Exploring the Far-Reaching Effects on Public Well-being
Rafat Fields
Helping Healthcare Leaders Build Influence & Create Change | Digital Marketing & Policy Advocacy | Community Storyteller l GrassTops - GrassRoots Connector
Introduction
Immigration policies play a pivotal role in shaping the public health landscape of the United States. According to 2022 data published by the Kaiser Family Foundation (KFF), there are 45.5 million immigrants living within the U.S., comprising about 14% of our population. Many of these individuals are from families with mixed immigration statuses. For example, parents who have immigrated to the U.S. may have children who are natural-born citizens. These dynamics are key to how immigration policies and practices influence health outcomes.
As the American Public Health Association (APHA) emphasizes, equitable access to health services is essential, regardless of citizenship status. This article explores recent policy changes and their implications for public health outcomes and resource utilization among immigrant populations.
Expanding Health Coverage for Immigrants
Health Coverage for Lawfully Present Immigrants
One of the bedrock principles of American culture is fostering an environment where everyone can work hard and build a better future. Many who enter our country have limited resources and take on low-wage employment. Lawfully present immigrants can access coverage through the Affordable Care Act's Marketplace. However, many face a 5-year waiting period before becoming eligible for state Medicaid and Medicare programs. This creates a dynamic where individuals doing essential work within our country have limited access to healthcare resources.
When individuals lack health coverage resources, they may decide to delay care. By the time they seek medical intervention, their conditions could be significantly exacerbated, and they may access providers in settings like emergency rooms instead of private physician offices, which drives up the total cost of care.
To provide more equitable access and lower healthcare costs, 35 states and several territories have chosen to provide Medicaid coverage to lawfully residing children and pregnant individuals without this waiting period. Additionally, 28 states cover lawfully residing children or pregnant people in the Children's Health Insurance Program (CHIP). These policies help ensure that critical early life and maternal health needs are met and reduce the number of people living in poverty, which can have long-term benefits for public health.
State-Funded Coverage for All Residents
As of March 2024, six states (California, Colorado, Illinois, New York, Oregon, Washington) and the District of Columbia have expanded fully state-funded coverage to some income-eligible adults regardless of immigration status. Similarly, 12 states plus D.C. offer comprehensive state-funded coverage for children, regardless of immigration status. These expansions are critical in reducing disparities in health access and outcomes, particularly in underserved communities.
DACA Recipients and the ACA Marketplace
The Deferred Action for Childhood Arrivals (DACA) was created June 15, 2012 by the Secretary of Homeland Security. While this order granted relief from fear of deportation and allowed eligible immigrants to work and enroll in school, it does not extend permanent legal status and requires re-enrollment every two years.
This video shares perspectives from Ileana Salinas and Lydia Guzman on the mental health challenges faced by undocumented residents. They powerfully describe how fear and anxiety generated from the uncertainty of immigration status take a toll on mental well-being individually and collectively as a community. Expanding eligibility to ACA Marketplace coverage provides much-needed relief to a population needing
mental health resources.
Immigration policies have a deeply personal impact on the humans they affect. When our neighbors struggle to navigate challenges that negatively affect their well-being, it hurts all of us. You can learn more about Ileana’s story and her work with Aliento AZ to help DREAMers here.
Under the Biden-Harris Administration, significant strides have been made to include Deferred Action for Childhood Arrivals (DACA) recipients in the health insurance marketplace. Starting November 1, 2024, DACA recipients will be eligible to enroll in a health plan through the ACA Health Insurance Marketplace. This policy change aims to bridge gaps in coverage and promote better health outcomes, providing a greater sense of psychological and physical safety.
California's Landmark Medicaid Expansion
California has set a precedent by allowing all undocumented immigrants to be eligible for coverage under Medi-Cal, the state's Medicaid program, as of January 1, 2024. This expansion is expected to provide health coverage to approximately 764,000 additional adults. This move is anticipated to reduce emergency room visits and improve public health by providing preventive and primary care to a previously underserved population.
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Public Charge Policy Revisions
The Biden Administration has also revised the public charge policy, which previously posed a significant risk to immigrants seeking legal permanent residence with denial if they were enrolled in government programs like Medicaid or SNAP. Before the 2022 changes were enacted, immigrants avoided participation in public programs like Medicaid and CHIP due to fear of deportation if their immigration status was denied or revoked.
These changes aim to reduce the barriers to immigrants' accessing necessary health services, thereby improving health outcomes and reducing the strain on emergency health services. The White House has increased funding for community-led efforts to rebuild trust and reduce fears among families impacted by the public charge rule. Read an overview of how the changes to the public charge policy have impacted healthcare here.
Impact on Health Outcomes and Resource Utilization
Reliance on Community Health Centers and Emergency Rooms
Immigrant adults often rely on community health centers and emergency rooms for care rather than private doctors. This trend is more pronounced in states with fewer policy protections, where immigrants are less likely to have a trusted medical provider. The lack of continuous and preventive care can lead to poorer health outcomes and increased healthcare costs due to the reliance on emergency services.
Health Disparities and Preventive Care
Policies that restrict access to health coverage can exacerbate health disparities. Immigrants in states with inclusive policies are more likely to seek preventive care, leading to better health outcomes and reduced healthcare costs over time. Conversely, restrictive policies can lead to delayed care and worse health outcomes, increasing the burden on emergency services and public health systems.
Economic and Social Impacts
Access to health coverage is not only a health issue but also an economic one. Healthy individuals are more likely to contribute positively to the economy. By providing health coverage to immigrants, states can foster a healthier workforce, reduce absenteeism, and enhance productivity. Moreover, inclusive health policies can promote social cohesion and reduce the stigma and fear associated with seeking healthcare services.
Conclusion
Immigration policies significantly impact public health outcomes and resource utilization. By expanding access to healthcare, revising restrictive policies, and promoting equitable health coverage, we can ensure that all residents, regardless of immigration status, have the opportunity to lead healthy lives. These efforts are essential steps toward achieving true health equity in the United States.
*This newsletter article was co-created with an AI tool: ChatGPT.
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Your dedication to advancing health equity through policy change is truly inspiring! 🌟 Rafat Fields