Document Type

Working Paper

Date of this Version



Research links restrictive immigration policies to immigrant health and healthcare outcomes. Still, most studies in this area focus on the impacts of single policies in particular years, with few assessing how broader state-level immigration policy contexts impact groups by nativity, race-ethnicity, and legal status. Linking data from the National Agricultural Workers Survey (2005-2012) with information on state immigration policies, we use an intersectional approach to examine the links between state-level immigration policy contexts and healthcare utilization by nativity, race-ethnicity, and legal status. We also assess the associations between two specific types of state immigration policies—those governing immigrant access to Medicaid and driver’s licenses—with healthcare utilization disparities. We find that state-level immigration policy contexts are associated with healthcare utilization among U.S. born and naturalized U.S. citizen non-White Latinx agricultural workers, who report lower levels of healthcare utilization and greater barriers to care-seeking in more restrictive policy contexts. By contrast, we found little evidence that state policies shaped healthcare utilization among undocumented workers. These findings advance understanding of the impacts of “policies of exclusion” on the lives of marginalized groups and underscore the importance of racialized legal status in considering the links between sociopolitical contexts and health and healthcare disparities.

Copyright/Permission Statement

This working paper has been accepted for publication in the journal of Demography and is forthcoming at:


Latinx health; Healthcare utilization; Health disparities; Immigration policies; Legal status



Date Posted: 18 July 2022