As a nation, we are facing an unprecedented public health crisis in the U.S. As the number of confirmed coronavirus infections have increased, social distancing and weeks-long shelter-in-place orders have become the new norm for a growing number of individuals. These requirements have created dramatic changes in the way we live, work, and play, yet for many immigrants, the challenges are even greater. Many immigrants are not able to self-isolate or work from home because of their jobs in the service or agricultural sector, or due to their housing situation. Immigrants also face barriers to health insurance coverage and accessing care that have only been exacerbated by implementation of the Department of Homeland Security’s (DHS’) public charge rule in late February. The chilling effects of this rule and other restrictive immigration policies have created a hostile environment that makes it incredibly difficult for many immigrants to seek health care for COVID-19 testing or treatment.
The chilling effects of this rule and other restrictive immigration policies have created a hostile environment that makes it incredibly difficult for many immigrants to seek health care for COVID-19 testing or treatment.
The DHS rule made drastic changes to the definition and application of public charge for certain immigrants. Receipt of specified public benefits including non-emergency Medicaid can now be considered in a public charge determination for immigrants seeking to apply for a visa, legal permanent residence (also known as a “green card”), or an adjustment of status. Although very few immigrants with Medicaid coverage will actually be impacted by the rule, the changes are exceedingly complicated and burdensome, and have created a lot of fear and confusion within immigrant families. In short, the public charge rule has created a “chilling effect” on a wide swath of the immigrant community that continues to deter immigrants from seeking the health care they need.
Given the gravity of the situation, U.S. Citizenship and Immigration Services (USCIS), the agency responsible for implementing the public charge rule, announced on March 13, 2020 that testing, prevention, or treatment for COVID-19 would not be counted in a public charge determination, even if the services were provided through Medicaid. Yet many immigrants are still fearful of obtaining health care due to increased immigration enforcement activities. Earlier in the month, Immigration and Customs Enforcement (ICE) ramped up their immigration enforcement activities in some of the areas hardest hit by the coronavirus. Then, last week, DHS issued conflicting messages about whether it would continue with the enforcement actions, leaving many immigrant communities afraid and confused about whether they should try to seek care. Even those immigrants with health insurance coverage or access to a trusted community health center are fearful of seeking help, often because they do not want to place a family member at risk of deportation.
With Congress and the White House moving quickly to enact legislation to respond to the pandemic, health equity and public health advocates must continue to advocate for policies that support and protect the health and wellbeing of all Americans. A successful response to COVID-19 is contingent on the ability of every community member to access needed care and resources without fear of adverse immigration consequences on themselves or their loved ones. Yet, as of the writing of this blog, Congress had proposed a relief bill that excluded many immigrants from eligibility for Medicaid testing and treatment, and left millions of immigrant tax-filing families out from a proposed tax rebate. We must do better. Our lives and our futures depend on it.
