Since the 2016 presidential election, scholars have suggested that the Trump administration’s proposed immigration policies and rhetoric could exacerbate barriers to accessing social services and health care for vulnerable individuals in the United States [1,2,3,4]. A number of recent media reports highlight how anti-immigration policy rhetoric by the Trump administration has caused immigrants and their families to withdraw from participation in public assistance programs and to limit their interactions with public officials and health providers [5,6,7,8]. Hispanics, who make up approximately 18% of the population of the United States (nearly 59 million people) have faced a disproportionate share of these politically-driven barriers [9].
President Trump has emphasized immigration as a top priority through his rhetoric and his declaration of a national emergency to build a wall along the US-Mexico border. Additionally, news reports have emphasized proposed policy changes by the Trump administration to further restrict immigrant families (including lawfully-present non-citizens) from benefitting from a number of public programs including food subsidies and children’s health insurance [8, 10, 11]. This includes proposing that immigration officials consider immigrant use of government insurance and nutrition programs as a negative factor during legal residency applications [12,13,14,15,16].
These developments under the Trump administration may compound what scholars have recognized to be considerable barriers to health access for Hispanic populations in the United States. Even after the passage of the Affordable Care Act, which brought health coverage to 20 million Americans, a disproportionate share of Hispanics remain uninsured [17]. In 2016, Hispanics represented 33% of uninsured residents (and 18% of the total population) in the US while they made up much larger proportions of the uninsured in states like California (56%) and Texas (62%) with large Hispanic populations (39%) in each state [9, 18]. In both states, a large percentage of those born outside of the US arrive from Latin America, 50% in California and 69% in Texas, trends that have remained relatively consistent for decades [19].
The inequities and barriers found within the United States healthcare system are particularly problematic for immigrants. Permanent resident immigrants are only eligible for public health insurance programs like Medicaid and CHIP after five years in the United States, complicating health access for legal immigrants not covered by private, employer-sponsored insurance, which accounts for well over half of all insurance in the country [20,21,22]. Research has shown, including in examples in Canada and the United Kingdom, that barriers to health access are even more pronounced among undocumented immigrants and their children [23,24,25]. In the United States, undocumented immigrants are not eligible for any government run health insurance programs. Instead, they must rely on “a patchwork of Federally Qualified Health Centers, private charities, and hospital emergency departments” for needed health care services [26]. Notably, even as the resident children of undocumented immigrants are eligible for public health benefits through the Children’s Health Insurance Program, prior research demonstrates that these children have significantly fewer medical appointments and emergency room visits than the children of citizens, highlighting how the barriers faced by immigrant parents can affect their children [26]. While a lack of insurance presents an important barrier to accessing health care for Hispanic immigrants, prior research notes that access issues can be exacerbated by other barriers including the cost of care, transportation, the inability to take time away from work, child care, limited knowledge, language, gender, ethnicity, documentation status, and fear [27,28,29,30,31].
Recent perspectives from scholars studying Hispanic health suggests that these barriers could be intensifying under the Trump administration [1,2,3,4]. That said, to this point minimal empirical research has actually analyzed how access to health care services for immigrants has changed since President Trump’s election. This is particularly true for undocumented immigrants and their families who are expected to be most impacted by Trump’s policy efforts. Notably, research on undocumented immigrants and their families (mixed status families) can struggle to adequately capture the experiences of these families due to the difficulty of scholars gaining sufficient access to these vulnerable groups for analysis, especially in an era of growing distrust.
To overcome these challenges and provide timely evidence on how health access has changed for immigrants under the Trump administration, this empirical study relies on the experiences of Community Health Workers (CHWs) who work closely with immigrants and their families. As bridge figures who help to connect vulnerable populations with health and social services in a culturally appropriate manner, CHWs are uniquely positioned to provide critical insight into the challenges and barriers their clients face in accessing needed health care.
While CHWs have many different job titles and roles as health promotors, community health advocates, health navigators, and more, all CHWs are public health practitioners unified in their efforts to connect with the populations they serve, often through shared experience and cultural understanding [31,32,33,34,35,36]. Whether they work in the public, private, non-profit, or academic sectors, or just help as volunteers, their numbers are growing. In Texas, from 2008 to 2017, the number of certified CHWs grew to over 4000, a 600% increase over that time period, highlighting their growing influence in modern health care [37]. With Texas’ large Hispanic immigrant population, significant barriers to accessing needed care within that group, and the expanding role of CHWs as bridge figures in connecting marginalized individuals and families with services, this research provides important and timely insight into the changing nature of health access for a particularly vulnerable population in the Trump era.