Access is not the aim: the violent exclusion and hazardous inclusion of immigrant health care

In her book, Not All In: Race, Immigration, and Health Care Exclusion in the Age of Obamacare, Tiffany D. Joseph draws on interview-based research with over two-hundred Latinx immigrants, healthcare providers, and health advocacy organization employees in Boston, Massachusetts to illustrate that immigrant inclusion within the health care system is limited. This important book illustrates the enduring value of research in progressive-leaning contexts, the importance of racialized legal status, and the limits of purportedly "universal" health coverage. In short, the book highlights that coverage does not mean access, and access does not mean care. This inspires the question: should access be our aim? I argue that access should not be our aim because being incorporated into a structurally violent system only reifies that system. To ground this argument, I invite discussion about (1) racialized legal status, (2) racial capitalism, and (3) Joseph's top-down conceptualization of the US health care system.