Recent federal and state policy changes have complicated the health and well-being of immigrant populations in the U.S. Many of these policies have looked at foreign-born residents through the lens of border security and documentation status, rather than as individuals who deserve equitable access to health care. The end of the COVID-19 Public Health Emergency and the expiration of Title 42 has further complicated their care.

The end of the Public Health Emergency

On May 11, 2023, the federal Public Health Emergency (PHE) for COVID-19 expired. With it, ends resources, programs, and policies geared towards reducing the impact of the pandemic across the nation.

The most impactful provision ended earlier than the PHE: Medicaid’s continuous enrollment condition blocking states from removing enrollees since enacted in 2020. During the pandemic, over 25 percent  of Americans were on Medicaid resulting in approximately 95 million utilizing this public coverage. With its end, high estimates say 24 million people could lose health care coverage and their access to affordable, quality care.

Immigrants and other marginalized populations are among those most likely to become uninsured due to the end of this coverage. By 2024, foreign-born residents will make up over 30 percent of the uninsured population in U.S. Some may no longer even be eligible for Medicaid and must navigate the health care marketplace in their state or go without coverage. Disruptions in healthcare coverage, particularly Medicaid, is linked to increased hospitalizations and emergency room use. Complex documentation and eligibility processes make health care enrollment difficult for the average American citizen, let alone those with low health literacy and language barriers.

As states continue to unwind the continuous eligibility provision in the coming months, it will be integral to stay abreast of how immigrant populations are faring during this transition to ensure the health outcomes of a wide swath of our U.S. population are not negatively impacted by this shift.

The End of Title 42

An obscure public health law enforced to quell immigrants entering the country through Mexico or Canada, ended on May 11, 2023 with the PHE and with it comes the potential threat of deadly consequences for migrants. This transition to previous policies could lead to poor treatment, ignored healthcare needs, and death to those detained by Customs and Border Protection.  Title 42 allowed Border Patrol to expel migrants legally seeking asylum in the U.S. under the guise of public health. Those seeking asylum are similar to refugees, given they are within their legal rights when leaving an untenable situation to seek protection in a new country. The main difference between these two groups is asylum seekers, such as those at the U.S.-Mexico border, are not yet legally recognized as needing asylum and must go through the process of determining it is necessary. Enacted in 2020, Title 42 was enforced nearly three million times along the Mexican border, causing migrants to return to where their journey began.  

Now, for those that are awaiting a decision on their asylum status, they are sent to Immigration and Customs Enforcement Detention Centers across the country. As these private facilities prepare for the likelihood of more occupants, there are still no regulations or standards for the health care or medical treatment received there.  These facilities are notoriously prone to unsanitary and inhumane conditions, with opaque health care services and frequent underreported deaths. Most recently, an eight-year-old child died May 17th after not promptly receiving care while suffering a medical emergency.  Often the need for health care, even imminent or dire, is ignored for an inordinate amount of time. Inhumane treatment, lack of access to care, cultural and language barriers, and inappropriate treatment for the mental health toll of the migration process are some of the concerns documented in these facilities.  

Expansion of Health Care Coverage for DACA Recipients

Over ten years after the Deferred Action for Childhood Arrivals (DACA) program was created to defend those who were brought into the country illegally as minors from possible deportation, the Biden Administration announced the expansion of Medicaid eligibility and Affordable Care Act coverage to DACA recipients. With the enactment of DACA in 2012, the nearly 1 million young adults, known as “Dreamers,” became eligible to attend school, serve in the military, and work lawfully, but were unable to enroll in any federal programs.

As of 2023, there are approximately 580,000 DACA recipients in the U.S. who will now potentially have access to quality health care. This will hopefully lower the high uninsured rates of this population as an estimated 34 percent  of Dreamers are currently not covered. With this access, Dreamers are stepping closer to getting the care they need and achieving health equity.

Much is changing for the health care and health outcomes of immigrant populations as the country decides how to move forward from the COVID-19 pandemic. It is important to note that despite the end of the PHE, people are still getting infected and dying from COVID-19, as well as dealing with Long COVID. Migrants must endure confinement in ICE Detention facilities known for poor health care access and a history of underreported deaths, injuries, and abuse. Though important progress has been made for Dreamers, the need for access to high-quality equitable health care for all immigrants is dire. With better data, as mentioned in my previous post, arises the potential for impacting immigrant health positively through evidence-based health policy.

Julie Ressalam, M.P.H.

Doctoral Student - University of Colorado School of Public Health

Julie Ressalam is AcademyHealth’s Spring 2023 Health Policy Fellow Read Bio

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