Authored by Joshua Lim, Human Biology, Health, and Society ‘26
Art by Chloe Cho, Human Biology, Health, and Society ‘26
There are significant healthcare disparities in the United States. Socioeconomic status often determines the availability and quality of healthcare. Immigrants, in particular, face additional barriers to healthcare access. In the US, being an immigrant increases the probability of being uninsured by three times. Even worse, for undocumented immigrants, that number rises to five [1]. Due to their uninsured status, immigrants often forgo medical care resulting in worse health outcomes and higher future medical costs [2].
The health access problem for immigrants is primarily due to differences in income. Immigrants on average earn less than US citizens and work jobs where employers are less likely to provide healthcare coverage [1]. Even if they do have insurance, the financial burden that hefty deductibles and copays place on immigrants can make care unaffordable, especially as healthcare costs continue to climb [3]. Government healthcare programs such as Medicaid and CHIP (for children) fill the gap for many Americans in similar situations, providing basic healthcare access for millions who might otherwise not be able to afford care [4,5]. However, immigrants face unique barriers to receiving access to government programs.
Immigrants on a green card or work visa have greater eligibility requirements to meet for Medicaid, CHIP, and ACA Marketplace coverage than US citizens [6]. Moreover, the difference in requirements can confuse eligible immigrants and scare them from accessing healthcare. For example, in 2019, the Trump administration widened the scope of the Public Charge Rule, which meant that immigrants' use of government-provided healthcare could have a negative impact on their applications for citizenship or green card status. [7]. During this time period, there was a significant decrease in the number of immigrants accessing Medicaid and CHIP as they feared the loss of their green card or harm to their citizenship application [8]. As a result of this change, one in seven adult immigrants did not participate anymore in welfare programs, essentially creating a mass “chilling effect” [9].
Moreover, because there are many policy changes and the information can be convoluted and technical, many immigrants are not sure where they stand. For example, a study conducted in 2019 found that three-quarters of immigrant adults did not know that children’s enrollment in government healthcare programs does not impact their parents’ immigration status [10].
Although the Biden administration ultimately removed the revision to the Public Charge Rule in 2021, many immigrants are unaware of the policy change or are worried that the previous policy might be reinstated, resulting in lasting effects. [11]. Creating public education programs regarding the new policy changes can increase access to healthcare for immigrants without fears related to their citizenship or green card status. Such programs are essential to creating a more equitable healthcare system.
Undocumented immigrants on the other hand face even more barriers to healthcare. They are not eligible at all for many of the healthcare programs that are provided by the government [1]. Moreover, many undocumented immigrants avoid medical care for fear of deportation. In the past, there have been instances of ICE raids at hospitals [11]. To address these issues, certain state and local actors have implemented policies to create a more inclusive healthcare system. For example, in San Francisco, the local government implemented inclusive policies at healthcare facilities such as putting up encouraging posters and informing clinicians when deportations were occurring nearby. Researchers found that these policies increased the number of undocumented immigrants that received care, particularly during periods of heightened anxiety about deportation [12].
Millions of people immigrate to the US in hopes of a better quality of life and opportunities for their families and themselves. However, once here, they are confronted with cultural, financial, and logistical barriers. Basic healthcare is a basic human right, one that should not be determined by where someone is from. In order to create a more inclusive healthcare system where access is not determined by one’s socioeconomic status, it is imperative to critically analyze the healthcare system and understand the flaws within it.
Works Cited
KFF. (2022, December 20). Health Coverage and Care of Immigrants. Kaiser Family Foundation. Retrieved March 3, 2023, from https://www.kff.org/racial-equity-and-health-policy/fact-sheet/health-coverage-and-care-of-immigrants/#:~:text=Uninsured%20Rates%20by%20Immigration%20Status&text=As%20of%202021%2C%20more%20than,were%20noncitizens%20(Figure%202)
Wilson, F. A., & Stimpson, J. P. (2020). Federal and state policies affecting immigrant access to health care. JAMA Health Forum, 1(4). https://doi.org/10.1001/jamahealthforum.2020.0271
Young, R. A., & DeVoe, J. E. (2012). Who will have health insurance in the future? An updated projection. Annals of family medicine, 10(2), 156–162. https://doi.org/10.1370/afm.1348
Garfield, R. 10 things to know about Medicaid: Setting the facts straight. Kaiser Family Foundation. Retrieved March 3, 2023, from https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-setting-the-facts-straight/
Artiga, S. (2017, May 17). Key issues in children's Health Coverage. Kaiser Family Foundation. Retrieved March 3, 2023, from https://www.kff.org/medicaid/issue-brief/key-issues-in-childrens-health-coverage/
KFF. (2020, July 15). Can immigrants enroll in Medicare? Kaiser Family Foundation. Retrieved March 3, 2023, from https://www.kff.org/faqs/medicare-open-enrollment-faqs/can-immigrants-enroll-in-medicare/
Bernardo, R. (2023, February 6). What was the public charge rule for immigrants? Boundless. Retrieved March 3, 2023, from https://www.boundless.com/blog/public-charge-rule-explained/
Holder, S. (2019, August 13). New rules to scare immigrants off public services. Bloomberg.com. Retrieved March 3, 2023, from https://www.bloomberg.com/news/articles/2019-08-13/new-rules-to-scare-immigrants-off-public-services
Bernstein, H. (2019, May). One in Seven Adults in Immigrant Families Reported Avoiding Public Benefit Programs in 2018. Retrieved March 3, 2023, from https://www.urban.org/sites/default/files/publication/100270/one_in_seven_adults_in_immigrant_families_reported_avoiding_publi_7.pdf
Whitener, K., Clark, M., Gardner, A., & Park, E. (2020, July 2). New report finds chilling effect, avoidance of health care services among immigrant families. Center For Children and Families. Retrieved March 3, 2023, from https://ccf.georgetown.edu/2020/07/02/new-report-finds-chilling-effect-avoidance-of-health-care-services-among-immigrant-families/
Pillai, D. (2022, May 5). 2022 changes to the public charge inadmissibility rule and the implications for Health Care. Kaiser Family Foundation. Retrieved March 3, 2023, from https://www.kff.org/racial-equity-and-health-policy/issue-brief/2022-changes-to-the-public-charge-inadmissibility-rule-and-the-implications-for-health-care/
Yasenov, V. I., Hainmueller, J., Hotard, M., Lawrence, D., Gottlieb, L. M., & Torres, J. M. (2020). Association between Health Care Utilization and Immigration Enforcement Events in San Francisco. JAMA Network Open, 3(11). https://doi.org/10.1001/jamanetworkopen.2020.25065