The politics of citizenship and health care are two of the most contentious issues in the U.S. today, and their unstable intersection results in health inequalities for millions of people. My dissertation explores how anti-immigrant policies in the U.S. affect how immigrants and their healthcare providers have negotiated biological and social risks during turbulent political times. Through qualitative methods and social theory, my dissertation interrogates citizenship as a structural determinant of health in the U.S.

Specifically, I ask: How does political polarization around U.S. health and immigration policy affect the health care of noncitizen patients in safety-net clinics? To answer this question, I conducted ethnographic observations and in-depth interviews with 59 participants in two states with juxtaposed immigrant policies. Between 2015 and 2018, I spoke with immigrant patients, clinic staff and providers, and community partners to understand how they responded to changing federal health and immigration policies. I also shadowed clinic workers and attended public meetings where these policies were discussed. Using grounded theory methodologies and theories of legal violence and biopolitics, I reveal how anti-immigrant administrations at federal and state levels have used policy uncertainty to discipline both immigrant patients and the institutions that serve them. In the progressive state, the 2016 election set local clinics on a crash course with increasingly aggressive federal immigration enforcement and turned their trusted medical-legal bureaucracies into a potential tool for immigrant surveillance through a process I refer to as “medical legal violence”. In the conservative state, clinics seemed more prepared to weather federal policy realignment but worried about expanding federal health exclusions. In both states, participants expressed increasing panic as the Trump administration enacted zero-tolerance immigration enforcement and broadened surveillance strategies.

My comparative fieldwork suggests that anti-immigrant policymakers have ingeniously leveraged medical bureaucracies to expand legal violence against noncitizens in the U.S. In my dissertation, I contextualize how contemporary U.S. health and immigration policies came to be, with a particular focus on how the increasing criminalization of Latinx immigrants results in biological harms while reproducing existing inequalities. I also examine case law and bureaucratic documents and trace a before-and-after arc from 1996 immigration and welfare reforms, to the announcement of President Obama’s executive orders on immigration, and through the first years of the Trump administration. I review the political evolution that led to heightened exclusion and enforcement through clinical mechanisms in the U.S., and I trace how participants from two juxtaposed sites have weathered these challenges in relation to the biopolitics of immigrant health today. These timely findings suggest that the biomedicalization of citizenship boundaries in the U.S. has material consequences for immigrant health, with implications for sociological understandings of citizenship, immigrant health policy, and health justice in the United States more broadly.