Employment Exclusions and Health Care Access among Latine and Asian Immigrants in the Context of Racialization

Immigrants' employment is linked with health care access in the US, but we lack a thorough understanding of how immigrants' experiences of employment exclusions influence their health care access in the context of immigrant racialization. We aimed to assess employment exclusions (i.e., exclusions from jobs and violations at work) across Asian and Latine foreign-born adults, the two largest immigrant racial groups, and their associations with health care access. We also sought to understand variations by race, and current or past legal status.

We used 2018-2020 Research on Immigrant Health and State Policy survey data from 2,010 Latine and Asian foreign-born adults in California. We measured seven indicators of employment exclusions and used weighted logistic regression to estimate associations between employment exclusions and health care access: usual source of care and delaying care in the past 12 months. We tested race, current legal status and past legal status as moderators.

Nearly one-quarter (23.8%) of respondents reported ≥1 employment exclusion. Latine racial identity, current status as a non-citizen without permanent residency, and being previously undocumented was associated with greater employment exclusions. Employment exclusions were associated with 1.47 times (95% CI: 1.27, 1.69) greater odds of delaying care. Previous undocumented status, but not race or current legal status, moderated associations between violations at work and delay in care.

Latine immigrants face a greater number of barriers to employment opportunities and protections of worker rights compared to Asians, while employment exclusions and past legal status drives poorer health care utilization.