​Paul Dourgnon, Center faculty associate, discussed in the Center's Feb. 21 seminar how immigrants are served by California's health safety net. In this brief interview, Dourgnon discusses undocumented immigrants' obstacles to health services in California, the role of safety-net health centers in providing care to them, and the impact of a hostile political environment.

Q: What is the biggest obstacle for immigrants in need of health services in California?

​Fear of ''the system'' is certainly a factor in immigrants avoiding health care. Existing research has identified that fear of being deported creates a ''chilling effect'' in various settings, within and outside the health system. However, from what we observed as well as from what former studies have shown, lack of insurance coverage is clearly the biggest obstacle to undocumented immigrants accessing care in California, and should be addressed as a major element in tackling inequalities in access to healthcare and, eventually, health inequalities.

Q: What are safety-net clinics and others doing well where immigrants are concerned and where do they need to improve?

​County safety nets have a number of strengths. First, they are resilient. They are nimble and can adjust to changes in federal or state policies as well as changes in eligibility and funding. They are also committed to coverage expansion in most cases. These elements give safety-net health centers the capacity to remain innovative and to remain focused on providing more and better coverage to low-income and uninsured Californians, who in large part are undocumented immigrants.

Limitations stem from the very nature of counties as administrative entities, because some counties have the size and capacity to offer services, while smaller counties can’t undertake such programs. The result is that there is inequality between counties. So county-level efforts to expand coverage may take more time and not level the playing field.

Q: Has stepped-up enforcement by Immigration Customs Enforcement (ICE) and other law enforcement and the general political climate in the U.S. affected how care is provided through the safety-net?

​The federal government's attitude in general, which is seen as hostile toward undocumented immigrants and also toward universal coverage, seems to have strengthened cohesion of California stakeholders and advocates for undocumented immigrants' health coverage, and many see California as a stronghold for their policy hopes. Our qualitative study showed that many advocates consider the situation an opportunity to develop alternative policies towards more, not less, coverage.