State Immigration Policy Contexts and Racialized Legal Status Disparities in Healthcare Utilization among U.S. Agricultural Workers

Document Type

Working Paper

Date of this Version



Acknowledgments An early version of this article was presented at the 2021 annual meeting of the American Sociological Association. We thank the editors and anonymous reviewers for their helpful comments and suggestions. This research received support from the Population Research Training Grant (NIH T32 HD007242) awarded to the Population Studies Center at the University of Pennsylvania by the National Institutes of Health’s (NIH) Eunice Kennedy Shriver National Institute of Child Health and Human Development. Support was also received from the NIH’s National Institute on Aging under grant T32 AG000243 (PI: David Meltzer). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. The authors are grateful to the Population Studies Center (NIH grant P2C HD044964) and the Axilrod Faculty Fellowship program at the University of Pennsylvania for general support. The authors are additionally grateful to Gary Reich, at the University of Kansas, for graciously sharing data and related code on state immigration policies; and to Daniel Carroll, Wenson Fung, and Susan Gabbard, at the U.S. Department of Labor and JBS International, for providing access to and guidance on the restricted NAWS data




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.


This paper has now been published as an open access journal article: Schut, Rebecca A. and Courtney Boen. 2022. "State Immigration Policy Contexts and Racialized Legal Status Disparities in Health Care Utilization Among U.S. Agricultural Workers." Demography 10342687. Online ahead of print. PMCID: PMC. View the Online Appendix.


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



Date Posted: 18 July 2022