Reports are coming in from all over: some immigrants are hiding and afraid to go to the doctor or clinic, afraid to visit a food pantry, and afraid to send their children to school. Across New York City, some immigrants have stopped showing up for health care. As one primary care doctor put it, her immigrant patients “have just gone off the map.”
Precise estimates of the drop off are hard to come by because health providers do not (and should not be required to) collect information on immigration status. But the evidence is growing beyond anecdotes. For the first time since its inception, enrollment in NYC Care — a health care program that includes serving undocumented residents — is declining.
The assault on immigrants’ access to health care began in the first Trump administration. Among other policies, it broadened the definition of “public charge,” making it harder for immigrants who use certain public benefits, including non-emergency Medicaid, to obtain green cards or adjust their immigration status. That had a chilling effect, causing many immigrants to disenroll or avoid enrolling in Medicaid and other programs they were eligible for, fearing negative consequences.
In the current term, policies are getting worse, and fear is growing among immigrants, both those who are undocumented and those who are lawfully present. Even U.S. citizens of color report feeling the need to carry legal documents wherever they go for fear of getting swept up in immigration enforcement. Their fears are not exaggerated. Recently, the administration:
- revoked protections for “sensitive locations,” meaning that hospitals, schools and houses of worship are no longer off-limits for immigration enforcement;
- proposed to redefine “federal public benefit.” Under the proposal, community health centers would be newly prohibited from providing care to individuals deemed “unqualified aliens” lacking “qualified” immigration status. This will include undocumented individuals, but also several categories of people lawfully in the U.S. such as holders of H-1B and J-1 visas, as well as some lawful permanent residents;
- signed legislation that will strip away health insurance and nutrition aid and erect more barriers to Medicaid; and
- allowed the Centers for Medicare and Medicaid Services to share personal data of Medicaid enrollees with immigration enforcement agencies.
More than 4.2 million immigrants live in New York State, including 600,000 individuals who are undocumented, in mixed-status households, or have special authorization to be present. They are our neighbors, co-workers, classmates, and caretakers. Undermining their access to health care does not just hurt them; it destabilizes the health system for everyone.
Community organizations, advocates, and lawyers are working overtime to counter the rollback of health protections. For example, Make the Road New York is providing education and navigation for immigrants in New York City, Long Island, and Westchester. It is supporting health care institutions to uphold a universal standard of care for immigrants. The Asian American Federation is partnering with 15 Asian-led community-based organizations in New York City, Buffalo, Rochester, and Utica to expand health care services to downstate and upstate immigrant communities.
Creative approaches are needed. Telehealth may offer a lifeline for immigrant patients who are afraid to leave the house or receive care in-person. Just like at the height of the COVID pandemic when we were confined to our homes, telehealth can fill in some gaps. It has its limitations as a solution, but it can help along with home deliveries of medications.
Denying immigrants health care isn’t just inhumane. It’s reckless. Infectious diseases spread more readily when people avoid or delay treatment. Chronic conditions left unmanaged worsen until patients end up using emergency departments as a last resort.
No one should be denied health care, nor should anyone be afraid to seek it out when needed. New York has an obligation to protect immigrants’ access to care. Maybe the question isn’t whether immigrants should be afraid. It’s whether we all should.
