摘要：We conducted in-depth interviews in May to July 2012 to evaluate the effect of Alabama’s 2011 omnibus immigration law on Latina immigrants and their US- and foreign-born children’s access to and use of health services. The predominant effect of the law on access was a reduction in service availability. Affordability and acceptability of care were adversely affected because of economic insecurity and women’s increased sense of discrimination. Nonpregnant women and foreign-born children experienced the greatest barriers, but pregnant women and mothers of US-born children also had concerns about accessing care. The implications of restricting access to health services and the potential impact this has on public health should be considered in local and national immigration reform discussions. IN THE ABSENCE OF RECENT national immigration reform, state legislatures have increasingly proposed measures to address local immigration issues. Since 2007, legislators have put forth more than 1300 immigration-related bills and resolutions annually. 1 Most of these failed to become law; however, in the past 4 years, Alabama, Arizona, Georgia, Indiana, South Carolina, and Utah have passed omnibus legislation to enforce immigration policy and discourage settlement of unauthorized immigrants. 1 These laws contain numerous provisions that authorize local law enforcement personnel, employers, and others to verify an individual’s immigration status. All of these states also require verification of lawful presence in the United States for individuals seeking public benefits, such as health care, from state and local agencies; exceptions are made for prenatal and emergency care, child and adult protective services, and other services exempt under federal law (e.g., immunizations; the Special Supplemental Nutrition Program for Women, Infants, and Children; and short-term in-kind disaster relief). 2 Previous research has found that laws aimed exclusively at restricting immigrants’ access to public benefits reduce immigrants’ use of health services. Following the 1994 passage of California’s Proposition 187, immigrants failed to receive or delayed medical care out of fear of deportation. 3,4 As reported in one study, fear of deportation that results in delayed treatment of communicable diseases, such as tuberculosis, can pose significant health risks to the individual and the general public. 3 Requirements to present proof of lawful residence to receive publicly funded health services, such as those established in the 2005 Deficit Reduction Act, can also affect eligible legal residents and US citizens, 5–7 and groups that are less able to provide appropriate documentation, such as adolescents and the elderly, may be deemed ineligible for services. 6,8 The broader scope of recent state-level initiatives means that immigrants’ use of health care may be adversely affected not only because unauthorized immigrants are explicitly prohibited from receiving services, but also because the laws may exacerbate transportation and financial barriers, which affect other aspects of health care access. Anecdotal evidence suggests that recent state legislation has indeed hindered immigrants’ access to routine health care. 9,10 However, few studies have assessed how these laws have affected immigrants’ use of health services. 11,12 With growing calls for comprehensive national immigration reform, it is important to evaluate the impact of state-level laws on immigrants’ access to care to inform discussions that will shape future policies. We examined Latina immigrants’ experiences accessing health care following the June 2011 passage of the Alabama Taxpayer and Citizen Protection Act, House Bill 56 (HB 56), which was considered the toughest state immigration law in the United States. 13 Specifically, we assessed the range of ways the law has affected several dimensions of access to care for Latina immigrants and their US- and foreign-born children. Latino immigrants constitute the largest immigrant group in Alabama and in the United States overall 14,15 ; in fact, Alabama reported the second-largest percentage increase in its Latino population between 2000 and 2010, after South Carolina. 16 We focused on Latinas because they have a primary role in their children’s health and health care and typically have more health needs and greater use of health services than men. 17,18
