Caught in the middle of the ACA

The Affordable Care Act promises to expand health coverage to millions of Americans who would otherwise go without. Excluded are people living in the U.S. illegally who are barred from signing up and who won't be penalized for not carrying insurance.

Read about the projects of other 2014 California Health Journalism Fellows.

Mixed-immigration families are caught in the middle and could find themselves mired in a patchwork of coverage depending on a family member's status. A citizen who marries someone who entered the country illegally can apply for coverage, but the spouse cannot. Some children may be covered while others may remain uninsured depending on their immigration status.

Nearly a quarter of U.S. children live with at least one immigrant parent. Mixed-status households often don’t know what they may be eligible for, and many are afraid of enrolling eligible members for fear of deportation. Several advocacy groups have posted frequently asked questions online in an attempt to quell such fears.

I’d like to delve into the impacts to mixed-status families as they navigate the new health care law. How does this uneven care affect family dynamics and bonds? How are doctor visits coordinated? Is there any resentment? What’s the impact to the wallet?

Besides immigrant health, I’m also interested in exploring the doctor-patient relationship and how it may change under the ACA. With an emphasis on quality over fee-for-service and with some consumers facing high deductibles, will this cause people to negotiate and take more financial responsibility for their health?