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The Third Net

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View the page of Anthony Jimenez

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Anthony Jimenez reveals systemic health care inequities, advocating for a complete reevaluation to rectify these injustices.

Image courtesy of interviewee. March 8, 2024

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This video video discusses the motivation and findings of a book that investigates the changes in the healthcare safety net following the 2010 Affordable Care Act (ACA), particularly as it affects undocumented immigrants. The authors focused on U.S. cities along the Mexico border, exploring how organizations and clinics have adapted to new challenges posed by the ACA.

They emphasize the emergence of what they term the "third net," an informal safety net that provides care to those excluded from the formal healthcare system due to stringent policies that arose after the ACA was implemented. This video video third net, made up of volunteer-based organizations, plays a crucial role in supporting undocumented immigrants who have limited access to healthcare, especially as formal safety nets have become increasingly selective in who they serve.

The authors assert that the healthcare system is not broken but intentionally designed to exclude certain populations, highlighting the importance of recognizing the lives and needs of undocumented migrants within healthcare discussions. They hope their work prompts policymakers to acknowledge the destructive impact of exclusionary practices on families and communities.

Lastly, they warn that the deterioration of the healthcare safety net threatens not only non-citizens but all individuals, suggesting that the conditions of the third net could foreshadow future healthcare challenges for the broader population.

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X-TIMESTAMP-MAP:LOCAL=00:00:00.000,MPEGTS=900000

00:00.185 --> 00:04.765
The motivation behind the book is basically we wanted

00:04.765 --> 00:08.805
to understand, basically how the healthcare safety net,

00:09.345 --> 00:10.445
was changing

00:10.775 --> 00:14.525
after the passing of the 2010 Affordable Care Act.

00:15.025 --> 00:16.445
Um, we knew that

00:16.495 --> 00:18.325
after that act was passed,

00:18.395 --> 00:21.205
that things were gonna change, for everyone.

00:21.505 --> 00:22.965
Um, but we didn't know how.

00:23.585 --> 00:26.485
So that was kind of the, the guiding question for us is

00:26.485 --> 00:29.845
what was the impact of this policy, particularly

00:30.105 --> 00:31.645
for undocumented immigrants.

00:32.065 --> 00:34.885
My co-authors and I, we decided to,

00:35.455 --> 00:39.245
focus our research on US cities based along the US Mexico

00:39.305 --> 00:41.485
border, because they're so heavily populated

00:41.545 --> 00:42.925
by immigrant populations.

00:43.745 --> 00:46.245
Um, so our first step was

00:46.385 --> 00:48.605
to basically assess what's the terrain?

00:48.635 --> 00:52.045
What are, organizations and clinics and so on so forth.

00:52.345 --> 00:55.405
Uh, how are they already responding to,

00:55.405 --> 00:57.325
changes in the a CA and, and the,

00:57.325 --> 00:58.925
and the safety net and that sort of thing.

00:59.625 --> 01:03.085
Um, we got a, a sense of the terrain first,

01:03.185 --> 01:05.925
to see which organizations, which,

01:06.195 --> 01:07.925
individuals we would want to be reaching out

01:07.925 --> 01:09.685
to the next step.

01:09.785 --> 01:11.365
We went ahead and reached out to them,

01:11.775 --> 01:13.045
asked if we can do interviews,

01:13.545 --> 01:16.925
and when we got some, some yeses to that, we went

01:16.945 --> 01:18.245
to these different cities.

01:18.395 --> 01:21.325
This included Houston, Texas, Phoenix,

01:21.825 --> 01:26.045
and, Tucson, Arizona, and also San Diego, California.

01:26.945 --> 01:28.525
Um, we went to these cities

01:28.625 --> 01:31.765
and talked to different practitioners, health practitioners,

01:32.345 --> 01:35.325
staff administrators,

01:35.345 --> 01:39.965
and also volunteers, of more informal spaces and,

01:39.965 --> 01:43.205
and community organizations that provide,

01:43.205 --> 01:46.405
health provisions to undocumented immigrants in particular.

01:46.985 --> 01:49.605
And we basically interviewed them about, you know,

01:49.605 --> 01:50.805
how are things changing for them?

01:50.985 --> 01:54.245
How are they navigating challenges associated with,

01:54.245 --> 01:56.005
changes after the a CA.

01:56.665 --> 02:00.845
Um, and these interviews were also combined

02:00.845 --> 02:03.245
with some in-depth ethnographic research.

02:03.465 --> 02:06.285
And at two of the sites, in, in, Houston, Texas

02:06.745 --> 02:07.845
and in Phoenix,

02:07.845 --> 02:12.685
and Tucson, Arizona, where we, you know,

02:12.795 --> 02:16.205
decided to spend a longer duration of time with folks and,

02:16.265 --> 02:18.285
and see what their day-to-Day activities were.

02:18.625 --> 02:20.005
And again, trying to understand

02:20.105 --> 02:23.325
how are immigrants navigating, some of these changes?

02:23.545 --> 02:25.605
How are these, you know, how are these organizations,

02:25.625 --> 02:28.885
excuse me, responding to these changes.

02:29.315 --> 02:30.645
What was supposed to happen

02:31.215 --> 02:34.125
after the Affordable Care Act passed,

02:34.505 --> 02:35.565
was everyone was supposed

02:35.565 --> 02:37.285
to gain some form of health coverage.

02:37.905 --> 02:42.285
Um, and under that logic, federal funding that would go

02:42.305 --> 02:44.845
to the formal healthcare safety net started

02:44.845 --> 02:46.485
to get pulled out, right?

02:46.485 --> 02:49.885
So the federal, the federally reimbursed healthcare safety

02:50.025 --> 02:52.605
net, started to lose those reimbursements

02:52.785 --> 02:56.285
and shrink, the healthcare safety net is

02:56.285 --> 02:58.885
where uninsured migrants, and

02:59.045 --> 03:01.605
Indigent citizens would both go, right?

03:01.625 --> 03:05.165
The healthcare safety net is designed for anyone who can't

03:05.165 --> 03:07.165
otherwise afford to pay for care.

03:08.225 --> 03:13.005
Um, and so after the A CA passed,

03:13.425 --> 03:15.405
and these federal reimbursements started to be pulled out,

03:16.105 --> 03:20.405
these healthcare safety nets decided

03:20.505 --> 03:23.485
to be more stringent about who they were gonna provide care

03:23.785 --> 03:28.325
for, which excluded, migrants,

03:28.585 --> 03:30.445
particularly undocumented migrants.

03:31.065 --> 03:34.725
Um, so more and more they had fewer and fewer places to go.

03:35.945 --> 03:38.845
Um, and that's where the third net comes in.

03:39.705 --> 03:43.005
So, to outline this, for us, right,

03:43.105 --> 03:46.765
the healthcare system is basically made up of three tiers.

03:46.765 --> 03:48.885
Conventionally, we understand the healthcare system

03:48.945 --> 03:50.085
is made up of two tiers.

03:50.505 --> 03:54.045
The the first net, which is basically made up of hospitals,

03:54.625 --> 03:57.125
generally for profit, that sort of thing.

03:57.745 --> 03:59.405
The second tier is what's known

03:59.405 --> 04:00.685
as the healthcare safety net.

04:00.745 --> 04:02.325
That's community health clinics,

04:02.325 --> 04:03.885
federally qualified health centers,

04:04.275 --> 04:06.205
charity clinics, that sort of thing.

04:06.905 --> 04:10.005
Um, this is the healthcare safety net that provides care

04:10.025 --> 04:13.285
to folks who can't afford to pay for, for their care.

04:14.145 --> 04:17.445
Um, but then what we introduce in this book is

04:17.445 --> 04:18.565
what we call the third net,

04:18.585 --> 04:22.485
and that's in a nutshell, the safety net of the safety net.

04:23.025 --> 04:26.525
Um, it is this informal healthcare safety net

04:26.525 --> 04:30.725
that basically catches those who are pushed outside

04:30.865 --> 04:33.245
of the formal, healthcare system.

04:34.225 --> 04:37.605
Um, so these, these are the three tiers, the three nets

04:37.605 --> 04:38.845
that we're working with, with the,

04:38.845 --> 04:40.565
with the healthcare system and our book.

04:41.145 --> 04:43.205
Uh, the purpose of our book is to ex

04:43.385 --> 04:46.565
to introduce this idea to, to us, right?

04:46.565 --> 04:47.805
To show us what the third net is

04:48.225 --> 04:50.005
and to explain why it's important.

04:50.385 --> 04:51.605
The third net is important

04:51.635 --> 04:54.765
because ultimately it's the last place

04:55.115 --> 04:58.845
that undocumented migrants can go for care, right?

04:59.065 --> 05:00.645
Anyone who is unable

05:00.645 --> 05:03.605
to access care within the formal healthcare system has

05:03.605 --> 05:05.125
to rely on the third net.

05:05.785 --> 05:09.845
And this third net is made up of informal organizations

05:10.115 --> 05:12.965
that don't have any type of, you know,

05:13.065 --> 05:14.485
formal streams of funding.

05:15.065 --> 05:18.085
Uh, they almost always operate on a volunteer basis.

05:18.555 --> 05:20.485
They operate with the least resources

05:20.795 --> 05:22.285
that ultimately provide care

05:22.305 --> 05:25.245
for what's becoming the largest segment of, of the,

05:25.385 --> 05:26.765
the population in the country.

05:27.865 --> 05:31.685
Um, and so they're asked to do a lot with very little.

05:32.545 --> 05:35.205
Um, and so, again, to reiterate,

05:35.205 --> 05:36.765
the reason this is important is

05:36.765 --> 05:39.925
because the Third Net has this giant responsibility

05:40.025 --> 05:43.045
to provide care for a large population of people

05:43.105 --> 05:45.405
who have been excluded from the formal system.

05:46.345 --> 05:49.485
Um, if the third net didn't exist, then

05:50.175 --> 05:53.885
these populations would truly have nowhere else to go.

05:54.035 --> 05:56.725
They would be left in the streets to to die.

05:56.835 --> 05:59.125
Essentially, what we hear a lot in the media

05:59.145 --> 06:00.805
and among politicians and,

06:00.985 --> 06:05.765
and various places, is that the healthcare system is broken.

06:06.465 --> 06:09.085
And what our book shows is through the case,

06:09.475 --> 06:11.085
through the cases of the Third Net.

06:11.105 --> 06:12.165
The Third net teaches us

06:12.165 --> 06:14.645
that the healthcare system is in fact not broken.

06:15.155 --> 06:17.325
That this is actually how the system is

06:17.845 --> 06:19.765
specifically intentionally designed to be.

06:20.665 --> 06:24.725
Um, in talking to various practitioners to migrants

06:24.725 --> 06:27.605
who are receiving care within the third net, we've come

06:27.605 --> 06:30.405
to understand that this is a hundred percent intentional,

06:30.835 --> 06:35.165
that the formal healthcare system relies on this informal

06:35.385 --> 06:38.085
sector of the healthcare system that we call the Third Net,

06:38.785 --> 06:40.285
in order to provide care.

06:40.795 --> 06:42.965
What the third net teaches us is

06:42.965 --> 06:46.285
that the entire system is intentionally messed up in

06:46.285 --> 06:47.365
this way, right?

06:47.555 --> 06:50.285
That the healthcare system is not broken as

06:50.285 --> 06:51.525
so many people say that it is,

06:51.795 --> 06:53.565
that is intentionally designed

06:53.705 --> 06:55.925
to exclude undocumented migrants.

06:56.915 --> 06:59.445
What I really hope, and I think on behalf of my co-authors,

06:59.445 --> 07:00.525
what I think we all hope

07:00.915 --> 07:03.365
that readers will take from this book is

07:03.365 --> 07:07.965
that undocumented migrants, immigrants in general,

07:08.415 --> 07:11.325
these people's lives matter within the healthcare

07:11.325 --> 07:12.685
system, right?

07:12.795 --> 07:13.845
They have been excluded,

07:13.985 --> 07:16.685
and they continue to be excluded from even conversations

07:17.175 --> 07:19.485
about what universal healthcare can look like.

07:20.105 --> 07:23.885
Any type of policy debates about universal healthcare come

07:23.885 --> 07:26.165
to an abrupt stop whenever immigrants are mentioned.

07:26.825 --> 07:31.125
And so what I would like personally for this book to do

07:31.825 --> 07:35.445
is sort of a light, light of fire under policymakers

07:36.005 --> 07:37.485
a little bit, to have them understand

07:37.485 --> 07:39.845
that this is destroying families, right?

07:39.955 --> 07:42.645
This is destroying an, an entire, you know,

07:42.645 --> 07:45.285
entire populations of, of folks who need care.

07:46.385 --> 07:49.125
Um, another thing that I think is important to,

07:49.265 --> 07:52.045
to understand that the Third Net teaches us is

07:52.045 --> 07:55.325
that this is the third net gives us a glimpse of the future

07:55.325 --> 07:57.445
of healthcare for citizens as well.

07:57.715 --> 07:59.805
This isn't just for non-citizens.

08:00.465 --> 08:03.005
Um, what we've been seeing, what we,

08:03.005 --> 08:06.405
what the third net shows us is, is what happens to folks

08:06.995 --> 08:08.925
when every sector of the social

08:08.985 --> 08:11.885
and healthcare safety net starts to crumble and deteriorate.

08:12.545 --> 08:15.005
And what we've seen historically is

08:15.005 --> 08:17.325
that this is deteriorating for everybody.

08:18.185 --> 08:22.285
Um, so the Third Net gives us a really powerful foreshadow

08:22.425 --> 08:24.365
of the future of healthcare for everyone.

08:24.545 --> 08:26.525
And I think it's important that we take that seriously.

00:00 - The motivation behind the book is basically we wanted to understand, basically how the healthcare safety net, was changing after the passing of the 2010 Affordable Care Act. we knew that after that act was passed,

00:18 - that things were gonna change, for everyone. but we didn't know how. So that was kind of the, the guiding question for us is what was the impact of this policy, particularly for undocumented immigrants. My co-authors and I, we decided to, focus our research on US cities based along the US Mexico border, because they're so heavily populated by immigrant populations. so our first step was

00:46 - to basically assess what's the terrain? What are, organizations and clinics and so on so forth. how are they already responding to, changes in the a CA and, and the, and the safety net and that sort of thing. we got a, a sense of the terrain first, to see which organizations, which, individuals we would want to be reaching out to the next step. We went ahead and reached out to them,

01:11 - asked if we can do interviews, and when we got some, some yeses to that, we went to these different cities. This included Houston, Texas, Phoenix, and, Tucson, Arizona, and also San Diego, California. we went to these cities and talked to different practitioners, health practitioners, staff administrators, and also volunteers, of more informal spaces and, and community organizations that provide,

01:43 - health provisions to undocumented immigrants in particular. And we basically interviewed them about, you know, how are things changing for them? How are they navigating challenges associated with, changes after the a CA. and these interviews were also combined with some in-depth ethnographic research. And at two of the sites, in, in, Houston, Texas and in Phoenix, and Tucson, Arizona, where we, you know,

02:12 - decided to spend a longer duration of time with folks and, and see what their day-to-Day activities were. And again, trying to understand how are immigrants navigating, some of these changes? How are these, you know, how are these organizations, excuse me, responding to these changes. What was supposed to happen after the Affordable Care Act passed, was everyone was supposed to gain some form of health coverage.

02:37 - and under that logic, federal funding that would go to the formal healthcare safety net started to get pulled out, right? So the federal, the federally reimbursed healthcare safety net, started to lose those reimbursements and shrink, the healthcare safety net is where uninsured migrants, and Indigent citizens would both go, right? The healthcare safety net is designed for anyone who can't otherwise afford to pay for care.

03:08 - and so after the A CA passed, and these federal reimbursements started to be pulled out, these healthcare safety nets decided to be more stringent about who they were gonna provide care for, which excluded, migrants, particularly undocumented migrants. so more and more they had fewer and fewer places to go. and that's where the third net comes in. So, to outline this, for us, right, the healthcare system is basically made up of three tiers.

03:46 - Conventionally, we understand the healthcare system is made up of two tiers. The the first net, which is basically made up of hospitals, generally for profit, that sort of thing. The second tier is what's known as the healthcare safety net. That's community health clinics, federally qualified health centers, charity clinics, that sort of thing. this is the healthcare safety net that provides care

04:10 - to folks who can't afford to pay for, for their care. but then what we introduce in this book is what we call the third net, and that's in a nutshell, the safety net of the safety net. it is this informal healthcare safety net that basically catches those who are pushed outside of the formal, healthcare system. so these, these are the three tiers, the three nets that we're working with, with the, with the healthcare system and our book.

04:41 - the purpose of our book is to ex to introduce this idea to, to us, right? To show us what the third net is and to explain why it's important. The third net is important because ultimately it's the last place that undocumented migrants can go for care, right? Anyone who is unable to access care within the formal healthcare system has to rely on the third net.

05:05 - And this third net is made up of informal organizations that don't have any type of, you know, formal streams of funding. they almost always operate on a volunteer basis. They operate with the least resources that ultimately provide care for what's becoming the largest segment of, of the, the population in the country. and so they're asked to do a lot with very little. and so, again, to reiterate,

05:35 - the reason this is important is because the Third Net has this giant responsibility to provide care for a large population of people who have been excluded from the formal system. if the third net didn't exist, then these populations would truly have nowhere else to go. They would be left in the streets to to die. Essentially, what we hear a lot in the media and among politicians and, and various places, is that the healthcare system is broken.

06:06 - And what our book shows is through the case, through the cases of the Third Net. The Third net teaches us that the healthcare system is in fact not broken. That this is actually how the system is specifically intentionally designed to be. in talking to various practitioners to migrants who are receiving care within the third net, we've come to understand that this is a hundred percent intentional, that the formal healthcare system relies on this informal

06:35 - sector of the healthcare system that we call the Third Net, in order to provide care. What the third net teaches us is that the entire system is intentionally messed up in this way, right? That the healthcare system is not broken as so many people say that it is, that is intentionally designed to exclude undocumented migrants. What I really hope, and I think on behalf of my co-authors,

06:59 - what I think we all hope that readers will take from this book is that undocumented migrants, immigrants in general, these people's lives matter within the healthcare system, right? They have been excluded, and they continue to be excluded from even conversations about what universal healthcare can look like. Any type of policy debates about universal healthcare come to an abrupt stop whenever immigrants are mentioned.

07:26 - And so what I would like personally for this book to do is sort of a light, light of fire under policymakers a little bit, to have them understand that this is destroying families, right? This is destroying an, an entire, you know, entire populations of, of folks who need care. another thing that I think is important to, to understand that the Third Net teaches us is that this is the third net gives us a glimpse of the future of healthcare for citizens as well.

07:57 - This isn't just for non-citizens. what we've been seeing, what we, what the third net shows us is, is what happens to folks when every sector of the social and healthcare safety net starts to crumble and deteriorate. And what we've seen historically is that this is deteriorating for everybody. so the Third Net gives us a really powerful foreshadow of the future of healthcare for everyone. And I think it's important that we take that seriously.

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