The fight against COVID-19 requires regaining and maintaining immigrants’ trust in our public health system. The Trump administration’s public charge rule, which empowers the U.S. government to deny green cards to immigrants who receive welfare benefits, could prove to be a public health problem by reducing immigrants’ willingness to engage in contract tracing and testing and trust leaders.
With 70% of immigrants in the labor force serving as essential workers, whether it be as healthcare providers or meatpacking plant workers, immigrants are at greater risk of being exposed to COVID-19. In fact, reports across the country show that migrant farmworker communities face not only higher COVID-19 exposure, but also more damaging effects from the current West Coast wildfires.
This news is concerning as immigrants are more likely to lack health insurance, with 23% of immigrants with legal status and 45% of undocumented immigrants lacking insurance, compared with 8% of citizens.
If this trend wasn’t bad enough, reports have shown that Trump’s public charge rule has made immigrants afraid to seek healthcare. The Kaiser Family Foundation has found that immigrants are disenrolling in healthcare benefit programs like Medicaid. A report from the Chicano Federation shows that this is not a theoretical issue as places like San Diego county struggle to convince community members to share personal information with contact tracers: it is an urgent one, with potentially catastrophic public health implications.
This lack of confidence is exactly why improving immigrants’ trust in the U.S. public health system is an issue of public concern. If immigrants distrust testing and contact tracing programs, there is an increased likelihood that COVID-19 will spread undetected in all communities — hampering states’ abilities to re-open their economies and contain the pandemic.
As individuals in the medical field and the children of immigrants, ensuring that immigrants trust COVID-19 testing and contact tracing programs is medically necessary and deeply personal. This understanding is why we have outlined some immediate policy steps to rebuild immigrants’ trust in public health systems during the COVID-19 pandemic.
- First, the public charge rule should be rescinded. This would ensure that immigrants are not afraid to use the many community clinics that serve people regardless of citizenship status or ability to pay. These clinics are often key resources for necessary testing that must take place. In addition, immigrants wouldn’t withdraw their children from important insurance programs, like the Children’s Health Insurance Program, that provide access to care for low-income children. Furthermore, removing green card penalties for obtaining necessary food and housing assistance programs will increase immigrants’ willingness to access testing and contact tracing programs
- Second, the federal government should make good on its promise to cover testing fees for all citizens and residents. This is very important as those who lack insurance face exorbitant testing costs. Covering the costs of testing fees will make it more likely that immigrant communities are able to access tests
- Third, on the state level, public health departments should work with community organizations to share information and emphasize the need for testing and contact tracing. In Boston, organizations like the Chelsea Collaborative work to ensure immigrants know about available social services that do not affect their future immigration status. Community-based organizations are trusted in immigrant communities and can combat misperceptions that have come to the forefront in a political environment that has not been hospitable to immigrants
- Finally, state and local health departments need to guarantee the privacy of healthcare data obtained through testing and contact tracing. This means ensuring immigrants that their health data will be used solely for health purposes. To explicitly address the fear of deportation, state and local governments must also guarantee that any health-related data will not be shared with ICE or their subcontractors. This promise is especially important for cities that contract with private entities to assist in the testing and contract tracing process. It is crucial that immigrant communities are confident that their healthcare data won’t be used as a means to separate or terrorize their families in order to further an anti-immigration agenda. This fear of immigration enforcement can deter individuals away from utilizing needed testing and contact tracing resources. The efforts to tap into the resources of the private, public, and nonprofit sectors to solve the COVID-19 testing deficit will live and die by how well the information is safeguarded against improper use and more importantly, based on immigrants’ trust in the process
In order to engage in the necessary testing and contact tracing that is needed to open up the economy, we need to have effective buy-in and trust from all segments of our population including our many immigrant communities.
It is important that our immigrants, who make up a sizable portion of our population and a disproportionate share of essential workers, have faith in and access to our healthcare system.
This makes the public charge rule a public healthcare hazard that must be removed.
Victor Agbafe is a medical student at the University of Michigan Medical School and a former volunteer with the Harvard Citizenship tutoring program. Jesper Ke is a medical student at the University of Michigan Medical School. Vinay Gupta, MD, is an assistant professor of pulmonary and critical care medicine at the University of Washington and a major in the U.S. Air Force medical corps.