LAUSR

ABSTRACT The Affordable Care Act (ACA) aimed to reduce stark health inequalities by providing universal health insurance to all Americans and long-term authorised immigrants. Later regulations, however, gave the 50 U.S. states latitude to choose the degree of coverage for their constituencies. In this paper, we explore how interactions with these diverse systems of care contribute to the incorporation of immigrants into America, especially among the most likely to remain uninsured: the working poor. We uncovered a process in which immigrants’ access to health coverage and care was informed by the procedural justice embedded in their interactions with representatives of the health care system. These interactions signalled to immigrants their deservingness in American society, operating as a system of incorporation in the most inclusive states and as a barrier to incorporation in the most exclusive ones. Repealing the ACA may exacerbate differences across states in access to health care among eligible immigrants and end the incipient transformation of the U.S. health care system into an agent of immigrant incorporation.