Linking Immigration and Health

by Iyanrick John

As the child of immigrants from Pakistan and India, I am very aware of the challenges that immigrants face when they come to this country. When they first arrived in Maryland in the mid-60s, it was challenging for my parents to adapt to life in the U.S. At one point, my mother was working full-time and my dad was working three part-time jobs, all while they were both attending graduate school. Thankfully, my parents were eventually both able to get good jobs that included health insurance coverage before I entered the picture. I am grateful to have grown up without severe hardships, I knew many relatives and friends in our tight-knit community who experienced challenges finding jobs, obtaining decent housing, and accessing health care services.

I’ve felt incredibly privileged to be part of the Policy Team for the Asian & Pacific Islander American Health Forum, an organization that works to improve the health of Asian Americans, Native Hawaiians, and Pacific Islanders (AAs and NHPIs). Our work is two-fold; we serve as a connector with community-based health organizations across the country and also as a representative in Washington, D.C., that can amplify the voices of AAs and NHPIs at a national level. It is challenging, yet fulfilling, to be able to do this work on behalf of communities across the country like the close-knit Indian community I grew up in.

With the expansion of health care through the Affordable Care Act, we have focused much of our efforts on addressing the language and cultural barriers that AAs and NHPIs face when trying to enroll in health coverage. As a part of Action for Health Justice (AHJ), a coalition of over 70 community health centers and community based organizations, we helped provided outreach, education, and enrollment assistance services to almost 850,000 AAs and NHPIs in 22 states to help them enroll in health insurance coverage through Medicaid and the Health Insurance Marketplaces.

In looking forward to the third open enrollment, we have been able to identify both best practices and the biggest challenges with outreach. It comes as no surprise that one of main barriers to health coverage for many is immigration status. Many AAPI families have mixed status and fear that enrolling one person in health coverage will jeopardize the immigration status of another family member. While this is not possible, this situation draws up deep emotions that prevent many families from enrolling in health coverage.

It’s the same fears and feelings of shame and guilt that pose barriers for young AAs and NHPIs who try to apply for Deferred Action for Childhood Arrivals (DACA). While many eligible young people have applied for the program, application rates have been lower for Asian and Pacific Islander countries. For example, young people from Korea, Philippines, China, and India apply at significantly lower rates than other countries even though they have large populations of eligible people.

Using the lessons learned from AHJ’s health enrollment outreach, we published a report applying best practices to increase AAPI applications for DACA. The report looks at barriers that AAPIs face when applying for the program and discusses how strategies used to increase health enrollment are applicable toward language and cultural barriers. For example, community interviews made clear that having an undocumented family member creates feelings of shame and guilt, as if they were “lawbreakers” in the community. This makes applying DACA tricky for young family members because some young people did not know they had an undocumented parent or because the family will fear negative repercussions from the application. Using best practices from health enrollment, AHJ recommends that community organizations work together to engage AAPI communities and provide one-on-one assistance to assuage fears and concerns.

Organizations and coalitions like AHJ are doing invaluable work all over the country to connect communities to the help they need, whether it be health insurance or applying for DACA. As immigration status continues to be a barrier to hea