The Promise of a Path to Citizenship: What It Means for Healthcare
Healthcare in the United States has always been treated as a privilege reserved for citizens who could afford it; undocumented immigrants are unilaterally excluded. A path to citizenship would circumvent the political debates around including undocumented immigrants in the health insurance pool and bring us closer to a just, equitable healthcare system.
Over 20 million more Americans have received health insurance since the Affordable Care Act’s implementation, but 11 million undocumented immigrants remain categorically excluded. There are no serious healthcare policy rationales for prohibiting undocumented immigrants from purchasing coverage. In fact, their contributions would help offset the costs of older, sicker citizens. The argument against enabling them to purchase coverage is a proxy for a fight about whether they should be in the United States in the first place. A path to citizenship would nullify that argument by removing the question of status—of who is and isn’t American, of who we are and aren’t willing to care for—from the healthcare debate altogether. Although our healthcare system would still have a long way to go to become truly equitable, the question of including the undocumented would no longer paralyze those policy discussions.
We know there is urgency behind this issue: the pandemic has made obvious that the exclusion of some from healthcare jeopardizes the health of us all.
We know there is urgency behind this issue: the pandemic has made obvious that the exclusion of some from healthcare jeopardizes the health of us all. Some 48 million people live in households where at least one person lost their job during the COVID pandemic in this country, where health insurance is largely tied to employment. Millions of Americans were forced to confront the possibility that treatment for a life-threatening disease could end in bankruptcy. To prevent that economic cataclysm and to ensure people get tested and seek treatment once they become ill, Congress stepped in to guarantee health coverage for COVID-related illness. Except, that is, for undocumented immigrants.
Political opposition to extending protections to the undocumented led to their categorical exclusion from the CARES Act for COVID relief, despite the fact that many undocumented immigrants are essential workers who continue to put their lives on the line for our national and collective vitality.
Although no data is available for COVID infection rates among undocumented immigrants specifically, racial data provides some insight into the scope of the inequities that immigration status only exacerbates. Ninety-three percent of undocumented immigrants are people of color; of that group, Latinx people make up the largest subset. Latinx people are nearly twice as likely as White people to contract the virus, and our healthcare system is clearly failing those who do get sick: data from summer 2020 shows that of Latinx people who died, more than a quarter were younger than 60. Only six percent of White people who died were that young.
A path to citizenship would eliminate the political rationale for forcing millions of mixed-status American families to regularly decide whether to seek care and face devastating medical bills or wait until it’s too late or until others have become sick—the very problem Congress sought to preempt for most Americans in the CARES Act. Of course, a path to citizenship will also lift the overarching risk factor influencing whether undocumented immigrants seek critical medical assistance: fear of deportation.
A path to citizenship would eliminate the political rationale for forcing millions of mixed-status American families to regularly decide whether to seek care and face devastating medical bills or wait until it’s too late or until others have become sick—the very problem Congress sought to preempt for most Americans in the CARES Act.
It is perhaps unsurprising that the psychological toll of lockdown poses an outsized threat for the undocumented, too. The social isolation required by the pandemic is a familiar loneliness for many: a retreat from social interaction is standard, not out of fear of illness, but of deportation. And when isolation isn’t a temporary measure but a way of life, the impacts are devastating. In a yet-to-be published study, an Arizona State University scholar found that, compared to immigrants with legal status, undocumented immigrants are 2.9 times more likely to report symptoms of depression, 8.5 times more likely to report symptoms of anxiety, and 5.9 times more likely to report symptoms of stress. As we make strides to ensure we include mental health in our healthcare system, we have to recognize and alleviate the toll that being undocumented takes on the psyche.
A path to citizenship would not only remove that mental health toll, but also the political minefield surrounding insuring the undocumented. And it would resolve the national hypocrisy of a deploying an undocumented workforce that has our reliance but not our care. A path to citizenship for the 11 milion aspiring Americans would advance the promise of better health for generations to come and a better public healthcare system with justice and equity at its center.