A recent opinion piece in the Philadelphia Inquirer highlighted troubling public health concerns for immigrant families in the United States. While there is a growing number of “mixed status” immigrant families in the United States, they continue to face difficulties finding affordable healthcare. 

Addressing the Disparities in Healthcare Coverage

Dr. Diana Montoya-Williams of the Children’s Hospital of Pennsylvania recently authored a poignant article for the Philadelphia Inquirer that raised important questions about immigrants’ ability to access necessary healthcare coverage in the United States. She noted that by ensuring coverage regardless of documentation status, legislative action could eliminate needless barriers to healthcare for a substantial number of Americans. Despite growing support for expanding coverage, many people still face barriers to healthcare coverage. 

By 2016, the under-insurance of children in the United States had reached historic lows. This achievement followed decades of eligibility expansions of Medicaid and the Children’s Health Insurance Program (“CHIP”), not to mention newly-minted coverage provisions of the Affordable Care Act (“ACA”). Even at that time, however, a disparity still existed between children with citizen parents and those with at least one noncitizen parent. Indeed, those children with citizen parents were 3.3% uninsured, while those with at least one noncitizen parent experienced a 6.0% lack of insurance. Unfortunately, by 2019, the numbers grew worse for children with at least one noncitizen parent: lack of proper health insurance rose to 8.0%. 

The urgency of this problem is underscored by the sheer numbers involved. In recent decades, the number of immigrants and refugees in the United States has increased dramatically. Today, over 1 in 4 children in the country are born to immigrant families. However, while nearly 90% of these children are U.S. citizens, these “mixed-status” immigrant families face unique challenges and consequences that impede their access to public health benefits. Especially given the urgency of the current public health crisis, questions of accessibility for this vulnerable population are more important now than ever before. 

Barriers to Care for Immigrant Families

In her article, Dr. Montoya-Williams discussed her first-hand experiences with patients who questioned whether accessing important health benefits would result in negative immigration consequences. Patients wondered if signing up for healthcare would result in their inability to gain legal status, or even result in their removal from the United States. 

Given the severity of these risks, these concerns make sense. After all, there are significant barriers to healthcare access for immigrant families. For instance, undocumented immigrant families do not qualify for generous premium subsidies offered under the Affordable Care Act’s marketplace health insurance options. 

Immigrant families were deeply affected by the 2019 public charge rule, proposed by the Trump administration. A “public charge” is a ground of inadmissibility, or a reason that a person can be denied a green card, visa, or admission to the United States. Under prior regulations by the Department of Homeland Security (“DHS”), the government would consider only cash benefits to determine if an individual was likely to become a public charge. Accordingly, non-cash benefits, like food stamps or health insurance, would not be considered.

However, in 2019, the Trump administration briefly implemented an expansion of what constitutes a “public charge” to include non-cash benefits like food stamps, housing subsidies, or Medicaid access. Due to this change, immigrant families across the United States feared the potential immigration consequences of utilizing Medicaid coverage.

The Biden administration swiftly reversed course on Trump’s expanded “public charge” rule, reverting to pre-2019 guidance. Nonetheless, its impact still affects countless immigrant families, as reflected by the disparities in healthcare coverage we see today.

Simple Solutions to a Complex Problem

As noted by Dr. Montoya-Williams, several states recently took legislative steps toward universal healthcare coverages for children. Just this year, the state Senate of New Jersey passed a bill to expand health insurance coverage for children. In Pennsylvania, campaigns are fighting for similar results. 

The article by Dr. Montoya-Williams raises important questions. In an increasingly diverse and global world, legislators will have to address the disparities in healthcare access for immigrant and mixed-status families in the United States.