As Millions Are Pushed from Jobs amid Pandemic, the Loss of Employer Health Coverage & Limited Access to Public Coverage for Many Immigrants Hold Major Implications for Them – and U.S. Overall

WASHINGTON – As more than 33 million U.S. workers have lost their jobs since March amid the pandemic-induced economic crisis, immigrants are among the most vulnerable: They are more likely than the U.S. born to be laid off and to live in communities with high COVID-19 infection rates, and less likely to have health insurance coverage and access to a doctor or other usual source of health care. The resulting barriers to testing and treatment for the virus hold significant implications for immigrants and their families, of course, but also for the wider community if non-citizens do not have timely access to health care when facing possible coronavirus symptoms.

“The undetected and unchecked spread of the virus among any segment of the U.S. population risks driving further transmission to others, with severe consequences for communities across the country,” Randy Capps and Julia Gelatt write in a new Migration Policy Institute (MPI) fact sheet. “And as it affects the health and well-being of essential workers, many of whom are immigrants, the spread of the virus places stress on the health care system, food supply and access to other necessities for all.”

Between February and March, the number of unemployed immigrants increased by 30 percent, compared to 17 percent for U.S.-born workers. The rapid job loss, occurring even before most state lockdowns had kicked in, marked the start of steep declines in employer-based health insurance coverage for the native born and immigrants alike. This trend may be even more pronounced for immigrants, as Capps and Gelatt explain, because immigrants disproportionately worked, pre-pandemic, in the types of businesses (retail, food service and hospitality, for example) that were hit first and hardest as government officials issued orders closing non-essential businesses and/or requiring residents to stay at home.

In this context, immigrants—like other U.S. residents—are becoming increasingly dependent on publicly funded health care for screening and treatment, should they develop symptoms of the virus. But many immigrants who have not become U.S. citizens (a category that includes legal permanent residents, temporary workers and other non-immigrants as well as unauthorized immigrants) do not qualify for Medicaid—the main public health insurance program for low-income people—because of eligibility restrictions related to immigration status. (For example, most legal permanent residents, aka green card holders, must have five years in that status before gaining eligibility; unauthorized immigrants are generally barred from Medicaid and a number of other means-tested public-benefit programs.)

Even before the pandemic, millions of U.S. residents were uninsured: 28.6 million overall in 2018, with an estimated 7.7 million of them non-citizens.

The fact sheet offers U.S. and state-level estimates of the numbers of low-income uninsured non-citizens who are excluded from Medicaid based on their immigration status, using three employment scenarios: the pre-pandemic 4 percent unemployment rate, the jobless rate of 17. 5 percent hit at the end of April and a high scenario of 25 percent, which mirrors the rate during the depth of the Great Depression. Drawing on a unique MPI methodology that permits the assignment of legal status in U.S. Census Bureau data, the fact sheet finds that a spike in joblessness from the 4 percent rate pre-pandemic to a hypothetical 25 percent rate could add 1.1 million low-income non-citizens to the rolls of those ineligible for Medicaid based on their legal status. MPI estimates:

• At the 4 percent, pre-COVID jobless rate: 7.7 million non-citizens likely lacked private or public health insurance, with 2.6 million low-income non-citizens (comprised of 2.1 million unauthorized immigrants and 500,000 green card holders and temporary non-immigrants) facing Medicaid exclusions based on their legal status.
• At the 17.5 percent rate: The number of non-citizens lacking private or public insurance would rise to 9.3 million, with 3.2 million of them (2.5 million unauthorized immigrants and 700,000 green card holders and non-immigrants) ineligible for Medicaid.
• At 25 percent unemployment: 3.7 million non-citizens would be excluded from Medicaid (including 2.9 million unauthorized immigrants and 800,000 green card holders and non-immigrants), out of a pool of 10.8 million non-citizens lacking private or public coverage.

While Congress has included funding for COVID-19 testing and treatment for the uninsured in recent pandemic relief packages, lawmakers did not lift Medicaid eligibility bars for non-citizens. There are widespread reports of low-income U.S. residents—citizen and non-citizen alike—avoiding COVID-19 testing and treatment because they cannot afford them. Some non-citizens may also forgo testing and treatment because they fear immigration enforcement or worry that if they enroll in Medicaid, the new public-charge rule could disqualify them from getting a green card.

Read the fact sheet, Barriers to COVID-19 Testing and Treatment: Immigrants without Health Insurance Coverage in the United States, here: www.migrationpolicy.org/research/covid-19-testing-treatment-immigrants-health-insurance.

For detailed U.S. and state data tables showing the size of uninsured populations by citizenship and immigration status, with breakdowns for low-income populations as well as children 18 and under, for the three unemployment scenarios modeled by MPI, click here.

For all of MPI’s research, analysis and commentary on the COVID-19 pandemic, visit: www.migrationpolicy.org/coronavirus.