Philip Marcelo/Associated Press
As the coronavirus pandemic continues to spread throughout the United States, inequities in the health care system have become more prevalent. Vulnerable populations have become much more susceptible to severe illness, as many barriers stand in the way of a successful recovery from COVID-19. Among the vulnerable populations are undocumented immigrants, who undoubtedly face innumerable struggles to maintain good health through such tumultuous times.
As these groups face economic hardship, physical and psychological distress, and social pressures, not only do undocumented immigrants become more susceptible to infection, they are also less equipped to get proper care. In times like these, where status appears to heavily dictate one’s health, a question arises: is citizenship a necessary identity for humans to gain access to proper health care?
Undocumented immigrants represent an essential demographic of workers who occupy many of the frontline jobs in our economy. One UCLA study found that undocumented immigrants contribute an estimated $1 trillion to the country’s GDP, and roughly $263 billion to California’s GDP. Despite substantial contributions to the U.S. economy, this demographic was offered very little job security and relief funding during the pandemic.
Typically, in frontline jobs, companies cannot afford to provide paid time off, nor do they offer health insurance benefits. These jobs not only frequently increase risk of exposure to COVID-19 and other illnesses, but they do not provide support when undocumented immigrants become sick. In this instance, undocumented immigrants often become unemployed, and this was seen at strikingly high rates throughout this pandemic. According to the same UCLA study, the unemployment rate of undocumented immigrants reached 29% in the U.S., the highest of any demographic during the pandemic. This unemployment status further inhibits the ability of undocumented immigrants to access proper health care.
Even still, when reaching the point of unemployment, very few forms of relief are extended to these immigrants. For instance, the CARES Act, passed in March 2020, provided $2.2 trillion in urgent relief to those negatively impacted by COVID-19. However, this relief did not extend to undocumented immigrants, although many were taxpayers. If the Act were to have provided relief to this demographic, it would have spurred $10 billion into the economy, enough to support 82,000 jobs. Not only would it have yielded economic benefits, but undocumented immigrants would likely have enjoyed better health care access with the improved job security.
In recent years, then, the U.S. economy has provided very little to such a marginalized group. As workers, these undocumented immigrants are utilized for their abilities to effectively work frontline jobs, but were quickly left high and dry when the pandemic began to rampage throughout the United States.
Beyond many of the financial hardships that undocumented immigrants have increasingly experienced, there are many other factors that have put these communities at higher risk for infection and serious illness during the pandemic. Take, for example, the heightened discrimination that foreigners have experienced during this time. Being a foreign-born virus, many Americans have felt hostile to minority communities, as they broadly attribute the presence of COVID-19 in the U.S. to foreigners. This has been seen on various levels across the country.
At the highest level, political leaders from the Trump administration referred to COVID-19 as the “Chinese virus,” while ensuing xenophobia towards Asian Americans and Pacific Islanders became commonoplace. By September 2021, Stop AAPI Hate had reported over 10,300 hate incidents towards these populations. However, these xenophobic trends have also been seen to carry over towards other groups, such as Latinos. For instance, two employees within the Lehigh Valley Health Network were terminated for tweeting posts such as: “It is this simple. The Latino Community does not care and they act and they have acted very irresponsibly... They do not care and they do not follow the rules and advice of our government. And it has been that way since they flocked to Hazleton.”
With this sort of discrimination seen even in the health care system, it is no wonder that undocumented immigrants fear seeking medical attention in the U.S. Even if one has the financial ability to receive treatment, oftentimes the fear of deportation is a deterrent. Heightened during the pandemic, this type of fear and mistrust in the American government has kept undocumented immigrants from getting tested and vaccinated. Furthermore, undocumented immigrants tend to defer any sort of medical care unless it is an emergency. Immigration status, then, becomes a social determinant of health, as chronic stressors accrue and mental and physical health worsen over time.
Taken together, this culture of fear of deportation continually heightens the health risks associated with the pandemic among undocumented immigrants. Now more than ever, it is critical that our health care system undergoes reformation to provide equitable access to this population.
Undocumented immigrants provide many resources to the United States. As frontline workers, this demographic serves as foundational support to the economy, while contributing billions of dollars to taxes each year. Despite their contributions to our nation, national sentiments towards this population continue to be hostile. This results in social ostracization, less financial support, and most importantly, inequitable access to health care. This vulnerable population has been subjected to higher risks of illness and mortality, especially during the pandemic. As current and future health care providers, it is important to prioritize the health of the patient above any other social determinant or characteristic, including immigration status.
For this to materialize, health care providers and policymakers must better inform patients of their rights, prevent ICE from conducting deportations at or near health care facilities, make COVID testing and treatment more accessible, offer economic relief during times of heightened job insecurity, and provide better health insurance and more safety-net clinics (1,2). By implementing reformations such as these, our health care system can work to rebuild the trust of undocumented immigrants while improving their mental and physical health. When achieved, immigration status will become less of a social determinant of health and physicians will be well-equipped to offer care, practicing the principles of beneficence and nonmaleficence in a clinical practice focused on justice.