Citizenship, policy barriers limit access to health care for some Latino, Asian immigrants

Two new studies by the UCLA Center for Health Policy Research explore the link between citizenship status and access to health care among Latino and Asian immigrants in California. The studies are part of the center’s Research on Immigrant Health and State Policy Study, or RIGHTS, which analyzed the experiences of Latino and Asian immigrants in the state from 2018 to 2020.

In the first study, researchers compared job opportunities and workplace conditions for immigrants based on whether they had ever had undocumented status.

Among immigrants who had ever been undocumented, 49.5% said they had been unable to apply for a job because of their status, compared to 21.6% of immigrants who had never been undocumented. In addition, immigrants who had ever been undocumented had significantly higher rates of:

• Settling for a job that paid less than what they deserved (47.3% compared with 29.3% for those who were never undocumented).
• Being injured at work (36.7% versus 22.1%).
• Not getting paid for hours worked (28.1% versus 14.2%).
• Being asked to perform dangerous job duties (22.1% versus 8.1%).

“Immigration status is an important factor not only in whether an individual gets hired and gains health insurance, but in terms of how they are treated at work and how that can harm their health,” said May Sudhinaraset, a faculty associate at the center and lead author of the study. “Our research showed that many undocumented immigrants felt pressured to keep working while sick so they wouldn’t lose their jobs.”

The second study examined perceptions of the so-called public charge rule among the state’s Latino and Asian immigrants, based on their immigration status — whether they were naturalized citizens, noncitizens with green cards or and noncitizens without green cards — and race. The federal government defines an immigrant who relies on specific types of public aid as a “public charge,” and that person can be denied a green card and the opportunity to become a U.S. citizen.

The researchers found that 67% of all respondents had negative perceptions and negative experiences related to the public charge rule. The researchers also found:

• 52% of Latino immigrants had negative perceptions of the public charge policy, but not negative experiences; compared to 44% of Asian immigrants who said they had negative perceptions only.
• 26% of Latino immigrants reported having both negative perceptions and negative experiences related to the rule, compared to just 11% of Asian immigrants.
• 21% of Latino immigrants said they had neither negative perceptions nor experiences related to the public charge rule, compared with 45% of Asian immigrants.

“Some immigrants are afraid to use public aid such as health care and food programs because of the public charge rule,” said Michael Rodriguez, a faculty associate at the center and the lead author of the second study. “Although most immigrants in the U.S. are here legally and ‘public charge’ doesn’t apply to them, this confusing policy leads them to believe they will lose their path to permanent citizenship, and as a result they forgo benefits that affect their health and well-being.”

Both studies demonstrate that restrictive immigration policies affect immigrants’ experiences in California, regardless of their legal status. The authors write that federal and other government officials could tailor policies that avoid having adverse impacts such as deterring access to heath care.

The new study draws data from the 2018, 2019 and 2020 California Health Interview Surveys​ (CHIS), which also were conducted by the center.

In fall 2021, the Center for Health Policy Research published two fact sheets on immigrants’ experiences with law and immigration enforcement and their perceptions of the immigrant experience.​