Expanding Vulnerability: Health Care, Well-Being, and Arizona’s Immigration Policies – Julie Armin & Robin Reineke
Julie Armin & Robin Reineke
University of Arizona
Arizona has seen a systematic attack on immigrants over the past year. Several anti-immigrant measures have passed through the legislature in recent months, and more are in the planning stages. Through the everyday enforcement of these policies, the borders of the United States are re-inscribed on bodies and within communities, creating “legal” and “illegal” categories of people who have differential access to state resources and services. Nicholas De Genova argues that ‘illegality’ “is an erasure of legal personhood” that is designed not to physically exclude individuals, but “to socially include them under imposed conditions of enforced and protracted vulnerability.” These constructed categories can expand, compromising the well-being of those who seem to fall outside their initial reach, as friends, co-workers, teachers, doctors, and community members are implicated.
In this report from Tucson, we embed a discussion of HB2008’s effects on Arizona residents’ health and well-being within Arizona’s current political context and immigration policy history. The stories and data in this article come from Julie’s research into health care access in Southern Arizona and Robin’s investigation of missing and deceased migrants in the desert. In response to the rapid changes in immigration policy in Arizona, we conducted participant-observation and discussions with local human rights groups and community health care providers. Finally, our perspective on this topic is informed by our active membership in a variety of Tucson communities and our own experience of Arizona’s policies.
While this post focuses on House Bill 2008, which requires Department of Economic Security (DES) workers to report individuals who disclose their undocumented status, we emphasize the importance of situating it within a cascade of recent anti-immigrant legislation. In the past half-year, three other major anti-immigrant bills have swept through the statehouse:
- Senate Bill 1070, which requires police officers to determine the legal status if reasonable suspicion exists that the person is in the U.S. illegally;
- Senate Bill 1097, which states that the Department of Education will collect data on school districts’ non-citizen students; and
- House Bill 2281, which bans any instruction primarily designed for pupils of a particular ethnic group.
Arizona has a history of fostering a climate of fear with regard to immigrants and immigration. This can be traced to national immigration policy shifts during the Clinton administration of the mid- to late-90’s that pushed migrants into Arizona. The Immigration and Naturalization Service’s (INS) 1994 Southwest Border Strategy sealed off traditional urban border crossing routes, funneling migrants through Arizona deserts where high temperatures and rugged terrain have led to hundreds of deaths each year. Human rights advocates argue that migrants are channeled not only across perilous Arizona deserts, but also into Arizona cities with xenophobic immigration policies, making them especially vulnerable to apprehension and deportation.
Vulnerability has effects that radiate through networks of policies, people, and bureaucracies. House Bill 2008, for instance, passed through the Arizona legislature and was signed into law by the governor without much fanfare, but it generated several weeks of confusion and anxiety among human rights advocates, state workers, and undocumented residents. HB 2008 mandates that workers within the state DES, which administers benefit programs such as Medicaid and the Supplemental Nutritional Assistance Program (“food stamps”), report individuals they know to be undocumented. As news of the law spread through community networks, undocumented patients failed to show up for their previously scheduled health appointments at their trusted clinics.
Moreover, the law’s passage generated temporary yet sustained panic among DES employees and undocumented immigrants. We were told by human rights advocates that many DES workers initially reported to U.S. Immigration and Customs Enforcement (ICE, previously INS) everyone they suspected of being undocumented. When DES released a 7-page memo containing reporting guidelines, it reminded DES employees that they are required to report individuals who voluntarily disclose they are in violation of immigration law following the passage of HB2008 in November 2009. Despite these clarifications, employees also know that failure to report can lead to them to be charged with a Class 2 misdemeanor crime, resulting in a fine of up to $750 and four months in jail. We argue that in transforming DES employees into informants for ICE, this policy expands the category of “criminal” or “illegal” to include government employees.
Although DES workers do face punishment for non-reporting, ultimately this law is intended to limit access to state-funded health care. Therefore, many human rights advocates argue that HB 2008 has the greatest effects on the health of U.S. citizen children of undocumented parents. When the state’s KidsCare health insurance program ran out of money in late 2009, the legislature put a cap on new applications. Many undocumented parents are now afraid to renew their children’s policies, which may cause them to lose their spot and go to the bottom of the waiting list for a cash-strapped program. In spite of this fear, many parents continue to interact with state programs, temporarily putting aside concerns about being identified as “illegal” by DES employees in order to ensure that their children do not lose their state-conferred benefits.
By emphasizing the law’s effects on citizen children, advocates try to appeal to a broad swath of Arizonans with varied political leanings. Perhaps finding it politically problematic, media outlets and advocates less often discuss the health of the law’s intended targets—undocumented residents of Arizona. In fact, HB2008 most likely deters undocumented individuals with serious health issues from seeking care. An advocate at Derechos Humanos told us about a woman who was diagnosed with an ectopic (tubal) pregnancy, a painful and potentially life-threatening condition. She received treatment for the condition at the hospital prior to the passage of HB 2008 and was told to return for follow-up care. When the law passed, she was so afraid to go to the hospital that she waited and continued to suffer symptoms. After bleeding for more than a month, during which time she received gentle coaxing by Derechos Humanos staff, she reluctantly sought emergency medical care. She was terrified that she would be deported and separated from her children or that her pursuit of care would threaten their eligibility for KidsCare.
In addition to creating emotional and physical vulnerability for undocumented residents of Arizona, HB2008, along with other recent legislation in the state, extends vulnerability throughout networks of people—children, parents, DES employees, school principals, and police officers. If we accept that health and well-being have physical, mental, and social components, we must recognize that these policies have real effects upon every Arizonan’s well-being. By deploying the violence of categories that expand and circumscribe the definitions of “legal” and “illegal,” these policies make new populations—such as DES workers, teachers, and police—legible to a punishing state if they do not follow reporting guidelines. These new ICE informants are then compelled to betray long-standing social relationships with communities, families, and individuals, thus fracturing social solidarities and producing new exclusions, disquietude, and uncertainties.
 Nicholas P. DeGenova. 2002. Migrant “Illegality” and Deportability in Everyday Life. Annual Review of Anthropology 31: 419-47.
 See, for instance: Wayne Cornelius. 2005. Controlling “Unwanted” Immigration: Lessons from the United States, 1993-2004. Journal of Ethnic and Migration Studies 31(4):775-795;
Joseph Nevins. 2002. Operation Gatekeeper: The Rise of the “Illegal Alien” and the Making of the U.S.-Mexico Boundary. New York: Routledge; Rubio-Goldsmith, R., M.M. McCormick, D. Martinez, & I. Magdalena Duarte. 2006. The “Funnel Effect” & Recovered Bodies of Unauthorized Migrants Processed by the Pima County Office of the Medical Examiner, 1990-2005. Binational Migration Institute Report Submitted to the Pima County Board of Supervisors.
 For example, human rights advocate and Pima County (AZ) legal defender Isabel Garcia describes a national political strategy to funnel migrants through Arizona’s harsh deserts and regions with strict immigration policies.
 For example, the memo reminds DES employees that failure to produce evidence of United States citizenship is not evidence that someone is residing in Arizona illegally.
 And following a definition of well-being by Robert G. Evans and Gregory L. Stoddart. 1990. Producing health, consuming health care. Social Science & Medicine 31(12):1347-1363.
WHO definition of health: Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
Julie Armin, MA is a graduate student in the medical anthropology program at the University of Arizona (Tucson). Her primary interests focus on the intersection of anthropology and public policy, access to health care in the United States, the political-economy of cancer, and gendered experiences of health. Her dissertation research examines the treatment trajectories of uninsured and low-income breast cancer patients in the border region of Arizona.
Robin Reineke is a Ph.D. student in the School of Anthropology at the University of Arizona. Her research interests include migration, the U.S.-Mexico border, death, human rights, forensic anthropology, and the identification of human remains. Her ongoing dissertation research involves multi-sited ethnography in Tucson, Arizona, and in the state of Oaxaca, Mexico into the causes and effects of migrant deaths, and the family and institutional approaches to locating, identifying, and burying these bodies.
Armin, Julie and Robin Reineke. 2010. Expanding Vulnerability: Health Care, Well-Being, and Arizona’s Immigration Policies. AccessDenied: A Conversation on Un/authorized Im/migration and Health. Accessed (date) at https://accessdeniedblog.wordpress.com/2010/07/11/expanding-vulnerability-health-care-well-being-and-arizona%E2%80%99s-immigration-policies-%E2%80%93-julie-armin-robin-reineke/.