2024/07/27 by Meredith Van Natta
Health Professions · Medicine · Psychology · #Citizenship #Enforcement #Family medicine #Federal law #Global Health Workforce Issues #Health care #Healthcare Systems and Challenges #Immigration #Immigration law #Law #Law enforcement #Legislation #Medicine #Migration, Health and Trauma #Political science #Safety net #Specialty
paper · pdf · doi:10.1177/00221465241254390
openalex publication_date 2024/07/27 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/05
This article examines how U.S. immigration law extends into the health care safety net, enacting medical legal violence that diminishes noncitizens' health chances and transforms clinical practices. Drawing on interviews with health care workers in three U.S. states from 2015 to 2020, I ask how federal citizenship-based exclusions within an already stratified health care system shape the clinical trajectories of noncitizens in safety-net institutions. Focusing specifically on cancer care, I find that increasingly anti-immigrant federal policies often reshape clinical practices toward noncitizens with a complex, life-threatening condition as they approach a "specialty care cliff" by (1) creating time penalties that keep many noncitizens in a protracted state of injury and (2) deterring noncitizens from seeking care through threats of immigration enforcement. Through these processes, medical legal violence also creates the potential for moral injury among health care workers, who must adapt clinical practices in response to socio-legal boundaries of belonging.