For nearly a decade, respected sociologist and Northeastern University professor Tiffany Joseph, Andover ’00, IRT ’03, researched the impact of health reforms like the Affordable Care Act/Obamacare on everyday people’s ability to access health coverage and care in our complicated US healthcare system. In her new book, NOT ALL IN: RACE, IMMIGRATION, AND HEALTH CARE EXCLUSION IN THE AGE OF OBAMACARE (Johns Hopkins University Press; March 2025), Joseph reveals how Obamacare’s documentation status exclusions alongside persistent structural racism in the healthcare system reduced healthcare access for Latino immigrants and citizens. Her 200+ interviews with immigrants, providers, and advocates in Boston drives home an essential point: access to coverage does not guarantee access to care in a system that prioritizes profits over people.
With the 15th anniversary of the signing of the Affordable Care Act (ACA) fast approaching (March 23, 2025), Joseph expertly provides a roadmap outlining Obamacare’s recent past through the lens of individuals struggling to apply for coverage and medical professionals battling to provide care in our divisive sociopolitical climate. Complex enrollment processes, difficulty scheduling appointments, lack of language assistance for non-English speakers, and immigration enforcement fears undermined healthcare access under the Obama and Trump administrations. Not All In reveals that even in Boston, home to world-class hospitals and the health reform that was the model for Obamacare, health policy alone is insufficient to deliver quality, affordable, and culturally competent care to everyone. As Congress works to defund key Obamacare provisions (e.g. Medicaid, ACA navigators), Joseph argues that we need to bolster the ACA and other policy areas to improve the healthcare system and our collective health.
30% Discount with Code “HNAI25” at the John Hopkins University Press
About the Author
Dr. Tiffany Joseph is an Associate Professor of Sociology and International Affairs at Northeastern University. She is also the author of Race on the Move: Brazilian Migrants and the Global Reconstruction of Race (Stanford University Press, 2015). She has written and spoken frequently about race relations in the US and abroad, migration in the Americas, immigrants’ health and healthcare access, and the impact of policy on people’s lives for media outlets like The Atlantic, Newsweek, and Nature. You can learn more about Dr. Joseph at www.tiffanydjoseph.com.
Advance Praise for Not All In
“Not All In is revelatory. Drawing on in-depth interviews, Tiffany Joseph gives voice to individuals born abroad as they navigate the challenges of a health care system tilted toward the privileged. Throughout, Joseph proves a wise, sensitive, and humane guide through the labyrinths of health care and public policy. Not All In ought to be required reading for all Americans.“
—James A. Morone, author of Republic of Wrath and coauthor of Whiplash: Presidents and Health in a Divided America
“Not All In makes invaluable contributions to understanding the reverberating impacts of ACA, the most significant federal health care legislation since 1965. Joseph’s carefully researched study provides new insights into how race, ethnicity, and documentation status intersect to create health disparities in Brazilian, Dominican and Salvadoran immigrant communities. Highly recommended!”
— Lisa Sun-Hee Park, co-author of The Third Net: The Hidden System of Migrant Health Care
“Exhaustively researched and thoughtfully argued, Not all In exposes how the Affordable Care Act is fraught with the same discrimination by documentation status and by ethnoracial origins as other public policies and has led to worse outcomes. This compelling book has implications beyond a single state or policy domain and reveals the fraying ideal of an immigrant America.”
—David Cook-Martín, Professor of Sociology, CU Boulder, author of Culling the Masses: The Democratic Origins of Racist Immigration Policy in the Americas
“Just when the term ‘migrant crime’ has been launched into our national consciousness, Tiffany Joseph provides a masterly response to help us make sense of the demonization of immigrants and the impact of racialization on access to health care. This is a must-read to grasp how a health care system built on structural racism collides with those of precarious legal status—often with deadly effect.”
— Colleen M. Grogan, author of Grow and Hide: The History of America’s Health Care State
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