Examines how health policy shifts fail to fully serve immigrant communities due to structural racism and anti-immigrant rhetoric and enforcement measures. Despite progressive policy strides in health care reform, immigrant communities continue to experience stark disparities across the United States. In Not All In, Tiffany D. Joseph exposes the insidious contradiction of Massachusetts' advanced health care system and the exclusionary experiences of its immigrant communities. Joseph illustrates how patients' race, ethnicity, and legal status determine their access to health coverage and care services, revealing a disturbing paradox where policy advances and individual experiences drastically diverge. Examining Boston's Brazilian, Dominican, and Salvadoran communities, this book provides an exhaustive analysis spanning nearly a decade to highlight the profound impacts of the Affordable Care Act and subsequent policy shifts on these marginalized groups. Not All In is a critical examination of the systemic barriers that perpetuate health care disparities. Joseph challenges readers to confront the uncomfortable truths about racialized legal status and its profound implications on health care access. This essential book illuminates the complexities of policy implementation and advocates for more inclusive reforms that genuinely cater to all. Urging policymakers, health care providers, and activists to rethink strategies that bridge the gap between legislation and life, this book reminds us that in the realm of health care, being progressive is not synonymous with inclusivity.