The issue of undocumented immigration has long been a source of a heated political debate in the United States. Although public perception of immigration has fluctuated dramatically in recent years, particularly in the setting of the Trump administration’s anti-immigration rhetoric, the American population seems to have largely positive views of immigrants. 1 In spite of this, undocumented immigrants face unique problems related to their immigration status, including discrimination, a lack of employment opportunities, difficulty accessing education, fear of deportation, and access to health care. 2
The COVID-19 pandemic has been particularly revealing of the dramatic inequities in our health care system, especially as they pertain to undocumented immigrants. According to the US Department of Homeland Security’s COVID-19 Vulnerability Report, noncitizens are more vulnerable to COVID-19 infection due to greater rates of employment in higher-risk occupations, higher poverty rates, and lower insurance enrollment rates. 3 Although these individuals are disproportionately represented on the pandemic’s frontlines, our health care system has failed to provide them with adequate access to health care, even as necessitated by a crisis like the COVID-19 pandemic. 4
Undocumented immigrants have been called an “invisible population” within our health care system, as their circumstances often bar them from seeking medical treatment. 5 Consequently, little data exists regarding the health status of undocumented immigrants. Studies have shown, however, that undocumented LGBTQ individuals are often denied access to vital health screenings, leading to higher rates of HIV infection. 6 Similarly, undocumented pregnant women have been shown to suffer from higher rates of adverse perinatal outcomes, as these women are often denied care or choose to forego care due to fear of deportation. 7
Lack of health insurance coverage is central to the difficulty undocumented immigrants face in accessing health care. In a recent analysis by the Kaiser Family Foundation, noncitizens were found to be significantly more likely to be uninsured than citizens, with greater than 46% of undocumented immigrants having no health insurance compared to 9% of citizens and 25% of lawfully-present immigrants. 8 This disparity in health insurance coverage can be explained by limitations in access to health insurance options, eligibility restrictions, and high cost of coverage. These factors are then compounded by language barriers, immigration policy, and fear of seeking care. 9
Although the Affordable Care Act (ACA), enacted in 2010, was designed to expand health insurance coverage to the uninsured, undocumented immigrants are currently still ineligible to purchase insurance through the ACA Marketplaces. In addition, undocumented immigrants are not eligible to enroll in Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP). 8 Currently, the only federal avenue by which undocumented immigrants may obtain access to health care services is through the Emergency Medical Treatment & Labor Act (EMTALA), which provides emergency services to the public, regardless of immigration status. In addition, since 2002, individual states have the option to extend CHIP coverage to undocumented women requiring prenatal care. 10
While federal insurance options for undocumented immigrants are virtually non-existent, some states have state-funded health programs that provide coverage to some groups of immigrants, regardless of immigration status. In 2016, California expanded Medi-Cal coverage to undocumented children and, in 2019, expanded coverage to undocumented young adults up to the age of 26. In July 2021, Governor Newsom signed AB 133 into law, which expands full Med-Cal eligibility to low-income adults over the age of 50, regardless of immigration status. In addition, AB 133 extends postpartum coverage for undocumented women to 12 months. 11
Ultimately, undocumented immigrants who fail to meet criteria for state-funded insurance programs and those residing in states without such programs continue to rely on low-cost community care, emergency room services, and costly private insurance plans. Thus, federal insurance plans should either be expanded to include undocumented immigrants, or these individuals should be given the option to purchase coverage. These changes must then be accompanied by immigration policy that quells rather than provokes fear in the undocumented immigrant community, such that these individuals feel safe seeking the care they deserve as contributing members of our society.
Alexandria Lee is a fourth year medical student at Loma Linda University School of Medicine. She graduated from UCLA with a degree in Ecology and Evolutionary Biology and has always been interested in intersectionality in medicine. When she’s not studying, she can be found at a coffee shop in LA.
