Published: Sept. 15, 2020

Power inequality - Fundamental causes - Health inequalities - Public Health  Scotland

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United States: Health Inequalities are Worsening ​by Elizabeth Mather

As the United States experiences a second uptick in COVID-19 cases, public health officials continue to advise communities to stay home and avoid nonessential contact with others, even advocating for telemedicine over in-person doctor visits. Some Americans have the ability to follow these guidelines, but many are unable to “quarantine” in the way the government recommends, often due to a lack of financial stability and a need to continue working to provide for their families. For many undocumented immigrants, working from home or not working at all is not an option, and if they get sick, calling the doctor isn’t either. The COVID-19 pandemic has exposed countless weaknesses in the US healthcare system, and the lack of healthcare coverage for undocumented immigrants is a major issue that puts around ​7.1 million people ​at risk.

On February 24, 2020, around the same time the first cases of COVID-19 were detected in the country, a new public charge restriction went into effect. This new rule penalizes immigrants who have used, or are using, public assistance such as Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and public housing, by making it more difficult to change their immigration status. Immigrants who use these programs are referred to as “public charges.” The implementation of the new rule immediately led to widespread confusion and anxiety among immigrants, and many low-income immigrant parents disenrolled their children from the SNAP program out of fear that it would damage their chances of being granted legal status in the future, or worse, lead to deportation. The rule specifically states, “aliens are inadmissible to the United States if they are unable to care for themselves without becoming ​public charges​.”

The US Citizenship and Immigration Service’s new public charge rule is just another example of the profusion of anti-immigration policies established under the Trump Administration in recent years. Threats to the Deferred Action for Childhood Arrivals Program (DACA),
increased Immigration and Customs Enforcement (ICE) raids in immigrant communities, changing asylum restrictions, and separation of families at the border have left immigrants in the US understandably fearful. This fear translates to increased distrust in the government, and immigrants have ​expressed concerns ​about leaving their houses due to recent ICE raids, meaning that even those who have access to medical care are unlikely to utilize it. In clinical spaces, immigrants fear ICE presence and the threat of medical staff sharing patients’ legal status. As the pandemic persists and healthcare utilization becomes increasingly necessary, immigrants are ​being encouraged ​by community organizations, healthcare providers, and US Citizenship and Immigration Services (USCIS) to seek medical care for COVID-19 if necessary. However, recent events suggest immigrants have consequently limited their interactions with medical services, and have actively worked to reduce their reliance on public assistance programs.

Despite the pandemic with the new public charge rule and ICE presence in their ​communities, it is increasingly important that immigrants have the ability to safely access health care systems. Millions of undocumented immigrants lack health insurance, largely because they are ​prohibited from accessing coverage through the Affordable Care Act, Medicare, and Medicaid programs. The ability to call primary care physicians and seek care in clinical settings, such as emergency rooms, is a privilege that is not extended to many. The anti-immigrant and public health messaging in the United States are in direct contradiction, ultimately, at the expense of the millions of immigrants in the country who will be forced to seek care only when their symptoms are life threatening. This pocket of immigrants being persuaded to avoid healthcare will only create a larger public health crisis, as these cases will be harder to eradicate.

Moving forward, the United States must ensure that every member of the population has access to and receives treatment for COVID-19, for the sake of both equity and public health. Government at every level must streamline public health messaging to convey the necessity of seeking treatment when necessary, and must focus on messaging that is linguistically and culturally inclusive. It is also important that this messaging is respectful in understanding the climate of fear and distrust in the government many immigrants are experiencing at this time, acknowledging that expecting immigrants to fully trust the government right now is naive, at best. States must broaden their Medicaid requirements, specifically ​Emergency Medicaid​, to encompass COVID-19 specific aspects of healthcare, including primary care, testing, and telemedicine, in order to reduce transmission and fatalities.

Finally, the same undocumented immigrants who do not have access to healthcare also lack access to the social safety net that is unemployment, stimulus checks, and loans. These people have been and continue to be harshly impacted by the extreme financial crisis the pandemic has created, and will have an even greater need for social programs such as SNAP and Medicaid. Some states ​have already begun to take steps towards financial support for undocumented immigrants by allowing DACA recipients to recieve unemployment benefits. States could go even further by making sure these unemployment benefits do not count toward public charge determinations. Lastly, the government must ensure that future stimulus bills include documented and undocumented immigrants as beneficiaries in order to give families the economic means necessary to stay afloat while following public safety orders to stay home. Addressing these health disparities is imperative to curbing the spread of COVID-19 for the entire American public.