Coming March 11, 2025

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Not All In: Race, Immigration, and Healthcare Exclusion in the Age of Obamacare

Despite progressive policy strides in health care reform, immigrant communities continue to experience stark disparities across the United States. In Not All In, Tiffany D. Joseph exposes the insidious contradiction of Massachusetts’ advanced healthcare system and the exclusionary experiences of its immigrant communities.

Joseph illustrates how patients’ race, ethnicity, and legal status determine their access to health coverage and care services, revealing a disturbing paradox where policy advances and individual experiences drastically diverge. Examining Boston’s Brazilian, Dominican, and Salvadoran communities, this book provides an exhaustive analysis spanning nearly a decade to highlight the profound impacts of the Affordable Care Act and subsequent policy shifts on these marginalized groups.

Not All In is a critical examination of the systemic barriers that perpetuate healthcare disparities. Joseph challenges readers to confront the uncomfortable truths about racialized legal status and its profound implications on healthcare access.

What people are saying about
Not All In

Not All In is revelatory. Drawing on in-depth interviews, Tiffany Joseph gives voice to individuals born abroad as they navigate the challenges of a health care system tilted toward the privileged. Throughout, Joseph proves a wise, sensitive, and humane guide through the labyrinths of health care and public policy. Not All ought to be required reading for all Americans.
— James A. Morone, author of Republic of Wrath and coauthor of Whiplash: Presidents and Health in a Divided America
Not All In makes invaluable contributions to understanding the reverberating impacts of ACA, the most significant federal health care legislation since 1965. Joseph’s carefully researched study provides new insights into how race, ethnicity, and documentation status intersect to create health disparities in Brazilian, Dominican and Salvadoran immigrant communities. Highly recommended!
— Lisa Sun-Hee Park, co-author of The Third Net: The Hidden System of Migrant Health Care
Exhaustively researched and thoughtfully argued, Not all In exposes how the Affordable Care Act is fraught with the same discrimination by documentation status and by ethnoracial origins as other public policies and has led to worse outcomes. This compelling book has implications beyond a single state or policy domain and reveals the fraying ideal of an immigrant America.
— David Cook-Martín, author of Culling the Masses: The Democratic Origins of Racist Immigration Policy in the Americas
Just when the term ‘migrant crime’ has been launched into our national consciousness, Tiffany Joseph provides a masterly response to help us make sense of the demonization of immigrants and the impact of racialization on access to health care. This is a must-read to grasp how a health care system built on structural racism collides with those of precarious legal status—often with deadly effect.
— Colleen M. Grogan, author of Grow and Hide: The History of America's Health Care State