Immigration status as a health care barrier in the USA during COVID-19

Abstract

In the context of the United States of America (U.S.), COVID-19 has influenced migrant experiences in a variety of ways, including the government's use of public health orders to prevent migration into the country and the risk of immigrants contracting COVID-19 while in detention centers. However, this paper focuses on barriers that immigrants of diverse statuses living in the U.S.-along with their families-may face in accessing health services during the pandemic, as well as implications of these barriers for COVID-19 prevention and response efforts. We report findings from a scoping review about immigration status as a social determinant of health and discuss ways that immigration status can impede access to health care across levels of the social ecology. We then develop a conceptual outline to explore how changes to federal immigration policies and COVID-19 federal relief efforts implemented in 2020 may have created additional barriers to health care for immigrants and their families. Improving health care access for immigrant populations in the U.S. requires interventions at all levels of the social ecology and across various social determinants of health, both in response to COVID-19 and to strengthen health systems more broadly.

Keywords: COVID-19; Health care access; Health policy; Immigrant health; Social determinants of health; Social ecological model.

Fig. 1

Concept Map of U.S. Federal Policies related to Uninsured Immigrant Populations’ Health Care Access in 2020 during COVID-19. This conceptual map theorizes ways three federal laws and policies implemented in 2020—(1) The Final Rule for Inadmissibility on Public Charge Grounds; (2) the Coronavirus Aid, Relief, and Economic Security (CARES) Act; and (3) the Families First Coronavirus Response Act (FFCRA)—may have influenced access to health care and health-seeking behaviors among uninsured immigrants and their families across levels of the social ecology during the COVID-19 pandemic. This conceptual map builds from previous work by Cholera et al. (2020); Clark et al. (2020); Derr (2016); Duncan and Horton (2020); Hacker et al. (2015); Page et al., 2020; National Immigration Law Center (2020); Schwartz and Tolbert (2020); Wilson and Stimpson (2020).