US immigration law increasingly excludes many immigrants materially and symbolically from vital safety-net resources. Existing scholarship has emphasized the public charge rule as a key mechanism for enacting these exclusionary trends, but less is known about how recent public charge uncertainty has shaped how noncitizens and healthcare workers negotiate safety-net resources. Drawing on ethnographic observations and interviews with 80 safety-net workers and patients in three US states from 2015 to 2020, I argue that intensifying anti-immigrant rhetoric surrounding public charge has extended a sense of surveillance into clinical spaces in previously unexamined ways. Drawing on theories of medical legal violence, system avoidance, and legal estrangement, I demonstrate how these dynamics undermined immigrants' health chances and compromised clinic workers' efforts to facilitate care. I also reveal how participants responded to this insinuation of legal violence in healthcare spaces by promoting situational trust in specific procedures and institutions.

中文翻译：

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公共负担、法律疏远以及美国医疗安全网中情境信任的重新谈判

美国移民法越来越多地将许多移民从物质上和象征上排除在重要的安全网资源之外。现有的学术研究强调公共负担规则是实施这些排他性趋势的关键机制，但人们对最近的公共负担不确定性如何影响非公民和医护人员协商安全网资源的方式知之甚少。根据 2015 年至 2020 年对美国三个州 80 名安全网工作人员和患者的人种学观察和采访，我认为围绕公共负担的反移民言论不断加剧，以以前未经审查的方式将监视意识延伸到了临床空间。借鉴医疗法律暴力、系统规避和法律疏远的理论，我展示了这些动态如何损害移民的健康机会并损害诊所工作人员促进护理的努力。我还揭示了参与者如何通过促进对特定程序和机构的情境信任来应对医疗保健领域中这种法律暴力的暗示。