New Report Finds Chilling Effect, Avoidance of Health Care Services Among Immigrant Families

As the COVID-19 pandemic continues to wreak havoc across the US, public health experts have emphasized the disparate impact the virus is having on certain groups – those over 65 years old (especially in congregate care settings), those with underlying health conditions, and American Indian/Alaska Native (AI/AN), Black, and Latino communities. Immigrants are also disproportionately impacted.

The disparities for AI/AN, Black, Latino, and immigrant communities include not only disproportionately high infection rates, morbidity and mortality, but also disproportionately high job losses and economic hardship. These inequities stem from multiple problems, including long-standing, systemic biases in the health, labor, and financial systems and more recent policy changes.

For immigrant families, the disproportionate impact is linked to several factors. Immigrants play a key role in the frontline response as essential workers in health care, food production, and transportation, leaving them at greater risk of exposure. Immigrants also work in industries hit hard by the economic fallout such as food service and domestic household services. In a recent survey, over two-thirds of Latino adults in families with noncitizens reported that they or a family member have lost a job, work hours, or work-related income because of COVID-19.

Unfortunately, the disparate impact of the pandemic on immigrant families comes at a time when immigrant families were already under tremendous strain. Part of this pressure stems from sweeping changes to public charge rules. Researchers at the Urban Institute have been documenting the chilling effect as the Trump Administration proposed and finalized these changes over the last couple of years.

The most recent report finds that 1 in 5 adults in immigrant families with children reported chilling effects on public benefit receipt in 2019. The chilling effect is an intentional side effect of this Administration’s anti-immigrant policies, and the climate of fear and confusion created by anti-immigrant rhetoric and constantly changing policies will have lasting and harmful consequences. The chilling effect is worse for families with children (20.4%) than for those without children (10%), and it’s even worse for low-income families with children (31.5%). That’s before the public charge rules actually took effect in February 2020 – a sign that the worst is yet to come.

But, there is some room for hope. The Urban Institute researchers find that while nearly 7 in 10 adults in immigrant families with children are aware of the public charge rule, and of those, most are confident in their understanding of it, there is still a great deal of misunderstanding.  Over three-quarters of adults in immigrant families with children did not understand that children’s enrollment is not a factor in their parents’ public charge determination. (You might be wondering why I think that alarming statistic leaves any room for hope, but stay with me.)

The researchers also find that among immigrant families with children, the most trustworthy sources of information about public charge are government agencies and service providers in the community. But most of the information families are getting is coming from sources they consider less reliable, such as TV news. That means that if we can help trusted sources such as state and local governments, legal aid and community organizations, health care providers and schools do a better job of explaining the public charge rule and getting the word out, we could actually help mitigate the chilling effect over time.

The COVID-19 pandemic has only increased the urgency to make sure all children and families regardless of citizenship status have access to health care, and there is certainly more work to be done. But for those children who are eligible for Medicaid/CHIP today and not enrolled out of fear or confusion, we can start by making sure that trusted sources can break through the noise with reliable information.

Parents should continue to enroll their eligible children in Medicaid/CHIP. Doing so will not impact the parent when applying for a green card because children’s enrollment in Medicaid/CHIP is not a factor in their parents’ public charge determination. And having health coverage as a child not only helps children to grow into healthier adults, it also helps children do better in school and makes the whole family more financially secure. Spread the word! (And help trusted sources of information in your area do the same.)

Kelly Whitener is an Associate Professor of the Practice at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.