Immigrant Policies in the U.S.

Steven P. Wallace, PhDProfessor Dept. of Community Health SciencesAssoc. Director, UCLA Center for Health Policy

Research

Brief overview of immigrant demographyCurrent (hot) policy issuesLong trendsWhat to do about it– Research– Advocacy

Percent immigrant, 2017

Source: www.socialexplorer.com

Where do CA immigrants come from, 2017?

6.4%39.7%

1.7%

0.9%

Mexico38.5%

8.3%2.6%

0.7%

Canada1.2%

https://www.migrationpolicy.org/data/state-profiles/state/demographics/CA

2.7%

More Asians than Latinos now arriving each year

2015=37.4%

2015=28.0%

https://www.pewhispanic.org/2019/06/03/facts-on-u-s-immigrants/

Number of unauthorized immigrants living in the U.S.

https://www.pewresearch.org/fact-tank/2019/06/12/us-unauthorized-immigrant-population-2017/

(1) 2020 CensusAdd citizenship?– Already in ACS

So why not in full census?[hint: It’s all about politics]

(2) Public ChargePersons who rely on government cash assistance (SSI or TANF) can now be denied entry/ green cardsProposal to expand to any use, add SNAP, Medicaid, housingChilling effect will drive US-citizen children away from needed programs

(3) Affordable housingPublic housing to evict families w/ unauthorized members~25k households impacted w/ 55k citizen children1.2 million in public housing nationally https://www.nytimes.com/2019/05/10/us/politics/h

ud-public-housing-immigrants.html

(4) 2020 ElectionsDebate #1 (6/27/19)“Raise your hand if your government plan would provide coverage for undocumented immigrants”

The economic case for coverageAlmost all unauthorized immigrants in working families– Keeping healthy helps econ

Early intervention can cost less than late Prevents medical bankruptcy– Impacts entire household +

creditors

Paying for health care

27.6%

34.6%

42.8%

Ever unable to pay basic needs due to medical debt

US-born Naturalized NonCitizen

9.7%

7.3%

8.9%

Problem paying medical bill past year

US-born Naturalized NonCitizen

Source: California Health Interview Survey 2017

The ethical case for coverageUndocumented pay taxes, should receive servicesReduces the “chilling effect”Universal declaration of human rights– Health care as human

right– We’re all in this together

https://www.vaticannews.va/en/pope/news/2019-05/pope-francis-message-world-day-migrants-refugees-full-text.html

California CoverageMedi-Cal for low-income– PRUCOL/DACA– All pregnant women– All youth through age 25– LPR here <5 years

Covered CA subsidy– LPR <5 years

County plans for undoc– E.g. Healthy San Francisco– Most w/caps (Fresno=400!)

Emergency Medi-Cal

Headlines vs. long trends

Headlines = acute stressDifferential opportunities = chronic stress/ life chances

Mechanisms linking policy to health impacts?

Social/ psychological impact of experiences – most likely to have “spill over” effects across policies/domainsStructured opportunities (rights, eligibility)– Interactions with other structural factors, e.g.

poverty, residential segregation, political disenfranchisement, etc.

Racialization of immigrationPolitical rhetoric makes brown = undocumented immigrant = undesirable2/3 of Latinos are US-bornResult is “spill-over” of anti-immigrant to anti-Latino politics

Research, action

Study on Immigrant Health

Funded by NIH/NIMHD grant #R01MD012292

http://healthpolicy.ucla.edu/RIGHTS

Health in all policies!

Wallace SP, Young MT, Rodríguez MA, Brindis CD. A social determinants framework identifying state-level immigrant policies and their influence on health. SSM PopulHealth. 2018 Nov 2;7:016-16. http://dx.doi.org/10.1016/j.ssmph.2018.10.016

Knows someone personally who has been deported, CA 2018

4%

32%

42%

Asian language (301) English (373) Spanish (386)

Source: RIGHTS study, first 1060 Latin American and Asian immigrant interviews in 2018, preliminary data not for citation

Public Charge ConcernWas there ever a time when you decided not to apply for one or more non-cash government benefits, such as Medi-Cal, food stamps, or housing subsidies, because you were worried it would disqualify you, or a family member, from

obtaining a green card or becoming a U.S. citizen?

9.6%

16.3%

25.4%

Asian language (301) English (373) Spanish (386)

Source: RIGHTS study, first 1060 Latin American and Asian immigrant interviews in 2018, preliminary data not for citation

Reports immigrants get same level of health care as everyone else

10% 11% 9%5%

17%10%

9%

33%35%

0%10%20%30%40%50%60%70%80%90%

100%

Asian language English Spanish

alwaysusuallysometimesrarelynever

Source: RIGHTS study, first 1060 Latin American and Asian immigrant interviews in 2018, preliminary data not for citation

Action

Public comments on regulatory changes https://protectingimmigrantfamilies.org/Connect with community organizationsEvery person makes a difference– Decline Real ID & get regular driver’s license– Decline to answer citizenship question (if

added)Of course, vote

Policies to promote!Protect: University/ employer as sanctuary; inform all of rightsPromote Integration: ESL, worker rights, language accessHealth insurance for all CaliforniansPass: Comprehensive immigration reform

Thank you

http://healthpolicy.ucla.edu/rights