Commonwealth Beacon, April 2026
In 2006, Massachusetts made history as the first state to pass comprehensive health reform, creating a national model for near-universal health coverage. Even more remarkable, the Commonwealth extended that coverage to noncitizen residents at a time when many states were moving in the opposite direction, tightening immigration restrictions that cut immigrants out of health care.
Twenty years later, income-eligible immigrants of any status in Massachusetts can still apply for coverage. Yet immigrants remain far more likely than citizens to be uninsured, even in a state where less than 3 percent of residents lack coverage. Why? The answer lies at the intersection of race, ethnicity, and legal status – what scholars call “racialized legal status.” Despite Massachusetts’s inclusive policies, structural racism and legal status discrimination have consistently undermined immigrants’ access to care, creating barriers that persist even for those who have coverage.
