Is coverage enough? Persistent health disparities in marginalised Latino border communities

What has been the fate of those living in the place once dubbed the ‘county that needs the Affordable Care Act the most’? This article presents results from a longitudinal, five-year ethnographic study of healthcare access in the Rio Grande Valley of Texas. It explores reasons why this region along the U.S./Mexico border has the highest rate of uninsured persons in the country and remains among the most medically underserved, despite some increases in coverage accompanying the Affordable Care Act (ACA). It argues that the convergence of healthcare and immigration policy, framed by a unique regional history and social environment, has had multiple direct and indirect impacts on health and healthcare access. It examines the impact of the ACA on access for Latino immigrants and mixed-status households, which contain a mix of citizens, legal residents, and undocumented persons. It argues that the ACA aided in shifting the conversation to promoting private insurance coverage and away from more fundamental access barriers for low-income working populations ineligible for its benefits. This has eclipsed discussions about fundamental causes of persistent and highly racialised health disparities.