A New Threat to Immigrants’ Health — The Public-Charge Rule

Perreira, Krista M.; Yoshikawa, Hirokazu; Oberlander, Jonathan

doi:10.1056/nejmp1808020

Cited by 89 publications

(62 citation statements)

References 2 publications

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“…Whereas the Public Charge Rule previously affected 3% of undocumented immigrants, the revised definition will impact as many as 47% of current undocumented immigrants. 18,45 Important to note is that novel coronavirus disease 2019 (COVID-19) emerged just after enactment of the rule change. Although the pandemic's substantial health and financial impacts are being felt globally and nationally, there is heightened concern that current federal policies may further deter undocumented immigrants from seeking care during a critical public health emergency.…”

Section: Discussionmentioning

confidence: 99%

Challenges for Adult Undocumented Immigrants in Accessing Primary Care: A Qualitative Study of Health Care Workers in Los Angeles County

Yu¹,

Kelley

Morgan

et al. 2020

Health Equity

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Purpose: Amid increasingly restrictive federal immigration and health care policies in the United States, access to health care for undocumented immigrants is highly dependent on the extent to which local and state policies and programs address the needs of this population. In Los Angeles County (LA County), home to the nation's largest undocumented immigrant population, supportive policies are in place, yet little is known about how undocumented immigrants navigate available services. Methods: To gain insight into how federal, state, and local policies overlay and contribute to the experience of health care seeking among undocumented immigrants in LA County, we interviewed 19 key informant health care workers involved in the delivery of health care services, using a purposive snowball sampling approach. Results: Three key themes emerged: (1) health care workers at all clinics sampled reported primary care appointments are readily available for undocumented immigrants; however, primary care services remain underutilized; (2) fear, misinformation, and misperceptions of coverage and immigration policies-most commonly related to the revised Public Charge Rule-may reduce program enrollment and access; and (3) frontline health care workers feel ill-equipped to address patient fears and misinformation. Conclusion: Although county programs were perceived to improve access by covering health care costs and ensuring appointment availability, new restrictive immigration policies, such as the revised Public Charge Rule, and widespread misinformation present challenges that threaten the success of these programs. Future study to improve undocumented immigrant access to care should focus on addressing barriers resulting from these policies.

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Section: Discussionmentioning

confidence: 99%

Challenges for Adult Undocumented Immigrants in Accessing Primary Care: A Qualitative Study of Health Care Workers in Los Angeles County

Yu¹,

Kelley

Morgan

et al. 2020

Health Equity

View full text Add to dashboard Cite

show abstract

“…A chilling effect on enrollment in these programs has been noted due to immigrants' fear of deportation or becoming ineligible for citizenship. For example, there have been 10% decreases in participation in state-level food assistance programs among food insecure immigrant families who have arrived in the past 5 years [10][11]. A systematic study also showed that one in seven adults in immigrant families chose to forego public benefits they were otherwise entitled to in 2018 due to fears related to the proposed changes in public charge [12].…”

Section: Introductionmentioning

confidence: 99%

Documenting best practices for maintaining access to HIV prevention, care and treatment in an era of shifting immigration policy and discourse

et al. 2020

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Changes in the United States federal-level political landscape have been felt within immigrant communities, and the public health clinics that serve them. We sought to document how HIV prevention and care clinics are reaching and retaining their immigrant community patients during a period of retrenchment of accessible public resources and immigrant rights. From May 2018 through January 2019, we conducted 20 in-depth interviews with clinicians, case workers, advocates, legal experts, and peer navigators in Northern and Central California. Interviews were recorded and transcribed. Several themes emerged which can be grouped into three primary areas: changes post-election, challenges meeting the needs of patients, and best practices for maintaining access to prevention and care services. Post-election, providers reported some of their patients skipping clinic appointments due to fear of Immigration and Customs Enforcement (ICE) raids and deportation while other patients had moved to locations that they felt were less policed. Challenges emerged around linguistic competency, meeting basic needs such as housing stability and employment, and treating mental health sequelae resulting from trauma experienced in home countries or during migration itself. Best practices included hiring bilingual and bi-cultural staff, linking to legal services to assist with immigration status, holding trainings around immigrant rights and responses to ICE raids, and building trust with immigrant patients by assuring them that their status would not be collected or reported. In light of adverse policy changes affecting immigrants, agencies have begun to institute best practices to mitigate the negative impact of those policies on their clients and patients.

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“…Additionally, patients with fears about immigration enforcement may not be willing to risk a call to a physician's office or a visit to an urgent care center or emergency department given the increased number of deportations by Immigration and Customs Enforcement during the past several years and the recently revised public charge rules. 8,9 Implemented by the Department of Homeland Security in February 2020, the revised public charge rules have broadened the conditions under which the government can deny admission or visas to immigrants based on their use of public benefits. As a result, immigrants may wait too long to seek care for symptoms of COVID-19, putting themselves and their families at risk.…”

mentioning

confidence: 99%

The Disproportionate Burden of COVID-19 for Immigrants in the Bronx, New York

2020

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As general internists who work in the hospitals and outpatient clinics of a large safety-net health system in the Bronx, we care for an ever-increasing number of patients with symptoms of coronavirus disease 2019 (COVID-19) who call our clinics to ask for guidance, seek care in our hospitals, and die in our wards. We are distressed by the disproportionate burden of the COVID-19 pandemic for immigrant patients.The Bronx, a borough of New York City, is one of the most ethnically diverse urban areas in the US and ranked the least healthy of New York State's 62 counties. It has rates of chronic diseases such as asthma, diabetes, hypertension, obesity, and tobacco use disorder-all factors that appear to increase the risk of complications from COVID-19-that are among the highest in the state. 1 Poor health in the Bronx is due at least in part to decades of policies related to housing, education, environmental health, and criminal justice that have perpetuated racial and economic inequality. Unsurprisingly, the Bronx currently has the highest rate of COVID-19 diagnoses and deaths among New York City's boroughs. 2 More than half a million immigrants live in the borough, and most speak a language at home other than English. Immigrants in the Bronx are disproportionately represented in the essential workforce at risk for exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including physicians, nurses, nursing aides, home health aides, subway and bus drivers, grocery clerks, and others. The limited sociodemographic data available for COVID-19 cases in New York City show that Hispanic or Latinx individuals, who constitutemost immigrants in the Bronx, are considerably more likely to die of COVID-19 than white New York City residents. 3 As we care for patients in the community and in the hospital during this crisis, we are deeply troubled by some of the ways in which COVID-19 uniquely affects low-income immigrant patients. In these communities, the combination of high levels of chronic diseases, chronic stress, and less access to preventive health services 4 increases the risk of more severe SARS-CoV-2 infections. Many immigrant patients live in close quarters with multiple generations sharing bedrooms and bathrooms. In these families it is often impossible to isolate older family members, those with asthma or other comorbid conditions, or even those who are ill with COVID-19 from others in the household, including those who must continue to leave home to work.When conducting telemedicine visits because our clinics are shuttered, we routinely ask about COVID-19 symptoms and answer patients' questions. For immigrants with limited English proficiency, the lack of available translated information about the disease has meant relying on social media to obtain advice that may be

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A New Threat to Immigrants’ Health — The Public-Charge Rule

Cited by 89 publications

References 2 publications

Challenges for Adult Undocumented Immigrants in Accessing Primary Care: A Qualitative Study of Health Care Workers in Los Angeles County

Challenges for Adult Undocumented Immigrants in Accessing Primary Care: A Qualitative Study of Health Care Workers in Los Angeles County

Documenting best practices for maintaining access to HIV prevention, care and treatment in an era of shifting immigration policy and discourse

The Disproportionate Burden of COVID-19 for Immigrants in the Bronx, New York

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