health care, including discrimination and the fear of deportation, mean that immigrants, undocumented or not, seek and receive less medical attention than any other population in the country. Yet immigrants haven’t always been ostracized from health care in the United States—providers and activists have for over a century worked to make medical services available to newcomers and migrants, including, at times, the undocumented.

Drawing together stories from diverse communities from the mid-nineteenth century to the present, Borders of Care examines how health care in the United States has both included and excluded immigrants. Beatrix Hoffman analyzes both the health and immigration systems, adding to our understanding of why these structures, and the policies that support them, have resisted reform. Moreover, she shows that immigrants, often scapegoated as burdens on the health-care system, have strengthened it through their responses to systemic exclusion. By creating hospitals and clinics, serving as practitioners, fighting for safer workplaces, filing lawsuits, organizing and protesting, immigrants and migrants have improved medical access for everybody and advanced the idea of health care as a universal right. As accessible as it is authoritative, Hoffman’s survey could not be more timely.