The Undocumented Healthcare Experience

Gaining access to healthcare has always been more difficult for the undocumented population of the United States compared to the general population. Due to their immigration status, they are often excluded from federal programs such as Medicaid, Medicare and of CHIP (Children’s Health Insurance Program) and only 6 states use state funds to make up for this difference. Furthermore, undocumented immigrants are barred from purchasing health insurance through ACA marketplaces. In 2019, around half of the ten million undocumented immigrants living in the United States lacked health coverage.

Taking advantage of any public assistance is anxiety-inducing and often avoided by undocumented people due to so-called “public charge” rules. Public charge legislation, which was made more severe by the Trump administration in early 2020, rules that non-citizens who use social services, such as Medicaid or SNAP (Supplemental Nutrition Assistance Programme), may be ineligible for legal permanent resident status at a later point. A July 2019 study predicted that 0.8 to 1.9 million children with medical needs would be disenrolled from SNAP or CHIP as a result of the tightened rule. For fear of this rule, as well as raids and deportation, undocumented immigrants are often wary of the health resources that are available to them, especially under administrations vocally opposed to their presence.

Both these factors effectively exclude a large portion of the United States’ undocumented population from public insurance. Oftentimes, they are also excluded from the alternative, private insurance, which tends to be prohibitively expensive. Overall, undocumented immigrants have the lowest rates of health coverage of any segment of the US population.

This leads to a very different healthcare landscape for undocumented people that relies on healthcare that operates outside of the established system such as free community clinics. Due to low access to health insurance and primary care physicians, undocumented people are more likely to avoid seeing out earlier care; instead visiting emergency departments only when healthcare is urgent or necessary. Emergency Medicaid covers these emergency room visits for people who are unable to make use of any other insurance. 

The coronavirus pandemic has made maintaining a healthy population, and full access to the relevant healthcare for everyone, even more important. However, measures taken with the intent to keep the population healthy have inadvertently affected the livelihoods of many undocumented people. For example, the closing of many spaces where undocumented people work, such as restaurants and construction sites, has put many people who are inelligible for government unemployment benefits out of work; in California, 27% of undocumented workers were unemployed as of August, 2020. The segment of the undocumented population that has been able to keep working, tend to work “essential” jobs such as fruit picking, where risk tends to be high, and employers do not work hard to keep their employees safe. Should a worker here become sick, they face a host of new challenges. The previously described jobs are more likely to be lower paying, meaning that they have less savings to rely on if put in medical distress.

If people do seek help, they may run foul of official recommendations to avoid the emergency room in favor of primary care providers- which many undocumented immigrants to not have. The move towards telehealth as an alternative has also been difficult, as many undocumented migrants may struggle with acquiring and using the technology, or the decreased support for non-native English speakers. According to data from the Pew Research center, only about 50% of immigrants stated that they spoke English very well, and about the same amount held less than a high school education; both of which can make communicating with doctors more difficult.

Fighting a pandemic effectively requires high levels of trust in the government, which has been eroded in undocumented communities through many of president Trump’s policies such as the tightening of the public charge rule, an increase in the number of ICE raids, family separation at the border, and threats to the DACA program, among other factors. Undocumented individuals have, for example, felt “terrified of being sent to detention centers” while trying to access healthcare. People detained by ICE in these detention centers are often exposed to poor conditions and adherence to health guidelines is often dubious at best.

The United States government has so far taken several measures to mitigate the effects of the pandemic. To encourage widespread testing, the public charge rule has been determined not to apply to coronavirus testing. Sadly, the first two funding bills for coronavirus did not include any funding to alleviate the cost of coronavirus healthcare for populations that are ineligible for Medicaid. Furthermore, many undocumented people were excluded from financial relief bills – such as the stimulus checks, as only people who hold social security numbers could benefit. Indirect funding has been included in subsequent acts, such as Families First and the CARES act, both of which include funding to reimburse community health centers for the cost of testing for individuals without health insurance. However, the Families First act failed to expand emergency medicaid to testing. The CARES Act especially has alleviated some of the financial issues associated with seeking Covid related medical care. What comes next depends in part on the Heroes Act, which is currently being debated in the Senate.

It is clear that, just like in the overall healthcare system, the American government needs to show more compassion to undocumented immigrants, who form an integral part of not only this nation’s economic motor, but also of it soul. This holds true both while fighting the Coronavirus pandemic and its effects now and in the future, but also once the country has returned to relative normalcy.