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Borders of Care

Immigrants, Migrants, and the Fight for Health Care in the United States

Borders of Care

Immigrants, Migrants, and the Fight for Health Care in the United States

Probes the relationship between the immigration and health care systems in the United States.
 
For the roughly ten million undocumented immigrants living in the United States, federal health care coverage is out of reach. Barred from Medicare, Medicaid, and the Affordable Care Act, most rely on hospital emergency rooms when they get sick, or clinics that don’t inquire about immigration status. Further obstacles to health care, including discrimination and the fear of deportation, mean that immigrants, undocumented or not, seek and receive less medical attention than any other population in the country. Yet immigrants haven’t always been ostracized from health care in the United States—providers and activists have for over a century worked to make medical services available to newcomers and migrants, including, at times, the undocumented.
 
Drawing together stories from diverse communities from the mid-nineteenth century to the present, Borders of Care examines how health care in the United States has both included and excluded immigrants. Beatrix Hoffman analyzes both the health and immigration systems, adding to our understanding of why these structures, and the policies that support them, have resisted reform. Moreover, she shows that immigrants, often scapegoated as burdens on the health-care system, have strengthened it through their responses to systemic exclusion. By creating hospitals and clinics, serving as practitioners, fighting for safer workplaces, filing lawsuits, organizing and protesting, immigrants and migrants have improved medical access for everybody and advanced the idea of health care as a universal right. As accessible as it is authoritative, Hoffman’s survey could not be more timely.

296 pages | 24 halftones | 6 x 9 | © 2025

History: American History

History of Science

Medicine

Political Science: Public Policy

Reviews

“Hoffman is not only one of this nation’s leading historians of medicine, but with Borders of Care she’s also proven to be a leading historian, period. She has bravely taken on our two most screwed up realms, the border and healthcare, and shown how intertwined they are. Every page features a telling story, an under-reported fact, a trenchant analysis.”

Brian Alexander, author of “The Hospital: Life, Death, and Dollars in a Small American Town”

“In this deeply researched book, Hoffman chronicles the tangled histories of immigration and health care in the United States. She exposes a long-running conflict between our idealized values of universal care and the persistent fact of exclusionary policies. Through individual stories, collective campaigns, and analyses of larger structures of political economy, this history shows how the denial of basic rights has had immediate and mortal consequences. Hoffman also shows how people have organized in the face of tremendous opposition to make decent medical care a reality. This affecting and incisive work is essential reading for scholars, advocates, and policymakers.”

Luke Messac, author of “Your Money or Your Life: Debt Collection in American Medicine”

Borders of Care presents a sweeping and wide-ranging history of migrants’ treatment in the American healthcare system. Hoffman’s vivid and engaging narratives offer fresh insights into migrants’ varied experiences of inclusion and exclusion, as well as how their activism helped establish new rights for all American residents. Timely and deeply illuminating, this book ultimately reminds us of the profound dysfunctions of America’s immigration and health care systems.”

Cybelle Fox, author of “Three Worlds of Relief: Race, Immigration, and the American Welfare State from the Progressive Era to the New Deal”

Borders of Care provides a twentieth-century history of medical access, as seen through the experiences and campaigns of migrant communities, their advocates and their neighbors. By centering the century-long experience of immigrant communities, Borders of Care provides a guide to understanding the future of medical care in our multi-ethnic, transnationally connected United States. This is a model of inclusive, empathetic historical analysis.”

John Mckiernan-Gonzalez, author of “Fevered Measures: Public Health and Race at the Texas-Mexico Border, 1848–1942”

Table of Contents

Introduction: Two Broken Systems
1. Immigrant Health Threats, Immigrant Health Action
2. Health Care in the Era of Restriction and Expulsion
3. Insuring, Exploiting, and Caring for Migrants
4. From Access to Rights
5. Health Politics as Immigration Politics
6. Violence against Health
7. Undocumented, Uninsured, Unafraid
Epilogue: From Pandemic to Power

Acknowledgments
Archives Consulted
Notes
Index

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