Three Things You Should Know … Healthcare access

In thinking of people’s healthcare access, we must think of the social determinants of health - of which immigration status is hugely influential. Here are three things you should know about healthcare access.

1. Immigration Status is one of the most significant factors influencing healthcare coverage

The medical field has long accepted that a person’s health is impacted by social determinants of health such as economic status, race, education level, zip code. Immigration status is a highly influential factor that significantly affects access to healthcare and health outcomes. According to 2018 data, 23% of lawfully present immigrants and 45% of undocumented immigrants are uninsured, compared to only 9% of U.S. citizens. These trends continue when one looks at healthcare access for children; non-citizen children, and importantly, citizen children with non-citizen parents, are less likely to be covered by Medicaid and employer-based health insurance than their full-citizenship counterparts. Refugees, asylees, human trafficking victims and their families, and TPS recipients are “qualified” immigrants who could access U.S. healthcare plans. Undocumented immigrants face virtually zero options for healthcare coverage, resulting in accessing inconsistent care though Federally Qualified Health Centers (FQHC), migrant health centers, or public/nonprofit hospitals.

2. State by State variation

The healthcare system in our country is a patchwork of anti-immigration laws and rules that are now preventing millions of eligible people to access healthcare services when they most need it. There are only a few immigration statuses that are eligible to find a healthcare plan, and many immigrants, even though they are documented, don’t have access to healthcare. In many states, DACA recipients are not eligible to access a healthcare plan, and the situation is particularly difficult for mixed status families. It’s estimated that close to 4 million children lived in “mixed-status families – households that included both citizen and noncitizen members – making children’s health care access and eligibility for public benefits more complex.

Another example of the unintended consequences of having a patchwork of immigration laws and regulations in America’s 50 states is the confusing regulations around the Affordable Care Act. ACA’s goal of expanding Medicaid, a decision that would make more individuals eligible for coverage, is now solely depended on states’ willingness to expand services in their state. A number of states, as well as the District of Columbia, offer healthcare services for pregnant women and children under 18 years of age regardless of immigration status. California is the only state to extend their state Medicaid program, Medi-Cal, to low-income, undocumented adults ages 25 and younger.

3. Public Charge rules

In 1999, the Department of Justice created the so-called “public charge” rule, which looks at an immigrant’s likelihood of having to depend on the government for assistance. This is a complicated rule that used to exempt refugees or asylees, as well as certain government programs such as Medicaid. Aside from long-term care, Medicaid and other health services including immunizations, testing and treatment of communicable disease, clinic use, short-term rehabilitation services, and emergency care were not considered a public charge. However, the Trump administration announced in February 2020 that federally funded Medicaid now largely qualified as a public charge for adult, non-pregnant individuals. This announcement has created a chilling effect, with immigrants disenrolling themselves and their children from Medicaid and CHIP (Children’s Health Insurance Program) despite being eligible to access it.

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