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May 2023
Volume 9 | Issue No. 70
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A
ccording to the Center for Immigration Studies,
immigrant individuals – lawfully present and
undocumented – made up 46.2 million people in the U.S.
as of November 2021. Despite these numbers, the U.S.
continues to have a torrid relationship with non- U.S.-born
citizens, and especially those who require acute health
care services. As this country struggles with a history of
health and racial inequities among its own citizenry of
Hispanic/Latinx, Black, and Indigenous individuals, the
needs of its immigrant population are ignored, dismissed,
and flagrantly devalued. As for those in dire need of
lifesaving health care, the bureaucracy and red tape can
constitute a literal death sentence.
For context, noncitizens include lawfully present and
undocumented immigrants. Lawfully present immigrants
have temporary or permanent status like visas or green
cards. This includes refugees and asylees who are usually
able to apply for Medicaid and other temporary benefits
in certain states. If for any reason they don't qualify, they
are eligible for a temporary program called Refugee
Medical Assistance (RMA) for an eight-month period.
However, fear, confusion, and a reticence to seek support
were exacerbated during the Trump administration. The
public charge rule was drastically expanded to reduce
the number of people who were eligible for green cards
and visas by redefining what made them dependent on
government safety net programs. This made it scarier and
more confusing for immigrant individuals to seek care
and support. Although the Joe Biden and Kamala Harris
administration reversed the rule, research suggests that
the damage is already done. More immigrants forfeited
medical assistance or delayed care, worsening outcomes
for those with chronic disease.
Individuals who receive deferred action are authorized
to be in the U.S. for a period of time, as deportation is
temporarily deferred. The Deferred Action of Childhood
Arrivals (DACA) program was created to protect young
adults, who were brought to the U.S. as children, from
deportation, and provide them with work authorization for
temporary renewal periods.
According to Kaiser Family Foundation, as of December
31, 2022, there were approximately 580,000 active DACA
recipients from about 200 different countries of birth
residing throughout the U.S. Although these individuals
have work authorization, they have been ineligible for
many federal programs including Medicaid, Children's
Health Insurance Program (CHIP), and the Affordable
Care Act (ACA) health insurance Marketplace. However,
the Biden administration is poised to reverse this policy by
issuing a new rule to extend benefits to DACA recipients.
According to a White House fact sheet, the proposed rule
change is slated for late April.
Undocumented immigrants are foreign-born individuals
residing in the U.S. without authorization or are individuals
who entered the country lawfully but remained after
their visa status expired. They are not eligible to enroll in
Medicaid, ACA, or SNAP.
The Medicaid, CHIP, and ACA tightrope
Even for lawfully-present immigrants, eligibility for Medicaid
and CHIP comes with restrictions. For instance, eligibility
hinges on "qualified" immigration status. In addition,
there is a five-year waiting period, from date of entry,
after obtaining qualified status before they are eligible to
receive benefits.
Contrary to the negative discourse about immigrants' pull
on an already strained U.S. safety net system, approximately
50% to 70% of the undocumented immigrant population
pays federal and state taxes. Despite these contributions,
undocumented individuals continue to face discrimination,
racism, and dehumanizing barriers to quality health care.
These inequities are particularly palpable for individuals,
and their families, diagnosed with cancer.
"I hope I see in my lifetime a growing realization that we are one world. And that no one
is going to have quality of life unless we support everyone's quality of life.
- Dr. Helen Rodríguez-TrÍas
