The Health Care Safety Net and the Affordable Care Act: Implications for Hispanic Immigrants


  • Saltanat Liebert is assistant professor in the L. Douglas Wilder School of Government and Public Affairs at Virginia Commonwealth University. Her research focuses on immigration policy, comparative governance, and civil service reform. She is author of Irregular Migration from the Former Soviet Union to the United States (2009) and coeditor of Public Administration in Post-Communist Countries: Former Soviet Union, Central and Eastern Europe, and Mongolia (2013). E-mail:

  • Carl F. Ameringer is professor of health policy and politics at Virginia Commonwealth University. His research focuses on the health professions, health care delivery systems, and health care workforce issues. He is author of State Medical Boards and the Politics of Public Protection (1999), The Health Care Revolution: From Medical Monopoly to Market Competition (2008), and several journal articles, papers, and reports. From 1987 to 1992, he served as assistant attorney general and deputy counsel to the Maryland health department. E-mail:

  • Editor's Note: This article was reviewed for the PAR special issue on “The Health Care Crucible Post-Reform: Challenges for Public Administration,” published in September 2013. The special issue went to press before the revisions and reviews for this article could be completed. Our thanks to Frank Thompson, guest editor for the special issue, for helping bring this timely article to publication.


There are currently more than 11 million undocumented immigrants in the United States; the majority of them are of Hispanic origin. This article shows that Hispanic immigrants in the Greater Richmond, Virginia, area rely heavily on free clinics for basic health care services. Free clinics do not receive any public funding and thus face reduced government regulation. As a result, these clinics typically present fewer barriers to undocumented immigrants seeking care. Although free clinics function outside the mainstream of government funding for health care services, the Patient Protection and Affordable Care Act (ACA) of 2010 is so broad and far-reaching in its scope and potential application that free clinics cannot escape its grasp once the new law is fully implemented. Because the ACA does not provide insurance coverage to undocumented immigrants, free clinics will remain their primary sources of care and treatment. Consequently, those responsible for implementing the ACA should consider the impact on free clinics.