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Renewed Threats to the Health of Immigrants

Even before the current federal government hostilities, immigrants faced major barriers to receiving equal healthcare. Lack of access to insurance, or to a medical home, has often resulted in access only through an emergency department.

Even before the current crackdown, many immigrants reported fear of seeking emergency department care, resulting in delays in necessary care, thus worsening the severe health disparities experienced by that community. For example, 15 percent of the San Francisco population was Latino in 2020, yet suffered 60 percent of the COVID deaths.

ICE crackdown further threatens immigrant health
People with serious medical conditions, injuries, and high-risk pregnancies forgo medical care out of fear of being apprehended by immigration officials. If the trend continues, the list of consequences could be long: Infectious diseases circulating unnecessarily; worsening health care costs because of untreated chronic illnesses; and dangerous birth complications for women and infants who wait too long to seek help, among others.

Stress makes it worse. In a survey conducted by KFF in San Francisco, 31 percent of immigrants said that worries about immigration status – their own or that of a family member – were negatively affecting their health. About 20 percent of all immigrants surveyed said they were struggling with their eating and sleeping 31 percent reported worsened stress and anxiety.

Research confirms that immigration crackdowns are linked to poorer birth outcomes and mental health status, lapses in care, and fewer people accessing the types of public programs that reduce illness and poverty overall. Frightening people away from medical care is a sure way to increase expenses when controllable conditions such as diabetes, profound stress and depression explode into medical emergencies.

Health workers challenged by attacks on immigrants.
Some medical facilities have said they will comply with immigration officials. New York University Langone, in New York City, sent a memo to employees warning them not to try to protect undocumented migrants. But many other health centers and organizations are finding ways to take a stand, telling staff to display “Know Your Rights” information on the walls and to never record their immigration status in a patient’s medical records.

Historically, health care workers have not always risen to the occasion when patients have been targeted. Our recent history is tarnished by failures to report abuses or intervene at Abu Ghraib and Guantánamo Bay, as well as by forced sterilizations of prisoners, women of color and people with disabilities.

But patient advocacy is integral to health care. Medical professionals constantly battle insurance companies and pharmacy benefit managers to get patients’ medical treatments covered. They tussle with our own institutions to expedite CT scans and medical appointments. They write advocacy letters for things like walkers, dental clearance and problems with household mold. But in this upcoming era, they may have to face off against our own federal government.

For every patient who has the courage to reach out to a doctor with their deepest fears, there are many who are too afraid. Medical professionals should reassure all of our patients of our commitment to care for them, no matter the political environment. We’re in this fight together.

Immigrants subsidize the costs of care for the US-born
Undocumented immigrants pay substantial amounts toward the funding of public infrastructure, institutions, and services. A study by The Institute for Taxation and Economic Policy found that, in 2022, undocumented immigrants paid $96.7 billion in taxes at the federal, state and local levels. More than a third of that amount, $33.9 billion, went toward funding social insurance programs that these individuals are barred from accessing because of their immigration status.

The above study indicates that immigrants in general use fewer healthcare services than US-born citizens. Despite this, some worry that immigrants are a burden to the US economy, and particularly to the health care system. In fact, immigrants, particularly undocumented immigrants, contribute more to the Medicare program (mostly through payroll taxes) then they receive in benefits. They thereby help to prolong the life of the Medicare Trust Fund.

Similarly, private health insurance premiums paid by immigrants (and by employers on their behalf ) exceed the cost of care used. In the case of Medicaid, immigrants and US-born citizen spay similar amounts in premiums and health-related taxes, but immigrants consume less healthcare. This is particularly pronounced for undocumented immigrants, whose contributions to healthcare costs exceeded their expenditures by an average of $4,400 per person per year.

In addition, the Social Security Administration receives billions in free money each year from undocumented immigrants. In 2022 they paid an estimated $25.7 billion in Social Security taxes. Since unauthorized workers cannot collect retirement and other Social Security benefits without a change to their immigration status, that money acts as an additional subsidy for American beneficiaries.

How would Republican cuts to healthcare impact immigrants?
Republicans are leaning on all poor and working people, and even more so on immigrants, undocumented or not, to help make the math work for their sprawling tax package.

Even as they push to cut taxes on millions of Americans, (Covered California) particularly the wealthy, lawmakers want to simultaneously bar immigrants from claiming a panoply of tax benefits, from the popular Child Tax Credit to Obamacare
health-insurance subsidies to an obscure break on student-loan debt that’s forgiven when someone becomes disabled.

Their intent is to:

• End ACA Marketplace (Covered California) coverage eligibility for DACA recipients.
• Reduce federal Medicaid funding by $92 billion across states over 10 years if it maintains state-funded health coverage for undocumented immigrants. More than 1.9 million people could lose their health coverage if states drop or scale back their programs to avoid the penalty.
• End the requirement and federal Medicaid financing for states to cover people while they are verifying immigration or citizenship status.
• Eliminate ACA marketplace coverage for many lawfully present immigrants.

Progress towards achieving universal healthcare coverage in California is at risk
Gov. Gavin Newsom recently announced that he wants to freeze new enrollments for undocumented people 19 or older on Medi-Cal, California’s insurance plan for lower-income people, and charge a $100 monthly premium per person – which is out of reach for many families – starting in January 2026. There would be exceptions for pregnant people and emergency care.

Once again, leaders are looking to save money by cutting back services to the most underserved communities. We cannot go back to having millions of people getting their primary care in emergency rooms!

What must be done to end this cycle of abuse?
All residents, regardless of income, employment or immigration status, must have access to guaranteed universal healthcare without financial barriers (care that i s more often provided for all residents in other wealthy countries). A single-payer, government run system, funded by progressive taxation, would remove private insurance companies and their profits from the equation, saving hundreds of billions of dollars while at the same time providing generous health benefits to all.

Sounds unrealistic? Engage with us to find out more.

Contact the Healthcare for All Working Group, 707-480-2271 or [email protected]
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Terry Winter is a retired nurse and Chair of the Healthcare for All Working Group, So.Co.

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