Introduction
The novel coronavirus has led to a global health and economic crisis that has shaken nations, urging policymakers to develop solutions to mitigate the pandemic’s impact. The United States has passed several economic relief bills including the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Families First Coronavirus Response Act (FFCRA), to “lessen the coronavirus pandemic’s human and economic toll.”1 Unfortunately, these bills leave out entire segments of our country’s population, including undocumented immigrants, and do not fully address the barriers immigrant communities face in obtaining health care. Access to health care is critical during a pandemic to mitigate the impact of the virus and to slow the spread of the disease.
Undocumented immigrants comprise a significant proportion of U.S. residents. The Pew Research Center estimates there are 10.5 million undocumented immigrants in our nation, with many residing in the United States for an average of at least 15 years,2 all the while making significant contributions to the U.S. economy. Moreover, during the Covid-19 pandemic, undocumented workers are in jobs deemed essential, from farmworkers ensuring the flow of the national food supply chain to the 280,000 undocumented immigrants working in health care—including 62,600 who are DACA-eligible.2,3 As the U.S. faces a deep recession, undocumented immigrants are also among the millions of people who have lost their jobs, and yet they do not qualify for unemployment benefits due to their unauthorized status. Without economic relief, undocumented immigrants and their families are at great risk, especially since they tend to have lower incomes, larger households, and no public health insurance.4 This also includes U.S.-born children with either one or both parents who are undocumented, as these mixed-status families do not qualify to receive economic relief through the CARES Act.5
Aside from not being able to receive economic relief, undocumented immigrants continue to live in fear. Prior to the spread of Covid-19, immigration laws and policies were passed that forced undocumented immigrants to live in the shadows. The fears of being detained, deported, or being seen as a “public charge” have not been appeased. As the country reopens, it is imperative that undocumented immigrants be included in public health protections and decisions. Now, more than ever, it is crucial to ensure that every resident, regardless of legal status, has access to testing and treatment for Covid-19 and basic neccessitites such as clothes, food, water, and shelter.
This report provides an overview of health inequities and health care access for undocumented immigrants in the United States. It explores the serious health barriers and vulnerabilities further exposed by the coronavirus pandemic, reveals the gaps in the Covid-19 relief bills, examines the obstacles faced by undocumented immigrants attempting to access and utilize health care services, and considers the implications for immigrant children. It also argues for immigrant-inclusive policies to ensure the collective health and safety of all who reside in the United States.
Covid-19 Relief Bills and Undocumented Immigrants
The CARES Act, signed into law by President Trump on March 27th, 2020, provided a one-time economic impact payment to many American households.6 Several groups, however, were excluded from economic payments, including undocumented immigrants. To receive a stimulus payment, the CARES Act required that the recipient be a taxpayer with a valid social security number. Although undocumented immigrants do not have social security numbers, many pay taxes through the use of an Individual Taxpayer Identification Number, a tax processing number issued by the Internal Revenue Service. According to The Institute of Taxation and Economic Policy, undocumented immigrants pay an estimated $11.64 billion in state and local taxes each year.7 Despite their contributions to the American economy, they and their U.S.- born children were excluded from receiving economic relief through the CARES Act. As a result, a federal lawsuit was filed, arguing that children of undocumented immigrants were unfairly excluded from the CARES Act, but the outcome is still unknown.8
There are varying estimates on the exact number of undocumented immigrants that lack health insurance, as there is no official number on the size of the undocumented population residing in the United States. However, the Kaiser Family Foundation estimates around 45% of undocumented immigrants are uninsured, while the Migration Policy Institute estimates approximately 53% are uninsured, making this population particularly vulnerable in the midst of a pandemic.9 The CARES Act and the FFCRA included provisions that facilitated health care access for undocumented immigrants, but they still fell short of providing relief. For example, the CARES Act expanded the availability of free testing, but did nothing to reduce the cost of treatment for Covid-19.10 The FFCRA also did not change Medicaid eligibility requirements, meaning that undocumented immigrants are still excluded from accessing such coverage. Although undocumented immigrants are not eligible for Medicaid, states do have discretion to utilize emergency Medicaid funds to cover both testing and treatment for Covid- 19 for uninsured patients, regardless of legal status.11 With limited options for accessing primary and preventative care, community health centers (CHCs) play a vital role in providing comprehensive health care to uninsured populations, such as undocumented immigrants. Through the CARES Act, the Health Resources and Services Administration awarded $1.3 billion to CHCs for FY 2020.12 Although funding has increased, CHCs are reporting low numbers of undocumented patients seeking care, as fears of deportation still loom.13
As the country is reopening, some states have experienced an increase in positive cases and have enacted measures to ensure that all residents have access to testing, treatment, and in some cases economic relief. California, one of six states with the largest undocumented population,14 was the first state to provide disaster relief assistance funding for undocumented immigrants—$75 million in cash assistance with another $50 million committed by philanthropic partners.15 Other states like Connecticut have a smaller undocumented population, but have provided $1 million in financial assistance to undocumented immigrants and their families.16 Undocumented immigrants make up to nearly 5% of working Connecticut residents, which translates to more than $100 million in state and local taxes. Yet, their legal status prohibits their eligibility for federal assistance.17 Other states, cities, communities, and organizations in the U.S. have rushed to fill the gaps to provide some type of support to undocumented immigrants.18 Even so, undocumented immigrants still face unique challenges due to their immigration status. These challenges are being exacerbated by the coronavirus pandemic, especially in regards to health care access.
Health Access and Utilization
Health inequities in the United States are one of the contributing factors that have led to high costs of health care spending and a declining life expectancy for all Americans.19 The Affordable Care Act (ACA) was intended to provide coverage to those who are uninsured and to “close the gap.” Unfortunately, that coverage did not extend to undocumented immigrants, a segment of the United States population that faces limited health insurance coverage along with barriers to accessing quality health care. There are many predictors of access and utilization among undocumented individuals—including an individual’s gender, marital status, level of educational attainment, employment and poverty status, length of residency in the United States, deportation fears, the availability of a safety net, and unfamiliarity with the U.S. health care system20—that make this population more vulnerable in general, but even more so during the pandemic.21 Moreover, undocumented immigrants do not qualify for Medicare or Social Security benefits, leaving them with limited options for health coverage.22 Some may be able to afford private health insurance, but many depend on local and state community providers, including community health centers, nonprofit organizations, charity hospitals, and public hospitals and clinics—providers that, even before the pandemic, struggled with limited resources and funding.23
The pandemic highlights the vulnerabilities and barriers to health care undocumented immigrants experience when residing in the United States. These barriers complicate treatment and services during a global pandemic, and due to the rising number of cases, particularly as states reopen, immediate public health intervention is necessary to control the spread and to protect the most vulnerable and marginalized communities.24 These barriers also demonstrate the need for action to address the health inequities that exist in the United States.
Additionally, more attention may be required for the aging, longer-term unauthorized resident population, since nearly 12% of the undocumented population is now over 55. This is a worrisome statistic, as older adults have different health care needs, and those who have underlying medical conditions are at a higher risk for developing more serious complications from Covid-19.25 This is a significant portion of our population that must be addressed to successfully combat Covid-19. Failure to support undocumented immigrants and their families could slow the successful containment of Covid-19 and add to an already weak health system.
Limitations of Public Health Containment Measures
The containment of the coronavirus is critical to mitigate the impact of Covid-19 on residents in the United States. Public health officials are attempting to keep hospitals from reaching capacity by urging people who feel ill to call their doctor before seeking in-person care or visiting the emergency room.26 However, for undocumented immigrants, many of whom do not have access to health care or a primary care physician, this is not an option.
Moreover, once care is sought, language and cultural barriers may impede immigrants from receiving quality care. For instance, health care providers are struggling to provide adequate language translation and are currently reporting a shortage of bilingual staff to meet the needs of patients that have limited English proficiency.27 Undocumented immigrants must rely on translation services delivered via telephone, a service that is not always easy to find, and at times of poor quality.28 When patients are not provided with care in a language of their understanding, they are likely to misunderstand discharge instructions, less likely to seek follow-up treatment, and in some cases may be misdiagnosed.29 This leaves undocumented immigrants without a choice but to treat symptoms at home or to wait until symptoms worsen, likely resulting in a visit to the emergency room. Immigrants disproportionately depend on emergency room departments for care, but may also be afraid to seek the care they need due to fears regarding their immigration status.30 The current immigration environment in the United States impacts the utilization of care among undocumented immigrants and jeopardizes the public health and safety of all people and communities.
Unfortunately, current policies and practices are further hindering public health efforts to contain Covid-19. The Trump administration has continued raids, detentions, and deportations of undocumented immigrants, which increases the hesitancy among this population to seek testing and treatment.31 Further, cases of infection among deportees and in U.S. detention centers have also been reported. Even before Covid-19, inspections exposed the unsafe conditions of detention centers, with a 2019 report by the Department of Homeland Security’s (DHS) Office of Inspector General raising concerns over “dangerous overcrowding,” and stating that combined with prolonged detention, the conditions represent an “immediate risk to the health and safety not just of the detainees, but also to DHS agents and officers.”32 Unsurprisingly, the unhygienic and overcrowded conditions found in detention centers have contributed to coronavirus outbreaks, and a failure to detect Covid-19 in multiple cases.33 According to statistics from the U.S. Immigration and Customs Enforcement (ICE), as of May 30, 2020, the number of detained individuals in ICE custody was 25,421, with 838 of those individuals testing postive for Covid-19.34
Immigration advocates have been pushing for the release of at-risk detainees, especially elderly individuals and those with pre-existing conditions who are currently in ICE custody. In response to lawsuits and pressure from advocates, in March, ICE evaluated its detained population to determine if continued detention was appropriate for individuals facing a higher risk of complications related to Covid-19. ICE has since released over 900 individuals “after evaluating their immigration history, criminal record, potential threat to public safety, flight risk, and national security concerns.”35 Furthermore, as of June 5, 2020, 429 individuals have been released on judicial orders. ICE reports “actively litigating many of these court decisions,” and has published the criminal charges or convictions of these released individuals on their website.36
Aside from holding individuals at detention centers where there have been Covid-19 outbreaks, the Trump administration has also continued with deportations. This is happening despite the fact that the U.S. is among the countries with the highest number of Covid-19 cases worldwide.37 Some deportees have tested positive for Covid-19 after returning to their home countries.38 Deportation flights from the United States are often to some of the most vulnerable countries—including Guatemala, El Salvador, Honduras, Haiti, and other countries in Latin America and the Caribbean region—that are ill-equipped to handle a pandemic and to provide health care, housing, and support to deportees who might be infected.39 Other factors that are likely to affect recent deportees to these countries include poverty, crime, conflict, under-resourced health systems, economic instability, rampant corruption, and organized crime and gang activity.40 All this leaves deportees truly unprepared and unprotected—in limbo and at times stranded in other countries—dealing with lockdowns, curfews, travel restrictions, severe food insecurity, and the inability to work or access social safety nets.41 Such rushed deportations by the United States are ultimately putting lives at risk.
Implications for Children of Undocumented Immigrants
It is estimated that the U.S. has more than 16.7 million people who live in mixed-status households (families composed of a mix of citizens, legal immigrants, and undocumented immigrants).42 The Migration Policy Institute states that there are nearly 5.1 million minors in the U.S. with at least one unauthorized immigrant parent, with 4.1 million of them being U.S. citizens (known as citizen children).43 Research has shown that children of undocumented immigrants, even if not undocumented themselves, may still experience negative health consequences, such as trauma, anxiety, fear, and other stressors related to their family’s immigration status, as they deal with the possibility that a family member could be arrested, detained, or deported.44 This leaves these children just as vulnerable and unprotected as their parents, in a sort of “multigenerational punishment,” where they are penalized by the same policies and laws that limit access to resources and opportunities for their parents.45
While U.S. citizen children are eligible for public benefits, some undocumented parents have chosen not to enroll their children in programs that would otherwise protect their child’s well-being and health. This is largely due to fears of the “public charge” rule that has led undocumented parents with citizen children to opt out of Medicaid and the Children’s Health Insurance Program.46 The U.S. Citizenship and Immigration Services (USCIS) defines a “public charge” as a person that is or is likely to become “primarily dependent on the government for subsistence, as demonstrated by either the receipt of public cash assistance for income maintenance or institutionalization for long-term care at government expense.”47 Immigrants applying for permanent residence can be considered “inadmissible” if they are likely to become a public charge. Amid the confusion, misinformation, and fear instilled in immigrant communities, the public charge rule has been argued to be counterproductive to the health and safety of all U.S. residents during the coronavirus pandemic. The public charge rule is already causing individuals to forego the health care and services they may need.48 Therefore, the U.S. Citizenship and Immigration Services (USCIS) clarified in mid-March that the public charge rule would not negatively affect a person in future public charge analysis:
It will neither consider testing, treatment, nor preventative care (including vaccines, if a vaccine becomes available) related to COVID-19 as part of a public charge inadmissibility determination, nor as related to the public benefit condition applicable to certain nonimmigrants seeking an extension of stay or change of status, even if such treatment is provided or paid for by one or more public benefits, as defined in the rule (e.g. federally funded Medicaid).”49
While it is important to note that undocumented immigrants are not eligible for most of the benefits covered by the public charge rule, they would be subject to the public charge rule in the future if they applied for lawful permanent resident status, or if a family member who is a U.S. citizen petitions on their behalf.50
Table 1 — Uninsured Rate Among Children in the U.S. (2018)
Another important issue that may impact a child’s overall health is lack of health insurance coverage. Using the 2018 American Community Survey, the Kaiser Family Foundation estimated that 8% of citizen children with a noncitizen parent and 33% of undocumented immigrant children are uninsured (See Table 1).51 Just like their parents, U.S.-born children and undocumented immigrant children also experience significant barriers to health care and utilization, and undocumented parents may likely be fearful to seek testing or care for Covid-19 for their children as well.
Citizen children are also excluded from the U.S. federal coronavirus relief package, a move many immigration advocates consider unfair, and a federal class-action lawsuit has since been filed.52 In addition, parents that are undocumented with citizen children are opting out of or not renewing their nutritional food benefits like the Supplemental Nutrition Assistance Program.53 As a result, a number of children are at increased risk of food insecurity. School closures due to Covid-19 have further shown the need for food assistance. Schools provide “up to two-thirds of children’s daily nutritional needs.” To fulfill their children’s nutritional needs, undocumented parents are likely faced with choices about rationing food or not meeting rent or utility payments, which in turn could lead to housing insecurity.54 If undocumented families are forced to look for other arrangements like moving in with family members or moving to a shelter, this could increase their risk of exposure to Covid-19, as social distancing would be difficult to practice.55 In the case of families that aren’t able to pay their utility bills, this could lead to an interruption of basic amenities, such as water service, and increase their risk of exposure by making it difficult to follow health recommendations like hand washing and cleaning surfaces in the home.56
Ultimately there are many risk factors that may impact undocumented immigrants and their children as they experience a multitude of disadvantages and barriers that directly impact their access to quality and affordable health care—including both physical health and mental health services—and that negatively impact their long-term outcomes in health, educational attainment, economic stability, and more.57
Conclusion
Undocumented immigrants are among the millions of individuals who have lost their jobs due to the coronavirus-induced economic crisis. It is imperative to address health inequities, barriers, and challenges for undocumented immigrants and their families during this trying time. Future stimulus bills must ensure that all U.S. residents, regardless of legal status, have access to treatment and economic relief. Although states have discretion to use Medicaid funds as they see fit and while some states have already provided economic relief to their undocumented populations, this kind of aid isn’t available for the majority of the unauthorized residents in the U.S. Ignoring a segment of our population that has proven to be essential in times of crisis and comprises a significant portion of our workforce will only further the spread of the virus and negatively impact the economy.58 Lastly, in order to appease fears of deportation, eliminate confusion, and encourage undocumented immigrants to seek testing and treatment, Congress should suspend the public charge rule during the Covid-19 crisis.59 It is important to build trust with immigrant communities, so that they are not fearful of accessing care and treatment for themselves and their children. Unauthorized immigrants pay taxes, live, work, study, and contribute to American society, and therefore, Covid-19 relief policies should be inclusive of this most vulnerable population, for the safety and health of all those who reside in the United States.
Endnotes
1. Jacob Pramuk, “Here’s what’s in the $2 trillion coronavirus stimulus bill,” CNBC, March 25, 2020, https://cnb.cx/2CDBDVV.
2.Jeffrey S. Passel and D’Vera Cohn, “Mexicans decline to less than half the U.S. unauthorized immigrant population for the first time,” Pew Research Center, June 12, 2019, https://pewrsr.ch/2B5gB1Z.
3. New American Economy, “Immigration and Covid-19,” Launched on March 26, 2020, accessed on June 10, 2020, https://bit.ly/2Nu2qpC.
4. Genevieve Douglas, “Coronavirus Stimulus Cash Likely to Miss Some Immigrant Groups,” Bloomberg Law, May 1, 2020, https://bit.ly/37WlOVS.
5. Sarah B. Horton, “Citizen Children Left Out of Coronavirus Relief Efforts Deserve a Lifeline,” The American Prospect, May 7, 2020, https://bit.ly/3eqnbyu.
6. U.S. Department of the Treasury, “The CARES Act Provides Assistance to Workers and their Families,” accessed on June 11, 2020, https://bit.ly/2Z2dvUA.
7. The Institute of Taxation and Economic Policy, “Undocumented Immigrants’ State & Local Tax Contributions,” February 2016, https://bit.ly/3hW51Xy.
8. Marisa Peñaloza, “Lawsuit Alleges CARES Act Excludes U.S. Citizen Children Of Undocumented Immigrants.” NPR, 5 May 2020, https://n.pr/2NsYhSV.
9. KFF (Kaiser Family Foundation), “Health Coverage of Immigrants,” March 18, 2020, https://bit.ly/2NsYohj; MPI (Migration Policy Institute), “Profile of the Unauthorized Population: United States,” accessed May 27, 2020, https://bit.ly/31aRpBJ.
10. NILC (National Immigration Law Center), “Understanding the Impact of Key Provisions of COVID-19 Relief Bills on Immigrant Communities,” April 1, 2020, https://bit.ly/2B6Ih6v.
11. Ibid.
12. HHS (U.S. Department of Health and Human Services), “HHS Awards $1.3 Billion to Health Centers in Historic U.S. Response to COVID-19,” April 8, 2020, https://bit.ly/2NsK9JE.
13. Marisa Peñaloza, “Community Health Centers Struggling As Fewer People Seek Care During Pandemic,” NPR, May 19, 2020, https://n.pr/2CCkXOC.
14. Pew Research Center, “U.S. unauthorized immigrant population estimates by state, 2016,” February 5, 2019, https://pewrsr.ch/2BCzUiW.
15. “Governor Newsom Announces New Initiatives to Support California Workers Impacted by COVID-19,” Office of Governor Gavin Newsom, April 15, 2020, https://bit.ly/2CuGfxo.
16. Mark Pazniokas, “Connecticut provides coronavirus assistance for undocumented,” The Connecticut Mirror, June 3, 2020, https://bit.ly/3i7GpLI.
17. Ibid.
18. NILC, “Shared Crisis, Shared Solution,” April 2020, https://bit.ly/2Z39H5n.
19. The American Public Health Association, “Why Do We Need the Affordable Care Act?” 2017, https://bit.ly/3ewBPnQ.
20. Karen Hacker, Maria Anies, Barbara L. Folb, and Leah Zallman, “Barriers to health care for undocumented immigrants: a literature review,” Risk Management and Healthcare Policy 8 (October 30, 2015): 175- 183, https://bit.ly/2A0GdN5.
21. Alexander N. Ortega, Hector P. Rodríguez, Arturo Vargas Bustamante, “Policy Dilemmas in Latino Health Care and Implementation of the Affordable Care Act,” Annual Review of Public Health 36 (2015): 525-544, https://bit.ly/3euvGZj.
22. Teresa Wiltz, “Aging, Undocumented and Uninsured Immigrants Challenge Cities and States,” Pew Charitable Trusts, January 3, 2018, https://bit.ly/2VbR6mk.
23. Randy Capps and Julia Gelatt, “Barriers to COVID-19 Testing and Treatment Immigrants without Health Insurance Coverage in the United States,” Migration Policy Institute, May 2020, https://bit. ly/3fWV8au; Will Stone, “Under Financial Strain, Community Health Centers Ramp Up Coronavirus Response,” Kaiser Health News, March 27, 2020, https://bit.ly/3fWVgXw; Isabella Isaacs-Thomas, “How health care inequity could make the COVID-19 crisis worse,” PBS, March 13, 2020, https://to.pbs. org/3hZjBNW; Leighton Ku and Mariellen Jewers, “Health Care for Immigrant Families: Current Policies and Issues,” Migration Policy Institute, June 2013, https://bit.ly/2BDQAGN.
24. Joseph T. Wu, Kathy Leung, and Gabriel M. Leung, “Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study,” The Lancet 395, no. 10225, (February 29–March 6, 2020): 689-697, https://bit.ly/3dopUqY.
25. Wiltz, “Aging, Undocumented and Uninsured Immigrants;” MPI, “Profile of the Unauthorized Population;” CDC (Centers for Disease Control and Prevention), “Older Adults,” accessed April 30, 2020, https:// bit.ly/2Z7wSeD.
26. Kathleen R. Page, Maya Venkataramani, Chris Beyrer, and Sarah Polk, “Undocumented U.S. Immigrants and Covid-19,” New England Journal of Medicine 382, May 21, 2020, https://bit.ly/2YrIR7P.
27. Carlina Rivera, “Needed: More bilingual health-care providers,” New York Daily News, April 22, 2020, https://bit.ly/2Nn10NM.
28. Joseph Darius Jaafari, “Immigration Courts Getting Lost in Translation,” The Marshall Project, March 20, 2019, https://bit.ly/31cauDz.
29. Ka Ming Ngai, Corita R. Grudzen, Roy Lee, Vicky Y. Tong, Lynne D. Richardson, and Alicia Fernandez, “The Association between Limited English Proficiency and Unplanned Emergency Department Revisit within 72 hours,” Annals of Emergency Medicine 68, no. 2 (August 2016): 213–221, https://bit.ly/3hXNNZX.
30. Shamsher Samra, Breena R. Taira, Erika Pinheiro, Rebecca Trotzky-Sirr, and Todd Schneberk, “Undocumented Patients in the Emergency Department: Challenges and Opportunities,” Western Journal of Emergency Medicine 20, no. 5 (August 12, 2019): 791-798, https://bit.ly/2CuJeG6.
31. Caitlin Dickerson and Kirk Semple, “U.S. Deported Thousands Amid Covid-19 Outbreak. Some Proved to Be Sick,” New York Times, April 18, 2020, https://nyti.ms/2BvWNol.
32. U.S. Department of Homeland Security’s Office of Inspector General, “Management Alert – DHS Needs to Address Dangerous Overcrowding and Prolonged Detention of Children and Adults in the Rio Grande Valley,” July 2, 2019, https://bit.ly/3fScq8l; U.S. Department of Homeland Security’s Office of Inspector General, “Management Alert - DHS Needs to Address Dangerous Overcrowding Among Single Adults at El Paso Del Norte Processing Center,” May 30, 2019, 6, https://bit.ly/3dv9PzF.
33. Gaby del Valle and Jack Herrera, “‘Like Petri Dishes for the Virus’: ICE Detention Centers Threaten the Rural South,” Politico, May 5, 2020, https://politi.co/2Ve7rY2; Richard J. Durbin, et al., “Letter to Secretary of State Mike Pompeo and Department of Homeland Security Acting Secretary Chad Wolf,” May 2, 2020, accessed June 9, 2020, https://bit.ly/2NwIiTP.
34. Cases currently in custody and reported as “currently under isolation or monitoring” include detainees who tested positive for Covid-19 and are currently in ICE custody under isolation or monitoring. This number excludes detainees who previously tested positive for Covid-19 and were either returned to the general population after a discontinuation of medical monitoring/ isolation or are no longer in ICE custody. There have been 5,096 detainees tested as of June 5, 2020. See ICE (U.S. Immigrations and Customs Enforcement), “Ice Detainee Statistics,” accessed June 8, 2020, https://bit.ly/3hQPV5A.
35. ICE, “ICE Guidance on COVID- 19,” accessed June 9, 2020, https://bit.ly/3hQPV5A.
36. ICE, “Judicial Releases,” accessed June 9, 2020, https://bit.ly/3hQPV5A; Andrea Castillo, “Thousands of immigrants are stuck in ICE centers. Getting out depends on the judge,” Los Angeles Times, June 1, 2020, https://lat.ms/2YviHkQ.
37. “Coronavirus Map: Tracking the Global Outbreak,” The New York Times, accessed on June 9, 2020, https://nyti.ms/2Z4vJoj.
38. Caitlin Dickerson and Kirk Semple, “U.S. Deported Thousands Amid Covid-19 Outbreak. Some Proved to Be Sick,” The New York Times, April 18, 2020, https://nyti.ms/2BvWNol.
39. Human Rights Watch, “US: Suspend Deportations During Pandemic,” June 4, 2020, https://bit.ly/3hZnvX6; Kevin Sieff and Nick Miroff, “U.S. is deporting infected migrants back to vulnerable countries,” The Washington Post, April 21, 2020, https:// wapo.st/3duc32g; Congressional Hispanic Caucus, “Letter on Deportation Spreading COVID-19,” May 20, 2020, accessed on June 10, 2020, https://bit.ly/381mwBo; Richard J. Durbin, et al., “Letter to Secretary of State Mike Pompeo and Department of Homeland Security Acting Secretary Chad Wolf.”
40. International Crisis Group, “Deportation and disease: Central America’s COVID-19 dilemmas,” ReliefWeb, April 28, 2020, https://bit.ly/383YYvx; WOLA (Washington Office on Latin America), “U.S. Deportations During Global Pandemic Risk Spreading COVID-19,” April 9, 2020, https://bit.ly/2NpyM53.
41. World Bank Group, “COVID-19 Crisis Through a Migration Lens,” April 2020, https://bit.ly/3eqoSfn; WOLA, “U.S. Deportations During Global Pandemic.”
42. American Immigration Council, “U.S. Citizen Children Impacted by Immigration Enforcement,” November 22, 2019, https:// bit.ly/2Bz2yl9; Randy Capps, Michael Fix, and Jie Zong, “A Profile of U.S. Children with Unauthorized Immigrant Parents,” Migration Policy Institute, January 2016, https://bit.ly/2NoVdHo.
43. Capps, Fix, and Zong, “A Profile of U.S. Children with Unauthorized Immigrant Parents.”
44. Shawn S. Sidhu and Suzan J. Song, “Growing Up With an Undocumented Parent in America: Psychosocial Adversity in Domestically Residing Immigrant Children,” Journal of the American Academy of Child & Adolescent Psychiatry 58, no. 10 (October 2019): 933-935, https://bit.ly/3fRr1RB; Alissa Bey and Marsha Norton, “The role of parental citizenship status on depression of U.S. citizen children,” Journal of Prevention & Intervention in the Community, August 2019, https://bit.ly/2Z3DScL; Luis H. Zayas, Sergio Aguilar-Gaxiola, Hyunwoo Yoon, and Guillermina Natera Rey, “The Distress of Citizen-Children with Detained and Deported Parents,” Journal of Child and Family Studies 24 (2015): 3213–3223, https://bit.ly/2VbXpGw.
45. Laura Enriquez, “Multigenerational Punishment: Shared Experiences of Undocumented Immigration Status Within Mixed-Status Families,” Journal of Marriage and Family 77, no. 4 (2015): 939-953, https://bit.ly/2CzCpmJ.
46. Sara Rosenbaum, “The New “Public Charge” Rule Affecting Immigrants Has Major Implications for Medicaid and Entire Communities,” The Commonwealth Fund (blog), August 15, 2019, https://bit.ly/2Z5BgLh.
47. USCIS (U.S. Citizenship and Immigration Services), “Public Charge Fact Sheet,” May 3, 2011, https://bit.ly/3fX1GWC.
48. Hamutal Bernstein, Dulce Gonzalez, Michael Karpman, and Stephen Zuckerman, “Amid Confusion over the Public Charge Rule, Immigrant Families Continued Avoiding Public Benefits in 2019,” Urban Institute, May 18, 2020, https://urbn.is/3ewIq1A; “Letter to Acting Secretary Chad Wolf and Senior Official Kenneth T. Cuccinelli,” March 20, 2020, accessed June 10, 2020, https://bit.ly/31cfTul; 43 Congressional Members Letters to Mike Pence, March 10, 2020, accessed on June 10, 2020, https://bit.ly/37VqQlo; Miriam Jordan, “‘We’re Petrified’: Immigrants Afraid to Seek Medical Care for Coronavirus,” The New York Times, March 18, 2020, https://nyti.ms/2Nn6HLE; Office of Attorney General Xavier Becerra, “Broad Coalition of Healthcare Providers, Historians, Policy Leaders, Legal Experts, Members of Congress, and More Join Effort to Fight Harmful Public Charge Rule,” January 24, 2020, https://bit.ly/3dvsBHp.
49. USCIS, “Public Charge,” accessed on June 10, 2020, https://bit.ly/2B5rYHg; AILA (American Immigration Lawyers Association), “USCIS Clarified Public Charge Rules Do Not Restrict Access to Testing, Screening, or Treatment of Communicable Diseases,” AILA Doc. No. 20031491, March 13, 2020, https://bit.ly/3euRCnp.
50. Immigrant Legal Resource Center, “Public Charge: What the Community Needs to Know About Public Charge,” February 2020, 2, https://bit.ly/37XkNN9.
51. KFF, “Health Coverage of Immigrants.”
52. Peñaloza, “Lawsuit Alleges CARES Act Excludes U.S. Citizen Children.”
53. Joey Peters, “Fearing Retaliation, Some Immigrants Stay Away From Public Aid” Sahan Journal, December 9, 2019, https://bit.ly/2NDmA0R.
54. Caroline G. Dunn, “Feeding Low-Income Children during the COVID-19 Pandemic,” The New England Journal of Medicine 382, April 30, 2020, https://bit.ly/2B8n7VD.
55. Medha Makhlouf and Jasmine Sandhu, “Immigrants and Interdependence: How the COVID-19 Pandemic Exposes the Folly of the New Public Charge Rule,” 115 Northwestern University Law Review Online, (May 2, 2020), https://bit.ly/2BAYxg2.
56. Ibid.
57. Capps, Fix, and Zong, “A Profile of U.S. Children with Unauthorized Immigrant Parents;” Hacker, Anies, Folb, and Zallman, “Barriers to health care for undocumented immigrants;” American Immigration Council, “U.S. Citizen Children Impacted by Immigration Enforcement;” Jennifer Van Hook, Nancy Landale, and Marianne Hillemeier, “Is the United States Bad for Children’s Health? Risk and Resilience among Young Children of Immigrants,” Migration Policy Institute, July 2013, https://bit.ly/2NoCnAb; Randy Capps, Michael Fix, Jason Ost, Jane Reardon-Anderson, and Jeffrey S. Passel, “The Health and Well-Being of Young Children of Immigrants,” Washington DC: Urban Institute, 2004, https://urbn. is/2VgkM1N. This report does not go into more detail on child health and spillover impacts on education, but it is an issue that merits more research and attention even more so during the coronavirus pandemic. Children with undocumented parents face new challenges as their schools transition to online teaching. These children are already more likely to have lower levels of English proficiency and to live in poverty, and therefore they are less likely to have access to a computer. (See Janie T. Carnock, “Growing Up with Undocumented Parents: The Challenges Children Face,” New America (blog), February 1, 2016, https://bit.ly/2B8ofZn). While some schools are working to ensure that their students have access to a computer, many students are still left without access to the internet (See Tanya Basu, “The children left behind by America’s online schooling,” MIT Technology Review, May 13, 2020, https://bit.ly/2YuWTWd). This means that these students will fall behind and will experience difficulty in catching up to their peers who do have access to the technology needed to complete their coursework. For students who do have access to a computer and the internet, they may have siblings who they have to share the computer with, making it nearly impossible to complete assignments and have constant communication with their teachers. The transition to online teaching will also be a difficult transition for parents who might not be familiar with platforms like Zoom or who have limited English proficiency. (See Rikha Sharma Rani, “Imagine Online School in a Language You Don’t Understand,” New York Times, April 22, 2020, https://nyti.ms/2Nt9bYR). These parents will find it difficult to support their children’s learning and will be unable to prevent their children from falling behind.
58. Holly Straut-Eppsteiner, “To Ensure Collective Health and Safety, Federal Packages for COVID-19 Relief Must Include Immigrant Communities,” The Torch, National Immigration Law Center, April 21, 2020, https://bit.ly/37UsDHA.
59. Ryan Zamarripa, “A Phase 4 Coronavirus Relief Bill Must Include Protections for Undocumented Immigrants,” Center for American Progress, April 16, 2020, https://ampr.gs/2CDD5Yr.
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