Through her research that was aimed at examining immigrants’ access to healthcare, Northeastern professor Tiffany Joseph came to learn about a green-card holder who is eligible for Medicaid.

Though she is a legal resident, a woman using the pseudonym Mariana was afraid that her coverage would negatively affect her application for citizenship, so she disenrolled. When she needed to get a mammogram, she chose to pay for it out of pocket by putting in extra hours at work.

Joseph, an associate professor of sociology, anthropology, and international affairs at Northeastern, says Mariana is not the only legal immigrant she knows who has taken such measures.

Joseph expresses concern that penalizing legal immigrants such as Mariana for using public benefit programs will lead to increased class and racial inequality and result in poor financial and health outcomes among immigrants, as well as their children born in the United States.

The Trump administration is seeking to redefine a status known as “public charge,” a designation used by immigration officials to describe a person who is considered primarily dependent on the government for subsistence. A proposed rule would change how legal immigrants get green cards—which allow immigrants to live and work permanently in the United States—if they have received public assistance such as Medicaid, food stamps, and housing subsidies.

Joseph says that Trump’s proposal would make it more difficult for low-income immigrants to apply for entry to the United States from abroad as a result of how they might use public benefits in the future.

Joseph has spent the past seven years examining immigrants’ access to healthcare under shifting public policies, focusing specifically on three of the largest immigrant groups in the Boston area: Brazilians, Dominicans, and Salvadorans.

This year, she has homed in on the impact of anti-immigrant policies, anti-immigrant rhetoric, and attempts to repeal Obamacare on local immigrant populations. She says her research reveals that the legal status of immigrants has become a basis for stratification in healthcare and other domains of life. Increasingly, she says, all non-citizens, even the ones who have the proper documents for legal residence, encounter barriers to certain social services.

“The current climate has also generated fear in immigrant communities and increased concerns about detention and deportation,” she says. “This is also a racialized process, as immigrants and even some citizens of color are more likely to experience discrimination based on race or ethnicity and be targeted by immigration enforcement for looking undocumented or like a terrorist.”

In May, Joseph received the 2019 Senior Ford Foundation Fellowship Award, which will enable her to expand her research project into a book over the next year.

“I’m really excited about the opportunity to work on this project and research a topic I feel is very important at this moment in our nation’s history,” she says. “Given the policy changes that I’ve seen and the impact of those policies on our local community members over the last seven years, I feel an urgency to share their stories.”

Joseph says she’s doing this work because it’s important for lawmakers and the general public to understand both the intended and unintended consequences of policies that are passed. Everyone, she says, has to use our healthcare system at some point, and she wants to understand how being an immigrant under shifting state and national policies complicates that experience in Boston.

“People talk about immigration as though it’s a very black and white issue, but when you add healthcare into the mix and really start to talk to people, talk to the immigrant population, talk to health care providers, talk to lawmakers, people from various types of organizations, it reveals a much greater picture and a much more complicated and more nuanced picture, one with lots of moving parts and people can easily fall through the cracks,” she says.

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