Immigration policies like the Trump-era expansion of the “public
charge” rule that made it harder for immigrants on public assistance to obtain
legal residency can have a chilling effect on the health and well-being of immigrant
communities in California, according to a study
released today by the UCLA Center
for Health Policy Research.
The study, based on data from the center’s 2019 California Health Interview Survey, shows that 1 in 4 low-income immigrant adults in the state have avoided accessing public assistance like health, food or housing programs at some point for fear of jeopardizing their own or a family member’s immigration status. More than half of them indicated they had shunned
these programs in the time between the Trump administration’s proposed rule changes
in 2018 and their implementation in 2020.
The new public charge legislation penalized immigrants who rely
on Medicaid, food stamps or housing vouchers — even for short periods — by decreasing
their chances of getting a “green card,” or lawful permanent residency.
Immigrants’ avoidance of these public programs was linked to
worse access to care and higher food insecurity, the researchers say. They
found that among California immigrants who had reported avoiding programs over
the past year, 37% were uninsured and 54% were food insecure, compared with 16%
and 36% of immigrants who didn’t avoid them.
In addition, those who had avoided public programs in the past
year were twice as likely as those who hadn’t to report delays in receiving
needed medical care and prescription medication, as well as not receiving
mental health treatment — all of which suggest negative health outcomes for
this group.
Surprisingly, the authors also found that the proposed public
charge changes seemed to have an adverse impact on immigrants who weren’t even subject
to the rule. More than one-quarter, 27%, of those who were already lawful
permanent residents reported avoiding public assistance programs.
“Policies that sow fear and confusion around immigration status
contribute to the avoidance of public programs, which can have serious
implications for health and well-being,” said Susan Babey, a senior research scientist at the center and the study’s lead
author. “Programs like Medi-Cal
and CalFresh, for food assistance, serve as a crucial safety net for California families, and
inclusive policies that provide access to public programs could help
protect the health of Californians, particularly during a pandemic.”
While in February 2021 President Biden called for an immediate
review of the public charge rule and the Supreme Court agreed to take up a case
challenging the legislation, the researchers noted that complex and sometimes confusing
immigration policies have long prevented eligible immigrants from seeking
public assistance.
Although this is true for many segments of the immigrant
community, avoidance was found to be particularly high among noncitizens who are
not permanent residents (42%), those between the ages 18 and 34 (34%), Latinos
(30%), those who are married with children and single with children (36% and
32%) and those who do not speak English well (29%).
The study data adds to the evidence of how the public charge
rule, in particular, had a negative impact on immigrant communities and forced
individuals to make tough choices about their health and well-being — choices
made even more difficult by widespread uncertainty about which public assistance
programs were included, who the rule applied to and how it might affect citizenship
applications.
“The findings suggest the crucial need to provide accurate and
easy-to-understand information about immigration rules and the impact they may
have on public health,” said Ninez Ponce, director of the center and a co-author of the study.
The authors say that information campaigns led by legal and
advocacy organizations, with resources available in various languages, can
help immigrants overcome misinformation and confusion related to immigration
policies. They also recommend avoiding policies — and reversing existing
policies — that negatively impact participation in health and food
programs that serve as important safety nets for Californians.
“California is home to over 10 million immigrants and about a quarter
of the immigrant population in the U.S., more than any other state in the
nation,” Ponce said. “The COVID-19 pandemic, fraught with catastrophic life
events and economic loss, further amplifies the need to preserve vital services
for all residents.”
This study was supported with a grant from The California Endowment.
The UCLA Center for Health Policy Research (CHPR) is one of the nation’s leading health policy research centers and the premier source of health policy information for California. UCLA CHPR improves the public’s health through high quality, objective, and evidence-based research and data that informs effective policymaking. UCLA CHPR is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit healthpolicy.ucla.edu.