Executive summary

 Immigrant populations in the United States face significant barriers to accessing healthcare, contributing to health-related disparities and untreated medical conditions. Many of these barriers involve language obstacles, cultural stigma, and limited or lack of access to insurance due to citizenship status. Policy solutions reform existing healthcare structures to provide equitable care regardless of an individual’s background. 

Overview

   A large population of immigrant workers within the United States are employed in service occupations including natural resources, construction, maintenance, production, transportation, and material moving occupations (Bureau of Labor Statistics). As these jobs often involve higher safety hazards, many foreign-born workers face higher health risks as opposed to their native-born counterparts. Consequently, occupational health disparities exist between the two groups which become further compounded by undocumented workers who may feel unable to advocate for safer conditions or more fair compensation due to fear of deportation or job loss. Moreover up to one in four immigrant adults report being treated unfairly directly within healthcare institutions. Specifically, 16% accredit this due to insurance status, 15% from an accent or ability to speak English, and 13% from their individual race, ethnicity, or skin color (Samantha, et al.). These issues within healthcare facilities significantly complicate care for immigrant populations resulting in reduced quality of care or treatment. 

Pointed Summary

 Despite improvements in care standards inequities remain: immigrants continue to receive lower-quality care than their native-born counterparts, exacerbating health disparities within the United States.

2. Relevance

 Healthcare disparities among immigrant populations are relevant to public health, economic stability, and social equity within the U.S. As immigrant workers make up nearly 73% of agricultural workers alone—fueling a 1.053 trillion dollar industry—their health and well-being directly impact the nation’s economy and workforce sustainability (FWD.us). But beyond the economy, addressing health disparities underscores broader social justice concerns reflecting issues of discrimination, inclusivity, and basic human rights. Ensuring equitable access to healthcare for immigrants allows for a healthier, more resilient community 

3. History

   The health disparities immigrants face within the United States have historical roots shaped by immigrant policy and lasting social attitudes. In the late nineteen-hundreds, immigrants underwent medical inspections provided by the U.S. Public Health Services; policies like these often associated foreigners consistently with germs and contagion (Markel, Stern). Anti-immigrant rhetoric, as a result, further deepened heavy stigmatization and hysteria surrounding immigrants and the “diseases” they carried (Wishnie). In the 1980s and 1990s, immigration enforcement policies intensified which weakened social safety nets, impacting immigrants’ access to healthcare. The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), established new restrictions that prevented lawfully present immigrants from receiving Medicaid until five years of “qualifying” immigration status (KFF). Limitations like these pushed immigrant populations away from mainstream healthcare access, producing consequential disparities.

Current Stances

  Though healthcare disparities among the immigrant population remain an ongoing issue, there are existing policy stances and communities that have begun advocating for equitable healthcare among immigrants. For example, state-level expansions in California, New York, and Illinois have expanded Medicaid eligibility to undocumented residents providing pathways for access to medical treatment (Heyison, Gonzales). Public health organizations and nonprofits like the National Immigration Law Center and the Migration Policy Institute have also worked together to improve healthcare access for immigrants from language services to community health worker programs. Despite these advancements, however,  state-level barriers also exist that limit healthcare access for immigrants, indirectly. For example, Florida’s SB1718 requires all hospitals accepting Medicaid to ask patients about their immigration status. Similarly, a 2024 executive order issued by Texas Governor Abbott mandates that the Health and Human Services Commission direct Texas hospitals to collect information about patients’ immigration status. Collectively, asking about immigration status in healthcare settings can worsen health disparities by creating barriers to accessing care and fostering fear as immigrants become deterred from receiving medical services. 

2. Tried Policy

  In addressing healthcare disparities among immigrants, several policies have been enacted aimed at expanding healthcare services and reducing discrimination in medical settings. In 2009, the Immigrant Children’s Health Improvement Act (ICHIA) was enacted which allowed states to provide coverage to lawfully residing immigrant children without the five-year waiting period established by the PRWORA. Additionally, the Affordable Care Act (ACA) in 2010, aimed to reduce the number of uninsured Americans including immigrants by creating health insurance marketplaces for people to purchase coverage. While several of these policies had good intentions, both the ICHIA and ACA had limited benefits as undocumented immigrants were excluded from several of the services provided to legal immigrants, leaving them without affordable options for coverage. In addition, these policies do not address the lack of cultural competency within healthcare systems and the failure of healthcare institutions to address implicit biases that develop within these settings. Language barriers and communication gaps for example are one of the most prominent challenges that immigrants face in accessing healthcare as immigrants who are non-English speakers may create misunderstandings, improper diagnosis, and failure to disclose critical information. 

Policy Problem

A. Stakeholders

 Stakeholders within this topic involve government entities, healthcare institutions, healthcare providers, advocacy organizations, immigrant communities themselves, and the general public. Respectively the stakeholders individually hold the power to enact laws, address cultural competency, educate themselves on cultural differences, raise awareness to push for systemic change, and promote public awareness campaigns in valuing equality, fairness, and human rights. 

B. Risks of Indifference

   Indifference to health disparities experienced by immigrant populations in the United States risks both the immigrant communities and broader society. Specifically, continued disparities in access to care can lead to untreated medical conditions, higher rates of chronic diseases, and poorer health outcomes (Williams, Michelle). Furthermore, lack of proper healthcare access can also contribute to vulnerability in health which impacts public health programs. This harms the community individually, but also places a strain on public health systems which must manage the consequences of untreated diseases and infectious outbreaks that disproportionately affect marginalized groups. 

C. Nonpartisan Reasoning

  Healthcare within America has been a long contentious topic and when intersected with immigration only adds an additional layer of complexity. Policies that directly impact immigrant access to reproductive health services and general healthcare have been sought by both the Democratic party and the Republican party. The former has long pushed for expanding healthcare access to undocumented immigrants by extending federal funding, arguing their lack of Medicare, and inability to participate in the federal Affordable Care Act subsidies. The latter has been resistant to this idea, approaching this issue with a realistic perspective believing that the American people should be at the forefront of healthcare-related issues (Luhby). Regardless, nonpartisan support has largely involved expanding Medicaid coverage for all lawfully residing children and pregnant women. Furthermore, supporting public health safety net clinics that serve everyone has been acknowledged to reduce wait times and emergency room usage as well as dissipate costs for uninsured immigrants which become burdensome to both hospitals and taxpayers. 

Policy Options

Through nonpartisan reasoning, we can establish several policy options. The first would be to expand Medicaid Coverage for all lawfully residing individuals, including parent and children immigrants. Existing policies like the ICHIA have eliminated the 5-year waiting period prior to receiving Medicaid support for legal children specifically. Congress instead, could amend current Medicaid statutes to ensure uniform access to Medicaid nationally, to support all legal immigrants providing a more comprehensive approach. Furthermore, expanding community health center funding to support safety net clinics for immigrants could allow for basic preventive care, primary care, and health screenings for all individuals—helping immigrants and low-income individuals to access necessary healthcare without insurance requirements. Additionally, a new federally mandated cultural competency and language training program would be established for healthcare providers, requiring medical licensure candidates to complete cultural competency training. This curriculum could include modules on language barriers, cultural practices regarding healthcare internationally, and patient-provider communication strategies tailored toward immigrant populations. Federal incentive programs for hospitals that implement cultural education programs could also reward hospitals and clinics that invest in staff education. Collectively, these policy proposals aim to establish an equitable healthcare system for immigrants and a more inclusive healthcare environment. 

Conclusions

 The barriers to healthcare access facing immigrant communities in the U.S. are rooted in policy limitations and historically ingrained societal attitudes. As a result, many of these issues reinforce health inequities that must be addressed in promoting public health and advancing social equity and economic stability. Policies that expand Medicaid for all lawfully residing individuals, fund safety net clinics, and mandate cultural competency training for healthcare providers all present actionable solutions for reducing these disparities. By embracing a more inclusive healthcare model, it strengthens the health and resilience of the broader society and an equitable America for all. 

Acknowledgment

The Institute for Youth in Policy wishes to acknowledge Gwen Singer, Mason Carlisle, Lilly Kurtz, Paul Kramer. and other contributors for developing and maintaining the Fellowship Program within the Institute.

References

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