The Barriers to Health Care Access for Latino Migrant Workers in Saratoga County:An Exploration of Institutional, Personal, and Cultural Inhibitors of Receiving Quality Health

Care

Nathan HigueraSkidmore College

Word Count= 6,266 Direct all correspondence to Nathan Higuera at Skidmore College. 815 N. Broadway St.

Saratoga Springs, NY, 12866

Abstract Latinos experience worse health than any other racial group in the United States, and they have the lowest rates of health insurance. Saratoga County draws Latino migrant workers because of the tourist-influenced, low-wage jobs in the horseracing industry, agriculture, and restaurants. I analyze a 2008 survey of Latino migrant workers in Saratoga County (N=60) to identify the factors that inhibit their access to professional medical care. Segmented assimilation theory argues that individual and contextual factors both affect the process of assimilation for immigrants. I hypothesize that more positively assimilated migrant workers will have better access to healthcare. Factors such as length of time in the U.S., English proficiency, and the presence of employer health benefits are measures of acculturation and health care access respectively. Although the small sample did not yield statistically significant relationships, it did reveal several important patterns. In addition to the survey data, I explore alternative and transcultural methods of offering health care in a more efficient way such as promoturas- community health promoters, health fairs and bilingual medical centers.

The United States economy relies on the low-wage labor force that is powered by a population of immigrants seeking better economic opportunities in the United States. Migrant laborers find employment in industries like agriculture, day-to-day manual labor, horse racing, and restaurants. The jobs are high risk and low-wage positions that are often considered unsuitable for middle-class aspiring Americans, so they are left to a population of people who need the earnings more desperately. These jobs ensure grueling work within a loosely regulated working environment. Due to the lax nature of regulation, minimal qualifications, and type of work, these industries are havens for legal and illegal immigrants alike. While neither is advantaged in the American society, undocumented immigrants face far more difficulties dealing with exploitation by their employer. Even though the less-than-ideal working conditions may lead to health problems or put a worker at risk for injury, employers rarely offer the benefit of medical services for their immigrant workers. Consequently, migrant workers must find their own sources of health care and cover the cost out of pocket which is difficult for people surviving on low-wage earnings. Ways low-earning workers can deter the high costs of health care are by using outlets like public healthcare facilities and local clinics. These are places where working class citizens, Americans and immigrants alike, can obtain free and low-cost services, but they are difficult to access and utilize without proper knowledge of, or experience in American culture. Pieces of culture that Americans take for granted like fluency in the English language, social norms such as where to get a phone number or catch a bus, or a basic understanding of common laws can all confront immigrants trying to take advantage of the free and low-cost social services in the United States. These types of programs have saved and enriched many lives; we need to know how to maximize these services.

Most United States citizens are not willing to sacrifice their bodies and occupational prestige to perform the jobs that migrant laborers so deeply depend on. The low-wage labor sector is flush with Latino immigrant workers trying to make a life in America and/or send money back to their families in their home countries. Some migrants come with only the clothing on their backs and a duffle bag. They have no legitimate social connections, sparing a few friends, immediate or extended family members that may have immigrated to the United States before them. Even if an immigrant obtains a visa that legally permits them to be in the United States, navigating around a country can be extremely difficult with little knowledge of neither the English language nor the region they live in, especially while trying to access the healthcare system that they have a right to use. We cannot allow these workers to get lost and sick in our country. While national data in the field of Latino immigrants is normally sampled in California, the state with the largest population of Latinos, I will investigate data from Saratoga County in upstate New York. I hope to find similar conclusions as the existing literature which insists that several barriers exist toward the access of health care for Latino immigrants. The research is significant because Latino populations outside of California are less frequently studied and my results shed light on the healthcare system in the place my college calls home, Saratoga Springs. This is a county, highlighted by Saratoga Springs, which profits tremendously when it welcomes hundreds of thousands of tourists during the summer track season, none of which would function without the abundant labor of Latino immigrants. It is essential that we dig deeper into the support system the county provides for the workers and what is preventing the use, or successful of use, of these services.

Existing sociological literature about this topic is numerous and unified in results supporting the fact that there are extensive structural, belief, and cultural barriers to social services in the United States for Latino immigrants, and more so for those who are recently immigrated (Hamilton 2006). I examine if similar patterns exist for Latino workers in Saratoga County. Costs, transportation, language comprehension, and lack of knowledge are all cited as factors hindering the access of medical services for Latinos in the U.S. (Hamilton 2006; Kim 2011; Ransford 2010). I explore the effect of one's time in the United States and their English proficiency, as markers of acculturation to American society, and the effect on a Latino laborer's access to professional medical care when needed. It is important to know why some workers are able to manage the healthcare system while others are not. Are some possibly undocumented workers scared by the "officialness" of the receiving public medical care? Does the macho factor, men thinking they do not need a helping hand, contribute to the dismissiveness of the provided services? Do individual factors or institutional barriers have a greater effect on health care access? By examining the time spent in the United States and level of English proficiency as the independent variables and "how often received professional health care when seeking it" as the dependent while controlling for the presence of health benefits, I attempt to investigate the role a Latino immigrant’s acculturation plays when dealing with

health care institutions in Saratoga County. I hypothesize that immigrant workers who have been in the United States for a longer time will more frequently be able to get medical care when needed. I also hypothesize that Latinos who speak English more fluently will more frequently be able to get medical care when needed.

THEORETICAL FRAMEWORK

A development of classic thinking

Classic assimilation thinking supports that the level of acculturation is dependent on the amount of time living within that culture and that acculturation leads to upward social mobility for immigrants, especially for second and third generations. For the purpose of this research I assume that positive acculturation associated with upward social mobility, will also positively affect an immigrant’s access to professional medical care. The classic theory was developed using mostly data of European immigrants in the United States and is not applicable in the research of recent Latino immigrants, who do not have white skin. Portes and Zhou’s Segmented Assimilation Theory (1993) distinguishes itself from this framework by noting that all immigrant groups adapt to the new culture differently. Segmented Assimilation entails that there is no distinctive pattern of acculturation for all immigrants. The theory applies that individual and institutional factors both affect the process of assimilation for immigrants. While classic theory’s claim of upward social mobility as a result of more consecutive time spent in the U.S. still exists for certain groups of immigrants in the United States, many others, like Latinos, face negative mobility while acculturating into lower class neighborhoods. Acculturating into a detrimental, “under-class” environment often leads to neutral or negative social mobility for generations of immigrants (Portes and Zhou 1993; South 2005; Zhou 1999). Upward mobility is also seen when immigrant communities consciously try not to assimilate to American culture. When cultural values about family and education are prioritized, the role of location and other external factors are minimized. Researcher, Kalogrides, supports maintaining “a strong ethnic identity” can improve upward mobility. (Kalogrides 2009; 160).

The variables that guide Portes and Zhou’s theory can be broken into two groups: individual and contextual. Individual factors that affect one’s assimilation in the American culture are human capital like education level at the time of immigration, the proficiency of the English language, the birth country and the length of time in the United States. The contextual or environmental factors that contribute to assimilation in this theory are: the location emigrated to - is there a prevalent immigrant population?, the public policies of the receiving country, and the culture of the receiving people (Kalogrides 2009). All of the above factors contribute to the social opportunities an immigrant has access to, and also the type of social mobility that is likely. For the purpose of this research I assume that positive acculturation

factors associated with upward social mobility will also positively affect an immigrant’s access to professional medical care.

LITERATURE REVIEW

A trying environment

The demographics of the United States are changing. Researchers predict that 25% of the U.S. population will be of Latino descent by 2050 (Garcia 2009). The North American Free Trade Agreement (NAFTA) which was instituted by the Clinton administration in 1994 began a huge influx of illegal immigrants to the U.S. from Mexico. The bill diminished tariffs and subsidized crops like corn in America which eliminated an enormous portion of Mexico’s farming industry as Americans were able to export cheap, subsidized, genetically modified corn to Central America. The bill is one of the several institutional factors that contribute to the growing number of Latino immigrants in America. Because Mexican and Latin American farmers cannot compete with the phenomenally cheap corn prices that America produces, immigrating to the producing country seems like the only viable option for those who need to make a living off agriculture, a historically traditional lifestyle of Latino Americans. The United States is currently experiencing a cultural shift in the way Americans view immigrants as large waves of Latinos continue to enter the country, and imminent policy changes will hopefully be more accepting of our neighbors to the South. But without political fluctuation in immigrant policy legislation, Latino immigrants will continue to suffer at the hands of the American institutions. Since the 1996 Illegal Immigration Reform and Immigrant Responsibility Act, the number of deported illegal aliens has skyrocketed from about 50,000 or less per year (1996) to the 2008 statistic of nearly 400,000 (Fussell 2011). This style of strict deportation policy has increased fear in the lives of undocumented, and even documented, Latino immigrants. The fear of deportation, or of having friends or family deported, allows this group of people to be taken advantage of. Especially in a social dynamic with the employer, migrant laborers are virtually powerless. They cannot report wage theft, abuse, or other crimes against them for fear of having their immigration record reviewed (Fussell 2011). Employers know this and unfortunately use it to unethically maximize their business profits.

Heath concerns

A life with constant fear of being exposed and exploited can lead to a feeling of invisibility for Latino workers in certain social settings. Common assumptions that any Latino-looking person with an accent is an illegal can create dismissiveness and disassociation with American culture due to common ostracization. Unfortunately, the social atmosphere unto migrant workers is a

difficult one to conquer. In the case of immigrants who have little comprehension of the English language, it is nearly impossible to feel comfortable accessing the American healthcare system. In a study of the 2007 California Health Interview Survey (2011), researchers found that immigrants with limited English proficiency (LEP) suffered from more health problems and less frequently received professional medical care than their English proficient counterparts (Kim 2011). This is enormous disparity is a common theme within literature about the health of the Hispanic population in the United States.

In more extensive ethnographic research of the language barrier’s effect on medical care use for Latino American adolescents, researchers Garcia and Duckett, find that adolescents’ health does not fare better than Latino adults (Garcia 2009). After illuminating the health care patterns of several Latin American adolescents, the researchers found that the greatest barrier, by far, to quality medical care was in fact the language barrier. Difficulties included in the category of "language barrier" include: making appointments on the phone, interacting with health care provider, discharge planning, and executing the follow-up (Garcia 2009; 3). Teens mention increasing comfort and quality levels when the health care provider spoke Spanish or if they had an interpreter present for the appointment. Even with amplified public discourse about the new, affordable health care plan for American residents, the country is not providing the necessary resources that would eliminate the enormous and inhibiting language barrier that deeply damages the quality of medical care non-proficient English speakers can obtain.

Incongruent with existing research about the health status of Latino adults in the United States, the "epidemiologic paradox" is largely supported in the academic and medical world. The paradox supports that Latino newborns have no significant differences in their health than their White counterparts (Johnson 2009; Walton 2008). This similarity in Latinos and Whites diminishes with age (Hamilton 2006; 3). As age increases, the standard of health decreases more rapidly for Latinos than for other ethnicities in the United States. The health problems for Latinos include higher rates of certain diseases like heart disease, obesity, and diabetes as children grow into adolescence and into adulthood for first, second, and third generation immigrants (Hamilton 2006). Compared to English speaking peers, Latino adolescents faced suboptimal health at a greater rate. In a country where nearly a fifth of the population does not speak English, there needs to be better bilingual, low-cost healthcare options that are available to everyone trying to make a living in the country, especially for the youngest generation that will eventually become a prominent demographic in America.

The factors that contribute to the health problems of the Latino population in the United States are of the utmost importance to researchers trying to quell the racially-stratified pattern of medical care limitations. Upon arrival to America, the Latino population is statistically healthier than European immigrants but the acculturation process contributes to the deteriorating health for Latinos (Cho 2013). Factors such as poor nutrition, tobacco use, and

substance abuse have all been cited as behavioral factors that contribute to the decline in health (Cho 2013). This form of negative acculturation is dangerous for continuing generations of Latinos because the political and economic system in the United States perpetuates the unhealthy behavior by not educating the lower class population sufficiently, by not having enough bilingual schools, workplaces and health centers, and disregarding cultural differences within the healthcare system. While those concerned try to grasp the reality for Latino immigrants in the country, it is difficult because any data conducted in English is most likely skewed. A study by Cho, Holbrook, and Johnson found that foreign-born Latinos were more likely than Whites, African Americans, or U.S. born Latinos to have difficulty comprehending health survey questions. The researchers measured acculturations using the Short Acculturation Scale for Latinos (SASL), which evaluates self-reported data of language preference in certain situations and also a different measuring device that took into account factors of the respondent's birth country. The research unsurprisingly found that foreign-born Latinos are more likely to cite differences in comprehension of health surveys than all other sampled groups and that abstract questions posed the biggest comprehension threat to non-native English speakers. All groups with higher SASL acculturation scores had higher comprehension of the survey questions, even the most abstract (Cho 2013).

Health insurance

It is impossible to note how many migrant Latino workers possess health insurance due to the limited data about undocumented immigrants as a population, but we can look at the existing statistics for Latinos in America and assume that undocumented migrant workers face worse conditions. Latinos statistically have the lowest rate of health insurance compared to all other ethnic groups in the United States (Hamilton 2006; Ransford 2010). Studies have shown positive correlation with higher rates of insurance coverage for second and third generation Latinos but even so, more than sixty percent of first generation Mexican American children are uncovered by health insurance (Hamilton 2006; Marielena 2005). Even though the percentage of insured Latino Americans increases with succeeding generations, it does not mean the quality of health care improves along with the rate of people covered. Compared to insured White Americans, all minorities (including Latinos, Black Americans, and Asians) are at least two times more likely to be covered by public insurance rather than a private company. When Latinos need medical attention in the U.S. about thirteen percent rely on the emergency room or a local health clinic (Amendola 2011). These free or low-cost services often entail a long wait in lower quality facilities and a doctor or nurse who is a stranger to the patient. All of these factors that are associated with the lack of privilege for immigrants minimize the effectiveness of the overall

quality of care.

Community Health Services

No existing data support that Latino immigrants are utilizing the American health care system successfully, so researchers and community members are forced to think about ways to diminish cultural differences and create a more efficient system. Taking into account the current data regarding the health statuses of Latinos in the United States, one researcher notes the effectiveness of community and individual empowerment on improving health care conditions (Amendola 2011). Full transparency between healthcare providers and the patient is essential. Nothing can be lost in language translation without the effectiveness of the care decreasing. Amendola and other researchers note that ways to empower a minority community with health care knowledge are through health fairs and promotoras. A promotora is a community health advocate, usually a female Spanish speaker, who makes themselves available to the community and spreads awareness about health care services and health consciousness. The feeling of ostracization can prevent help-seeking behavior for Latino immigrants and it is much easier for them to connect personally with a Spanish speaker who can understand their native language and position within the social hierarchy. Health fairs also offer a way of spreading medical information by grouping members of a community in one place to do routine check-ups, pass out pamphlets, and offer their availability in the future. Normally these health fairs would have bilingual volunteers and/or translators/promotoras onsite to provide a transcultural atmosphere that empowers participants with an emphasis on understanding rather than diminish the confidence of immigrants who cannot fully comprehend English speakers. Both ways that the researcher suggests improve Latino healthcare conditions involve the increased distribution of health awareness and health service knowledge. The aforementioned literature that supports numerous institutional and individual barriers exist for Latino immigrants receiving medical services all hint at ways to deter the health care access inhibitors. An extensive study of Hispanic community health workers (CHW) and promotoras around the United States by Koskan (2013) supports that while the services are far from perfect; they are a fundamental component to the structure of a comprehensive and successful health care system that Latino immigrants can use. Promotoras combat several health care inhibitors like considering cultural differences, severing the language barrier, and dismissing the fear of deportation. Promotoras are essential because they come from the community they are intent on improving (Koskan 2013). Instead of a doctor-patient dynamic, community workers offer “peer-to-peer social learning” interaction (Koskan 2013). In place of a feeling of inferiority operating within the American system, Latinos have a sense of empowerment when they can learn about health education and resources from a peer, in their native language. Instead of trying to follow the instructions from a doctor who may not even

fully understand the problem, promotoras allow community members to be proactive about their health without feeling like an outsider.

With the lack of readily available Western medical care, Latino immigrant laborers often need to find different, cheaper ways to combat illness and injury. Many, often undocumented, laborers rely on the care from family or friends that they know in the area. In enclave-like communities that are predominantly populated by Hispanics, naturalistas exist, which are small shops filled with natural remedies. The use of these religion-based, once popular homeopathic healing outlets seem to be declining for Latinos, especially those with legal status (Akresh 2009; Ransford 2010). Another way of deterring inaccessibility of medical care is to not do anything at all. The macho factor is prevalent among Latino men, especially those with low levels of education, whom are normally the migrant day laborers in the U.S. This means that men's traditional views of gender roles, affects the way they act and treat women (Pitones 2007). In regard to health care accessibility, men who consider themselves macho will less frequently seek medical care, assuming the notion that they are tough enough to handle the illness or injury without professional help.

RESEARCH METHODS

I investigate the difficulty Latino migrant workers face in this country while trying to access healthcare services by analyzing the data from a quantitative survey of Latino workers in Saratoga County. More specifically I want to see the effect of acculturation, which I operationalize by the number of months lived in the U.S. combined with the level of English fluency, on access and utilization of healthcare, which I operationalize as "how often receive medical attention when seeking it," while controlling for the presence of health insurance. I use data from a study conducted by Skidmore Social Work Professor, Crystal Moore, and a team of her former students in 2008. This data were collected through quantitative surveys administered to sixty Latino immigrants currently working in the agriculture, restaurant, or horse racing industry. The sample is not random but rather a snowball sample that began with participants who had previously sought the services of the Latino Community Advocacy Program which is based in Saratoga County. Qualitative interviews were also conducted but my research will not focus on those data.

In the data set I investigate, the sample is 60, male and female, Spanish-speaking Latino immigrants working in different Saratoga County low-wage industries including horse racing, agriculture, and restaurants. I test the correlation between my independent variables, months lived in the United States and self-reported level of English proficiency, on the answers to the question "when you are sick or need medical attention, how often are you able to get needed medical care from medical professionals?" The answers to my dependent variable are measured on the Likert Scale of never, rarely, sometimes, usually, always. An additional answer,

“I have never needed medical services,” was valued as missing data because it is not feasible to measure a person’s medical care access if they have never sought it. Unfortunately calculating this answer as missing rid my research of nearly 40 percent of the already small sample. I control for the workers who have health insurance or health benefits because they probably have less trouble with obtaining medical care than their uninsured peers due to cheaper costs. To do this, I recoded health benefits as a dummy variable, with one meaning the respondent has benefits. I reverse coded the independent variable, English fluency, in order to make “fluent” the highest value. All missing data was systematically deleted.

My research will be violating assumptions that SPSS is performing bivariate analysis and multivariate regression on interval-ratio data. My data, with the exception of time spent in the U.S., is ordinal level data so it is necessary to take caution when analyzing the results. Due to the fact that more than a third of the already small sample did not answer the question that measures of my dependent variable, statistically significant findings are extremely difficult to achieve when using bivariate and multivariate analysis. These limitations are the primary reasons that I will primarily delve into the patterns offered by univariate analysis explore the implications of the existing health care system, and offer suggestions for future research and policy.

FINDINGS

The survey’s data generally support the findings of existing literature. Although the sample size does not allow any findings be statistically significant, patterns of an underprivileged class emerge. The data in Table 2 paint a picture of a diverse group of Latino workers whose time lived in the United States widely varies. More than two thirds of the sample had been in the country for 24 months or less and the median number of months for the sampled group was 15, as shown in Table 1. Research suggests that the people in the sample will most likely be healthier than their low-wage earning counterparts that have been in the U.S. for a longer time but they will also have poor access to health care because of their relatively recent migration. The relatively recent immigrants of the sample would also suggest that the sample would more likely have limited English proficiency.

-------------------------------------------------------------------------------------------------------------------------------TABLE 2 ABOUT HERE-------------------------------------------------------------------------------------------------------------------------------

The laborers’ self-reported categorization of language proficiency shown in Table 3 places the

majority in the middle category of the ordinal level data, “I speak some English.” Only 10 percent of the sample claims to be fluent in the English language. Past research has repeatedly found a direct connection between limited English proficiency (LEP) and unsuccessful utilization of the American health care system (Kim 2011). This data would suggest the need for low-cost health care facilities that have bilingual employees and volunteers, or capable translators who can assist the patient in Saratoga County.

---------------------------------------------------------------------------------------------------------------------TABLE 3 ABOUT HERE---------------------------------------------------------------------------------------------------------------------

As shown Table 4, a potential health care enhancer, health insurance, is sparse in the survey sample. Only 17 percent of the sample had health insurance or health benefits at the time of the survey, and half of those covered by insurance or benefits in the sample were employed in the horse industry where legitimately employed workers are provided health benefits. This sample shows 90 percent of laborers working outside the horse industry living without health insurance or benefits. This could be explained by the majority of workers being undocumented but only 20 percent cited legal status as a barrier to health care access. The data suggest that those employed in the agriculture industry, the restaurant industry, and other low-wage jobs are covered by any health benefits at an extremely low rate in Saratoga County. Two of the five insured workers whom were not employed at the racecourse, were the only respondents to claim to have university level educations in their home countries. These two men, the only university educated people in the sample, provide an interesting question of how much higher education levels of immigrants can affect having health benefits. This cultural capital is noted in segmented acculturation theory to have a significant effect on the standard of living an immigrant holds in their new country so we assume it also has a positive effect on health care access.

---------------------------------------------------------------------------------------------------------------------TABLE 4 ABOUT HERE---------------------------------------------------------------------------------------------------------------------

Unfortunately, after listwise deletion of the missing data, 37 percent of the sample claim to never have needed medical attention in the United States, so we are unable to find statistical significance in the remaining sample. 57 percent of the sample self-reported their own access to professional medical care when needed in the categories of never, rarely, and sometimes. This leaves only 6 percent of the sample who reported that they normally or always had access to professional medical care. It is interesting to note that the macho factor may play a role in

this result as a significantly larger percentage of males answered that they never sought medical care compared to the females in the sample. Although there is no statistical significance due to the sample size, this suggests very low rates of success for keeping the Latino migrant worker population healthy.

----------------------------------------------------------------------------------------------------------------------------TABLE 5 ABOUT HERE----------------------------------------------------------------------------------------------------------------------------

Bivariate Analysis

The only variable that showed any effect worth noting on health care access is time in the United States. By using the uncollapsed, interval-ratio version of the measure the Pearson Correlation is .22, showing a weak, positive relationship to access to professional medical care that cannot be defined as significant. The small sample size inhibits the chances of any correlations found being significant but it is necessary to unpack the relationship as if it were supporting a statistical trend. While the majority of the sample had been in the country for two years or less, this positive relationship supports the notion that more time in the foreign country results in better cultural opportunities such as professional medical care access. Another correlation found in the bivariate analysis, displays a relationship between time in the U.S. and level of English proficiency. Although it is weak and not statistically significant, a Pearson Correlation of .26 demonstrates that with a larger sample, we may find that time in the U.S., assuming positive assimilation not in an enclave-like environment, will positively affect the English language ability for Latino immigrants. The prior literature review explores the deep, preventative nature of limited English proficiency when dealing with the American health care system.

----------------------------------------------------------------------------------------------------------------------------TABLE 6 ABOUT HERE----------------------------------------------------------------------------------------------------------------------------

Multivariate Analysis The sample size and lack of ordinal-ratio variables do not allow any statistical significance in my multivariate analysis. This may indicate that other variables besides the one's I am researching affect health care access for this sample of Latino immigrants in Saratoga County but I would argue that a larger sample would support my hypotheses. A larger sample and more comprehensive survey are necessary to delve deeper into the factors that allow or prohibit the

access to professional medical care.

----------------------------------------------------------------------------------------------------------------------------TABLE 7 ABOUT HERE----------------------------------------------------------------------------------------------------------------------------

DISCUSSION

Illuminating the individual and contextual factors that contribute to Segmented Assimilation Theory provides a comprehensive lens for viewing the Saratoga County data that is central to this paper. Although the regression data was limited due to sample size and did not show statistical significance on the tested variables, it would be foolish to dismiss the notions of that English proficiency and time in the U.S. do not affect health care access for Spanish-speaking, Latino migrant workers. Univariate analysis is the most helpful while interpreting the small, non-random survey because it shows patterns of people who do not nearly have the same opportunities for accessing the American healthcare system as those born in the U.S. The data show that 98 percent of the sample cited at least one barrier to their health care access and 88 percent would like to see a doctor more. The startling statistic that only 83 percent of the sample had health insurance should be enough reason to explore deeper into the exploiting environments of low-wage workplaces and also government policy that does not comply with changing demographics. While the independent variables tested in regression analysis were part of the individual factors that Zhou and Portes’ theory offers, it is also necessary to look at the environmental factors that migrant workers face in Saratoga County.

It is difficult to conclude whether the community in Saratoga can be summed up as a detrimental for Latino immigrants, which would mean the community is perpetuating neutral and negative assimilation according to Segmented Assimilation Theory. During the summer season, the Latino population grows exponentially and an enclave-like community forms in the run-down apartment buildings in close proximity to Saratoga Race Course. I assume that this environment is not one that promotes upward social mobility, but rather one that fosters socially neutral or negative mobility if they were to raise kids there. About two thirds of the sample claimed to have dependent children at the time of the survey meaning that the effects of the migrant workers’ social environments and access to health services have even larger implications than just at the individual level.

The Latino population is growing tremendously in the United States. Due to the fact that younger immigrants are entering the country (people at a prime age for procreating), statistics

show that over a quarter of persons under the age of one are Hispanic in the United States (Passel 2012). As the baby boom generation ages and eventually dies off, White hegemonic control of the United States will be challenged by increasing ethnic and racial diversity. The focus on quality professional medical care for migrant workers needs to be viewed as an issue that will directly impact the future of American society. Research has shown a relationship between poor utilization of the health care system for parents and poor utilization for their children. Especially for undocumented immigrants, the fear of deportation creates severe mental and physical health problems for both them and their children. If someone is unable to use the existing healthcare system competently for themselves, how can it even be plausible that they would be able to access quality care for their children? Policy like the DREAM Act aims to combat the paradox that undocumented immigrants face while trying to care for their children but it still puts stressful pressure on parents to expose their possibly illegal status to public officials in the process.

All existing research conducted in the fields of health status, health care access, and health care utilization for Latino immigrant groups, support that the United States’ infrastructure is not conducive for Spanish-speaking immigrants. While the country is economically dependent on the low-wage employment that immigrants are associated with, very little has been done by the government to combat the problematic socio-political system that diminishes health, livelihood, and opportunity for upward social mobility for relatively low-educated immigrants who seek better lives for themselves and their families. Although this paper has taken a stance that institutional factors most negatively affect health care access for immigrants, there is hope for positive reform to the system if the Affordable Care Act is executed successfully. According to the White House web document titled, “The Affordable Care Act Gives Latinos Greater Control Over Their Own Health Care,” the Obama administration claims the Act will have a positive impact for the most uninsured ethnic group in the U.S. by attacking the most inhibiting barriers that Latinos face. The administration states that about 9 million Latinos will be newly eligible for health care due to the proposed lower costs of insurance and political measurements taken against discriminatory insurance plans. Other details of Obamacare are also promising to the Latino community for their cultural considerations. Focus on free preventive care, investment in community health teams, the funding of community health centers and clinics, lowering racial and ethnic disparities between professional medical workers, institutionalizing the National Center on Minority Health and Health Disparities at the National Institutes of Health, and furthering research on minority health disparities all show that previous studies done in the fields of Public Health and Sociology are able to positively impact public policy (whitehouse.gov/healthreform). It is exciting that this initiative addresses the structural and cultural barriers that Latino immigrants face and suggest additional policy that will benefit the marginalized population. The funding of community health teams and health centers are of the utmost importance in lowering health

care access disparities. At-risk communities have been performing these services for many years in the form of non-profits organizations and numerous literature cite the immense benefits of empowering members of the community with health knowledge, especially when provided by a Spanish-speaker (Amendola 2011; Akresh 2009; Koskan 2013). The fact that bilingual health centers are not mentioned in the outline of the bill’s implications for Latinos is worrisome because of the effect that limited English proficiency has on the successful utilization of public medical services. There may be flaws apart from the web-launch disaster of the program but if the Act can be instituted smoothly, it would be a victory for low-income legal residents of the United States which includes many Latinos. Undocumented persons would have no right to public health care under the Affordable Care Act.

CONCLUSION

The results of my statistical analysis were unable to support my hypotheses that Latino migrant workers who have spent more time in the U.S. and have more English proficiency would also have more access to professional medical care when needed, but this is not supported. The data show that there are several existing problems for Latino workers in Saratoga County including but not limited to: low English proficiency, lack health care, low levels of education, and the desire for better and more accessible medical care. All of these data support the notion that a combination of individual and contextual factors contributes to the access to health care which is conceptually derived from Portes and Zhou’s Segmented Assimilation Theory. Based on existing literature and review of the survey’s data I conclude that contextual factors, such as current public policy, lack of bilingual community services, and lack of health awareness promotion weigh more strongly against proper health care access for Spanish-speaking Latino migrant workers than their own individual factors like language proficiency and education level.

Limitations

Many aspects of the survey limited the significance of the quantitative results. The sample size of 60 that shrunk dramatically with missing data was very inhibiting to the results of the research. A larger, random sample is necessary to complete conclusive research about the subject. The fact that many of the participants were recommended by the Latino Community Advocacy Program means that they were more likely to be in need of services and those who were well established in the Saratoga community were probably excluded from the sample.REFERENCES

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http://www.whitehouse.gov/files/documents/health_reform_for_latinos.pdf

Table 1. Means, Medians and Standard Deviations for Variables (N=60)

VariableMean

Median

S.D. (N)

Months in U.S. 33.8 15.00 44.4 (53)

English Proficiency 1.8 2.0 .59 (59)

Health Insurance .17 0.0 0.38 (59)

Health Care Access 2.4 3.0 1.1 (34)

Table 2. Time in U.S.

Consecutive Months

Percent

1-3 15.1

4-5 20.8

6-15 15.1

16-36 17.0

37-60 17.0

61-240 15.1

Total 100.0

(N) (53)

Table 3. Language Proficiency

Level of English Percent

I speak very little English 27.1

I speak some English 62.7

I am fluent in English 10.2

Total 100.0

(N) (59)

Table 4. Health Insurance

Health insurance

Percent

No 83.1

Yes 16.9

Total 100.0

(N) (59)

Table 5. Access to Professional Medical Care When Needed

Access When Needed Percent

Never 20.4

Rarely 7.4

Sometimes 29.6

Usually 3.7

Always 1.9

Never sought professional care

37.0

Total 100.0

(N) (54)

Table 6. Correlations (r) between Time in U.S., English Language Proficiency, Health

Insurance, and Health Care Access (listwise deletion, two-tailed test, N=30)

VariableTime in U.S. English Proficiency

Health Insurance

Health Care Access .22 .05 .06

Time in U.S. .26 .04

English Proficiency .07

Table 7. Regression of Health Care Access on all Variables

Variable b β

Time in U.S. .01 .22

English ProficiencyHealth BenefitsConstant

-.02 .152.17

-.01 .06

R2=-.058; F(3,26)= .474; NS