How Trump Will Deter Immigrants from Seeking Health Care

NBC News revealed on December 11 that the incoming Trump Administration plans to rescind on his first day in office a policy preventing ICE agents from arresting undocumented immigrants at places such as places of worship, schools, and hospitals. The unmistakable implication of this is that undocumented immigrants will avoid seeking hospital care, even when it is medically necessary.

This move stands in sharp contrast with the Biden Administration policy, which had expanded the number of areas in which undocumented immigrants would be protected from arrest.

That Trump would make such a move is hardly a surprise, given his frequent call for mass deportations. But it puts immigrants in an even more precarious position when they may already be dealing with health concerns, whether chronic illness or even communicable disease.

This is not the only blow to immigrants’ health care this week. On December 10, a district court judge in North Dakota ruled, in a blow to the Biden Administration, that “Dreamers” may not obtain health insurance through the Affordable Care Act marketplace, the enrollment deadline of which is December 15 in most states for coverage beginning January 1. The ruling applies to the 19 states in which Republican attorneys general brought suit.

Immigrants already face a number of challenges in getting health coverage and health care in the United States. Most lawful immigrants must wait five years before enrolling in Medicaid, a policy change adopted amid President Clinton’s welfare reform in 1996. And people without a lawful immigration status are generally ineligible to enroll in ACA marketplace plans, Medicaid, or the Children’s Health Insurance Program (CHIP). It is thus perhaps unsurprising that the Center on Budget and Policy Priorities finds that 18% of lawful immigrants are uninsured (compared to 8% across the U.S. population), with a whopping half of undocumented immigrants being uninsured. This problem is exacerbated in no small part by employers’ restrictions on hiring people who are undocumented, with most adult Americans’ health insurance tied to employment.

In a country in which health care is notably expensive to receive, this translates into pronounced disparities in access to care and, in turn, health outcomes, especially among those who are less affluent. While the Kaiser Family Foundation finds that overall, 79% of immigrants report being in good health, 14% have a medical condition that requires ongoing treatment (with a higher rate among those less affluent) and nearly a third (31%) of lower-income immigrants report being in fair or poor health. What’s more, less than half (48%) of uninsured immigrant adults report having seen a doctor in the last year (compared to 84.5% across the U.S. adult population), with even lower rates among Hispanic and Black immigrants and those who are likely undocumented. They rightly attribute this to the likelihood that immigration-related concerns may reduce health care utilization. In fact, researchers at Tufts University Medical Center and Harvard Medical School found that despite comprising 5% of the population, undocumented immigrants only account for 1.4% of health care spending, which can be attributed to a combination of being younger, experiencing barriers to care, and reluctance to seek care.

What is the result of 22% of immigrants (36% of uninsured immigrants) skipping or postponing care in the last year? The Kaiser Family Foundation 40% reported that their health got worse as a result.

Cumulatively, is perhaps unsurprising in light of this that immigrants tend to be more reliant on emergency departments for care. But what if going to the ED for treatment of a worsening, unmanageable condition comes with the risk of being taken into ICE custody?

We know from 2019 that amid a ramp-up if ICE raids including at medical facilities, a poll of California health care workers who treated a large share of children in immigrant families found that 42% reported an increase in skipped scheduled appointments.

As scholars at UC Berkeley argue, amplifying ICE’s role in health care settings is bad for public health in a number of ways. Not only does it exacerbate stress (which we know is bad for health), but it “assault[s] social determinants of health of immigrants and their communities” and can sow distrust in public health institutions and, in turn, reduce health care utilization.

We know that delaying care of chronic conditions can lead to exacerbations. We also know that COVID-19 is not entirely over, and that is not the only contagious disease one might contract and from which one might get quite sick (for example, I kicked off 2024 with influenza A followed by pneumonia… fun!). And not receiving proper medical attention could facilitate these problems proliferating in families and communities.

The entering administration has made clear that it is not supportive of immigrant rights, let alone public health, as signified by those whom Trump has selected to lead our nation’s health agencies. Callous cruelty in policy implementation is going to be a feature, not a bug. But it is incumbent on people to ensure that Congress presses for appropriate protections that allow for immigrants to access the health care that they need and in safe, trusted settings.