Possibilities On the Horizon: State Pathways to Health Care for Undocumented Communities
Immigrants’ access to health care has always been a matter of deservingness. The political environment, perceived motives of migration, vulnerability of the immigrant group and presumed social proximity between citizens and non-citizens greatly influence the direction and outcome of immigrants’ access to health care coverage, particularly for undocumented immigrants.
Federal policies like the Personal Responsibility and Work Reconciliation Act of 1996 and the Affordable Care Act of 2010 have explicitly excluded undocumented immigrants from accessing health care coverage through Medicaid, Medicare, the Children’s Health Insurance Program (CHIP) and the ACA Marketplace. Lack of access to health care coverage has led to health concerns, as well as economic security concerns. Most recently, undocumented immigrants’ concerns have only been exacerbated by lawmakers’ failure to include immigrants in federal relief packages early on in the pandemic (e.g., the CARES Act), as well as the Trump administration’s proposed public charge rule – which is currently blocked – that further instilled fear and confusion about the health care services they could utilize. This has resulted in undocumented immigrants relying on a patchwork of health care services, delaying care, and facing significantly higher uninsured rates compared to citizens and other immigrant groups.
More than a year into the COVID-19 pandemic, undocumented immigrants’ health care deservingness remains a subject of debate, even in the face of their extensive contributions in combatting this pandemic. Immigrants make up one in five essential workers, one in five health care workers, and one in four long–term care workers. Despite their essential frontline-sector status, these jobs continue to be underpaid and often do not offer employer-sponsored health insurance or paid time off, putting immigrant workers in a vulnerable position if they become sick with COVID-19. Though states and the federal government have taken the initiative to ensure COVID-19 testing, treatment and vaccinations are free of charge to all residents, regardless of insurance or immigration status, there is still a lack of clear national guidance or consensus about permanently expanding coverage to undocumented immigrants beyond COVID-19.
As we continue to wait and see what may happen on the federal level with legislative proposals such as the HEAL Act, states have stepped in to provide immigrant residents access to care. For example, Illinois recently became the first state to adopt a Medicaid-like program to cover low-income older adults, regardless of their immigration status.
Our new policy brief, State Initiatives to Expand Coverage and Access to Care for Undocumented Immigrants, offers policy recommendations state advocates and lawmakers can push for to expand health care to undocumented residents in their states. The policy brief also provides examples of states that have already begun implementing some of these policy initiatives and key considerations for states thinking about expanding coverage. Some of the key recommendations include:
Using state funds to expand Medicaid coverage to low-income undocumented immigrants;
Requiring non-profit hospitals to make financial assistance programs (aka, charity care) available to undocumented immigrants;
Offering low-income undocumented immigrants’ ACA Marketplace bronze-like plans (meaning low–premium, high–deductible plans) to supplement existing emergency Medicaid benefits, such as costs associated with labor and delivery.
States’ willingness to provide health care to all their residents regardless of immigration status will be imperative in expediting a full recovery from the COVID-19 pandemic. As we aim to vaccinate as many people as possible, undocumented immigrants’ access to health care must be prioritized in the overall effort to avoid the spread of COVID-19 variants and prolong this already difficult pandemic. Ensuring access to primary care and the opportunity to build trusted relationships with medical providers can be a tool to remove barriers and encourage more immigrants to get vaccinated.
Advocates must continue to uplift the voices of immigrant communities and, alongside immigrant rights advocates, push for creative measures that will increase the dignity, accessibility, affordability, and quality of care for undocumented communities. The highlighted approaches in this issue brief are tangible solutions that can be implemented in tandem with one another to build a stronger health care infrastructure for everyone. Health care advocates have a responsibility and an opportunity to truly shift the conversations around undocumented immigrants’ right to health care.