In this COVID-19 pandemic, “racism is a killer.” But, being an immigrant with limited social protections is too. The impact of COVID-19 has been disproportionately felt in communities of color, rendering visible the insidiousness of structural racism. Missing from COVID-19 statistics is documentation status, which is associated with health care and health outcome disparities. Research on race and immigration as social determinants of health before COVID-19 suggests that the combination of minority race and undocumented status may be lethal. Since 2012, I have researched immigrants’ healthcare access in Boston, and that work has shown that documentation status poses a risk to getting care even in this progressive epicenter of health reform. That risk has escalated during COVID-19 due to pre-pandemic exclusions and hyper-enforcement.
Undocumented immigrants are especially vulnerable because many policies openly exclude them, making it difficult to get driver’s licenses, find quality affordable housing, and access health care. Their recent exclusion from the CARES Act will be a devastating blow, making post-COVID-19 recovery nearly impossible for many. There are several ways undocumented and documented immigrants’ exclusion may negatively impact their well-being in the present pandemic and its aftermath.
First, deportation concerns remain a huge deterrent for immigrants seeking healthcare under the Trump administration’s immigration policies. Immigration and Customs Enforcement detentions and immigration court dates continued after “stay-at-home” advisories were issued across the country. While new immigration arrests were eventually scaled back, COVID-19 transmission among those already being held in inhumane immigrant detention centers and prisons spiraled without social distancing measures and access to regular handwashing.
The Trump administration’s changes to the public charge rule are also causing panic. Targeting lower-income immigrants, the administration redefined “public charge,” and since February has allowed immigration officials to use more factors in determining immigrants’ future likelihood of using public benefits. Although the administration clarified that the rule does not limit the use of testing, screening or treatment of communicable diseases such as COVID-19, that statement is unlikely to reassure vulnerable immigrants. A medical interpreter I interviewed in 2019, long before COVID-19, shared that an immigrant patient with health insurance “didn’t want to use any benefits because she was in the process of getting her green card.”
Exclusion from the Affordable Care Act severely limits undocumented immigrants’ access to care. Most are ineligible for the Medicaid expansion and purchasing coverage in the healthcare exchanges. Some cities and states have used local funds to extend coverage to immigrants in their respective jurisdictions, but those options are still constrained by documentation status. In many cases, immigrants’ must be gravely sick before they seek care. According to a healthcare advocate I interviewed in 2015, immigrants must consider “jeopardizing their ability to stay here or their health.”
Even if they brave leaving their homes for COVID-19 testing and treatment, the next challenge for immigrants is finding help in their primary language and from culturally sensitive providers they can trust. Although the country has become more diverse racially and linguistically, that diversity is not reflected among medical professionals. This also influences immigrants’ health. In this pandemic, vital information and assistance in multiple languages have been harder to come by and may also undermine the care that immigrants receive.
Many migrants are suffering similar fates outside of the United States. In industrialized countries with robust social safety nets, immigrants have also been excluded from public benefits and face racialized anti-immigrant policies. Migrants from the Global South often form the backbone of Global North economies, working in agriculture, cleaning, and construction. They are vulnerable to labor exploitation and living in cramped conditions, factors which have contributed to the spread of COVID-19 in Europe, the Gulf States, and Asia.
For those who wonder why immigrants are important in combating this pandemic, one need look no further than demographics. Fourteen percent of the U.S. population is foreign-born. In the country’s largest states - some also COVID-19 hotspots—immigrants comprise at least 20 percent of the population. Further, an estimated 16 million people live in mixed-status families, meaning citizen relatives’ health and healthcare decisions are also affected. It is important for everyone in our country to be able to access good healthcare without fear, both for their own protection and to benefit public health. If healthcare is inaccessible to such a large percentage of our population, combatting COVID-19 will be an upward battle. It is important to include immigrants in policy and philanthropic efforts to combat and recover from COVID-19.