Arizona's Immigration Enforcement Policies: Implications for Accessibility of Care in Immigrant Familie

BACKGROUND: Arizona has enacted some of the harshest state-level immigration policies restricting public benefits and services to immigrant families. The passage and enactment in 2010 of Arizona Senate Bill 1070 (SB1070), "Support Our Law Enforcement and Safe Neighborhoods Act", criminalized the act of hiring or harboring undocumented immigrants (Magana 2013a). Particularly affected are children of mixed-status families where one or more children are U.S. citizens and entitled to public services. There is limited knowledge on the effects of immigration enforcement policies on immigrant access to health services in Tucson, Arizona (Hardy et al. 2012, Toomey et al. 2014). Of particular interest to scholars and policymakers is how the family unit navigates accessibility to care when one or several members have varied immigration statuses. OBJECTIVE: The purpose of this dissertation is to explore healthcare accessibility and the healthcare experiences of Latino mixed-status families in Arizona's political context. The overall goal of this research is to identify promoters and barriers to healthcare accessibility in Arizona's immigrant communities particularly mixed-status households. METHODS: To conduct this formative research a mixed methods approach was utilized consisting of three study aims: 1) semi-structured interviews (quantitative and qualitative) with members of immigrant families (n = 43) 2) the use of photovoice, a qualitative participatory research method, to understand healthcare experiences of immigrant youth under the Deferred Action for Childhood Arrival (referred to as DACAmented youth) (n = 7) and 3) dissemination of photovoice results through an exhibition and dialogue with the community and policymakers. RESULTS: The results by specific study aims demonstrate: 1) factors limiting access to healthcare relate to complexity of application requirements (57%); discrimination and fear (26%), and long wait times for application approvals and appointments (13%). Other reasons reported (26%) relate to cost of care, confusion over eligibility of care and misunderstanding regarding coverage. Promoters to care relate to affordability of care (43%); positive customer service (37%); colocation of services (20%) and assistance with applications (17%). Other findings relate to proximity of location, language availability, ease of appointments and employer based assistance with insurance, 2) DACAmented youth shared concerns related to the high costs of medical care, the complicated requirements to access care, limited healthcare options, discrimination and fear while also emphasizing their community's strength and resilience. Most importantly, DACAmented youth sought to be understood, asking that their humanity be acknowledged, and 3) public exhibits, presentations and meetings with policymakers provided additional lessons for both participants and researchers by illuminating the challenges that health practitioners face in delivery of care to mixed-status families (and particularly to undocumented individuals) in a politically restrictive environment and how this impacts perceptions of "deservingness" of care. CONCLUSIONS: The study results indicate that local response particularly safety net programs are vital and offer a platform to respond to the unique challenges that mixed-status families' face especially when family members are deported and/or detained. This study offers lessons and insights on how anti-immigrant and restrictive political environments impact health and how to engage immigrant populations in achieving health equity. Results not only have important implications and relevancy in Arizona but also over growing national fears of family separation and deportations under the Trump administration. Healthcare providers can benefit from the proposed recommendations in building bridges to care to address health equity in immigrant communities. RECOMMENDATIONS: In efforts to continue to address and expand access to care to mixed-status families recommendations include the expansion of safety net programs and training of healthcare professionals and frontline staff to address the unique needs of mixed-status families in the provision of care. Additionally there is a need for increased outreach to immigrant families to provide health literacy programming and know your health rights workshops to facilitate usage and assist in the navigation of healthcare programs to gain a better understanding of health systems. The inclusion of youth voices in participatory health research and health policy development is also at the core of this research. This recommendation would require health policymakers to work differently and to seek ways to engage and collaborate with youth on health matters. Ultimately continued advocacy for immigration reform and inclusivity in healthcare is at the heart of achieving health equity.