Exposure and Exclusion: Disenfranchised Biological Citizenship among the First-Generation Korean Americans

Abstract

Based on fieldwork with a highly uninsured and underinsured Korean American population, this article maps how the current healthcare system in the United States disenfranchises those of marginal insurance status. The vulnerability of these disenfranchised biological citizens is multiplied through exposure to disproportional health risks compounded by exclusion from essential healthcare. The first-generation Korean Americans, who commonly work in small businesses, face the double burden of increased health risks from long, stress-laden work hours and lack of access to healthcare due to the prohibitive costs of health insurance for small business owners. Even as their health needs become critical, their insurance status and costly medical bills discourage them from visiting healthcare institutions, leaving Korean Americans outside the “political economy of hope” (Good, Cult Med Psychiatry 52:61–69, 2001). Through an ethnographic examination of the daily practice of doing-without-health among a marginalized sub-group in American society, this paper articulates how disenfranchised biological citizenship goes beyond creating institutional barriers to healthcare to shaping subjectivities of the disenfranchised.

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Notes

  1. 1.

    Fieldwork was conducted in Houston from January 2004 to August 2004 and in Los Angeles from May 2007 to July 2007.

  2. 2.

    The interviewees’ ages range from 32 to 74 with a mean age of 54.

  3. 3.

    All names are pseudonyms.

  4. 4.

    All interviews were conducted in Korean and translated into English later by the first author.

  5. 5.

    For example, Bae, a 58-year-old Korean American man in Houston, enumerated his previous businesses as he moved from a grocery store and a beauty supply shop in a minority community to a Korean grocery and his current dry cleaning business in an upper-class community.

  6. 6.

    Among the 48 interviewees, 9 are categorized as underinsured. When they are added to the 22 uninsured, a total of 31 are uninsured or underinsured.

  7. 7.

    When Korean Americans decide to visit healthcare institutions, the population tends to visit Korean American clinics usually located in Korean Town. However, using clinics in Korean Town is also impeded by insurance status and costly medical bills.

  8. 8.

    Many issues frame accessibility to healthcare among immigrant populations, including linguistic and cultural ones. For Korean Americans (a highly uninsured and underinsured population) health insurance status is the critical issue shaping their practice of not seeking healthcare. Linguistic and cultural barriers do little to explain why many Korean Americans do not visit clinics in Korean Town run by Korean American doctors.

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Correspondence to Taewoo Kim.

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Kim, T., Haney, C. & Hutchinson, J.F. Exposure and Exclusion: Disenfranchised Biological Citizenship among the First-Generation Korean Americans. Cult Med Psychiatry 36, 621–639 (2012). https://doi.org/10.1007/s11013-012-9278-7

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Keywords

  • Biological citizenship
  • Risk
  • Uninsured
  • Underinsured
  • Korean Americans