Cost Effectiveness of Health

Ken Perez: Assessing the U.S. response to the healthcare needs of migrants and asylum seekers

February 23, 2024 3:11 pm

Immigration, for decades one of the most politically charged issues in the United States, is emerging as a top issue during this election year. A poll of 1,074 U.S. adults conducted Nov. 30-Dec. 4, 2023, found that immigration ranked as the fourth-highest priority for 2024, with 35% of those surveyed indicating that they want the government to work on it, up from 27% for 2023.a

It also seems to be a worsening challenge for the nation, as December 2023 set a new record of 302,000 migrant encounters at the U.S.-Mexico border, according to a recent ABC News story.b Meanwhile, more than 100,000 migrants have been bused to New York, Chicago, Washington, Los Angeles and other cities by governors of Texas and other southern states. Critics have been quick to condemn these moves as political stunts. But political stunt or not, the transport of thousands of “migrants” and the ensuing dramatic images of them on the streets of those sanctuary cities clearly delivered the message that the nation’s immigration challenge is not limited to the U.S.-Mexico border.

A priority among Republican voters

Not surprisingly, ABC News found that, when asked what the top issue is for them in deciding their choice of candidate in the Republican presidential primaries, Republican voters in Iowa and New Hampshire, two early-voting states located far from the southern border, ranked immigration as being almost as important as the economy, the perennial top issue.

According to the Pew Research Center, there were 10.5 million unauthorized (i.e., undocumented) immigrants in the United States in 2021, representing about 3% of the total U.S. population.c Saliently, an article published in February by Vox noted that during the past three years, more than 2 million people have been allowed to remain in the country by U.S. Customs and Border Protection while they await legal proceedings to determine whether they will
be deported.d

Without citizen status, undocumented immigrants face multiple challenges, including lack of access to healthcare.

The healthcare challenge for immigrants

Immigrants who are not U.S. citizens often lack healthcare coverage. A Kaiser Family Foundation/Los Angeles Times survey of immigrants conducted April 10-June 12 last year found that 50% of “likely undocumented immigrant” adults reported being uninsured, compared with 8% of U.S.-born citizen adults — and 72% of these immigrants reported having an annual household income of less than $40,000.e The survey also found that 38% of likely undocumented immigrants reported having no usual source of healthcare other than the emergency department, 37% had not had a physician visit in the past 12 months and 31% had skipped or postponed care in the past 12 months.

Lacking healthcare coverage, such immigrants often turn to public hospitals for medical care. According to New York City Health + Hospitals, which runs the city’s public hospitals and clinics, in 2023, medical centers across the city’s five boroughs received almost 30,000 visits from “undocumented migrants,” a quarter of which went to Bellevue Hospital alone.f

The situation in Denver, a city of 710,000, which received almost 40,000 “migrants” in 2023, is similar. Many of the migrants went to Denver Health, a public health system, for medical care. That “safety-net” institution has provided $10 million worth of uncompensated medical care to migrants, which has led it to request more financial assistance from both the state of Colorado and the federal government.g

Chicago, which received more than 19,600 “migrants” in 2023, has dedicated a county clinic to serve migrants who are housed in shelters. Meanwhile, accessing healthcare remains a challenge for others without a place to live. Recently, for example, healthcare access for over 3,300 migrants was limited to police stations and Chicago’s international airports, with service by a mishmash of volunteers, including student physicians, nurses and physician assistants.h

A policy failure

Who’s to blame for the nation’s current immigration challenge?

The federal government shoulders much of the blame because Congress has long failed to reform immigration laws. Legislative actions could have eased bottlenecks, such as application processing times for people looking to work and stay in the United States, and there has been inadequate funding for services that help migrants navigate the many bureaucratic hurdles that they face.

Consequently, many migrants are left in legal limbo for lengthy periods of time. As quoted in the Vox article, Iván Espinoza-Madrigal, the executive director of Lawyers for Civil Rights, a legal advocacy organization that has been assisting migrants in Boston, concluded, “We are seeing a complete lack of federal coordination and anemic federal support.”

In the absence of public policy progress at the federal level, cities and states have largely been left to fend for themselves, although their natural inclination is to ask for federal handouts, which have not been forthcoming. As a result, service levels have been highly uneven.

As with other complex social problems, two things are needed: the political will to act and better coordination across federal, state and local governments, as well as nonprofit organizations.

In the meantime, the nation’s 1,500 public hospitals, 300 essential hospitals and 1,400 federally qualified health centers must be extraordinarily resourceful in playing key, front-line roles in helping address the healthcare needs of immigrants. 


a. Weissert, W., et al., “More Americans think foreign policy should be a top US priority for 2024, an AP-NORC poll finds,” Jan. 1, 2024.
b. Hutzler, A., “Immigration emerges as key 2024 election wedge issue for Trump, vulnerability for Biden,” ABC News, Jan. 25, 2024.
c. Passel, J., et al., “What we know about unauthorized immigrants living in the U.S.,” Pew Research Center, Nov. 16, 2023.
d. Fayyad, A., “Cities have always been havens for immigrants. So why are they struggling now?” Vox, Feb. 8, 2024.
e. Kaiser Family Foundation, “Key facts on health coverage of immigrants,” Sept. 17, 2023.
f.  Ainsley, J., et al., “Inside a New York City hospital on the front lines of the migrant crisis,” NBC News, Oct. 3, 2023.
g. Ainsley, J., et al., “A city of 710,000 struggles to cope with 40,000 migrant arrivals,” NBC News, Jan. 27, 2024.
h. Tareen, S., “Volunteer medical students trying to fill health care gap for migrants in Chicago,” Associated Press, Nov. 2, 2023.


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