During the pandemic, our government should be making every effort to remove exclusions and barriers to health care, conducting proactive outreach to immigrant communities, and striving to ensure that everyone has comprehensive health care. Instead, already marginalized immigrants continue to be excluded from federal relief efforts and are subject to mounting fear and chilling effects of immigration enforcement efforts.
As several Johns Hopkins doctors described “[e]xpecting [immigrants] to trust the government now, during the Covid-19 crisis, is naive at best. . . . we are using mitigation strategies that will not compensate for years of harm.” In fact, the systemic exclusion of immigrants from health care is so entrenched that the government’s minimal mitigation efforts are re-creating the very same harms they are supposed to alleviate.
Immigrants Left Out of COVID-19 Relief
Congress purposefully excluded immigrants and their families from the $1,200 cash payments provided by the CARES Act by requiring that all tax filers in the same household have a Social Security number. If one spouse uses an individual tax identification number, the entire family received no payment. This excluded 3.7 million children and 1.7 million spouses who are U.S. citizens or green-card holders. Undocumented immigrants are also excluded from the Pandemic Unemployment Assistance, even if they paid into unemployment funds.
Congress’s efforts to expand access to health coverage have also intentionally left out most immigrants. Congress created a new Medicaid option to provide coverage for anyone who is uninsured, regardless of income. But it kept the restrictions on non-qualified immigrants and the five-year bar for that new group.
Congress also offered enhanced funding to state Medicaid programs to stop terminating Medicaid coverage during the public health emergency. The one exception, according to CMS is that lawfully present children and pregnant women who age out or reach the end of their post-partum period. Those individuals can be terminated.
HHS has also put up roadblocks for providers who seek to provide care to immigrants. Congress provided funding to reimburse hospitals and other health care providers for COVID-19 testing and treatment for the uninsured. As described above, this funding is available regardless of immigration status.
But HHS included a request for the Social Security numbers of the individuals who receive treatment. They did so even though it is well-known that asking for Social Security numbers will deter immigrants from seeking care.
Immigration Crackdowns Remains in Full Swing
A public health emergency hasn’t stopped the administration from continuing with immigration enforcement efforts, despite claims of limited resources. The Administration also has undertaken additional activities that are also harming immigrants include:
- a near-complete ban on immigrants entering the country through the end of the year (at least), keeping families separated when they need support more than ever;
- letting the rampant spread of coronavirus continue in detention facilities that a federal judge described as “on fire”;
- allowing immigration eligibility information for federal public benefits to be shared within DHS if the information can help DHS carry out national security, law enforcement, immigration, intelligence, or other homeland security functions; and
- slowing asylum applications and effectively ending entry at the southern border). For all of these reasons, and more, reports across the country describe immigrants avoiding seeking COVID-19 testing and care.
There have been some small efforts to mitigate the harm. COVID-19 testing and treatment will not count towards a public charge determination. Congress has also provided funds to pay for COVID-19 testing and treatment for uninsured individuals, regardless of immigration status. This funding will pay for testing at community health centers, outpatient clinics, and clinician’ offices.
But additional. aggressive short-term mitigation efforts are needed immediately. These include expanding cost-free coverage for all COVID19-related testing and treatment and suspending immigration enforcement during the pandemic.
These short term measures will never be enough on their own to overcome the impacts of engrained disparities. What we ultimately need is a fundamental re-imagining of our health care and immigration systems into something that provides comprehensive and immigration-consequence-free health coverage to everyone.