By: By Robert Vargas New York, New York University Press, 2022

Reviewed By Marcelo Siles

Robert Vargas conducts a careful analysis to illuminate
several constraints and barriers that Latinos face when
dealing with health care issues, including the purchasing
of health insurance. The book includes four chapters
to describe the different types of health concerns and the lack
of access to health insurance programs faced by members of
the Latino community in Chicago, and the last chapter explains
the role that the Latinos’ networks can assume in disseminating
information about how to get access to these insurance programs.
The first chapter, How the Uninsured are Criminalized, includes the
stories of two young people, one of them a 28-year-old Latino (Nick)
that suffered from asthma and is uninsured. “Living with asthma and
without inhalers made it difficult for him to hold down a job.” (pp.
22). The other, a 32-year-old black woman, had a very difficult life,
“When she was 14, her mother died in a car accident, and Lynette was
foisted by an uncle. Her uncle eventually sexually assaulted her, so
she ran away. She [currently] struggles with mental health.” (pp.34).
The experiences of these individuals have similarities. Both required
medical attention, from time to time, had odd jobs throughout their
life with no health insurance, needed huge amounts of money to
cover their health costs, and accumulated debt due to medical bills.
At one point, Nick had accumulated $60,000 in debt. Due to these
circumstances, both entered the informal economy, initially to
obtain the necessary medicines in the informal market from drug
dealers, and later to gain some money for their living expenses and
to cover their health costs. Nick shoplifted and sold these goods. A
drug dealer offered a job to Lynnette to sell prescription drugs. Both
had to serve time in jail due to their participation in the informal
economy. Both reported receiving good health care in prison,
according to Lynette “When you enter [prison] you see a psychiatrist,
counselor, therapist, and a doctor.” (pp.36). The two young people
not only received medical care, but also the necessary medicines.
Lynette recognized that: “The injustice of the state criminalizing
communities with inadequate health care in ways the Latino male
hadn’t.” (pp. 36). “At the same time, she was resourceful and remained
open to the idea of receiving health insurance from the government.”
(pp. 37). Medicaid expansion has extended health care to thousands
of often low-income people with criminal records (pg. 43).
The second chapter, Who deserves Health Care, highlights
that “First impressions matter. Positive first impressions
contribute to trust and social cohesion while negative first
impressions can lead to fear and avoidance. Latino’s impressions
of the health care system have been largely overlooked in
research on health insurance enrollment.” (pp. 44).
According to the author, “Race scholars argue that Black and Latinos’
learned avoidance of public benefit programs is not accidental, it’s
by policy design, while their interactions with the safety net made
White people feel more entitled to public benefits and confident in
their abilities to successfully navigate government and bureaucracy.”
(pp. 44-45). Vargas asserts that “In bureaucratic settings, where
social structures such as race, gender, and the family intersects,
individuals translate their experiences into internalized ideas about
their own deservingness. Some come out of their interactions feeling
supported, even empowered and motivated, to search additional safety
nets. Others leave feeling disrespected, dehumanized, and targeted
in ways that amplify system avoidance.” (pp. 45). He supports this
assertion based on interviews with both Latinos, gays, and Whites.
Chapter 3, Why Latina Women Sacrifice Their Coverage, documents the
struggles of young Latinos to deal with health issues during their college
days and during the “Waithood” period after graduation “In which young
people often shuttle back and forth between jobs or postsecondary
education programs. Each respondent of this chapter went uninsured for
the full duration of the study. . . these respondents felt doubly constrained
by their limited opportunities for upward mobility coupled with gendered
and racialized family obligations. Some felt—and complied with pressure
to prioritize their parents’ health and financial well-being over their
own.” (pp.79). Other respondents “Encountered a complete withdrawal
of parental support, a “tough love” effort families hoped would develop
financial independence and personal responsibility.” (pp. 80).
Chapter 4, The Role Gender Plays in Access to Health Care, provides
evidence of the gender gap of uninsured between young Latino men
and Latina women. “Latino men are more likely to be uninsured
(59%) than Latina women (41%).” (pp. 116). This gap could be
explained by the fact that Latino families expect their adult sons
to become financially independent by obtaining jobs that not only
will pay them decent salaries, but also include health insurance.
The uninsured Latino men who the author interviewed for this
chapter “Received additional support from family referral networks,
social workers, or labor unions, while some Latinas seeking to
escape abuse, tried but could not get similar institutional support
(pp.117). Another challenge faced by Latinos(as) is that some states
did not expand Medicaid eligibility under the Affordable Care Act
(ACA) or Obamacare, meaning quality and accessible healthcare
services were not available and/or serving at or beyond capacity.
Finally, chapter 5 The Power of Social Networks to Secure Insurance
discusses strategies for enrolling low-income uninsured Latinos
in health insurance plans. A director of a nonprofit organization
presented his strategy for recruiting college-aged Latinos to enroll
in health care programs. “Health insurance is not the most exciting
issue.” (pp. 137). The author describes many networks that college
students used to obtain information about health insurance, such
as getting information from a classmate, from roommates, and
college organizations. Vargas concludes that “The most powerful
campus referral for insurance enrollment seemed to be the mundane
word-of-mouth referrals that come from classmates, especially
when an individual was enduring a health crisis.” (pp. 161).
In conclusion, this is a very interesting and useful book for health
program directors, health care workers, researchers, and policy
makers interested in understanding the difficulties and constraints
uninsured minorities face when trying to enroll in government
sponsored programs (ACA – Medicaid), the high cost of these programs,
and uninsured minorities deal when they face with a health issue.