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.