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Immigration Enforcement and Health

Immigration Enforcement and Health thumbnail image of brief

Policy Brief
November 2024


Author: Caroline Kravitz, MPH

Introduction

Criminalizing immigration policy and local enforcement activities can impact health and wellbeing by discouraging participation in safety net programs, such as Medicaid and the Supplemental Nutrition Assistance Program (SNAP). This is because such enforcement can increase deportation risk for undocumented people. Therefore, program-eligible immigrants or US-born people living near immigrants may avoid enrollment because they fear sharing information with the government and calling attention to people in their homes and communities who could be deported. This can have downstream effects on health, particularly among Latine adults in metropolitan areas.

Immigration Enforcement May Have Far-Reaching Consequences on Health and Wellbeing

Immigration policies as well as enforcement activities by federal immigration authorities are designed to regulate immigration and citizenship in the U.S., but the consequences of these actions on the lives of immigrants and their family or community members are expansive. While immigration enforcement is generally conducted at the federal level, states, counties, and cities have adopted practices which assist or inhibit the federal government in these endeavors. For example, local law enforcement agencies can choose to comply with federal I-247 detainer requests which are sent from Immigration and Customs Enforcement (ICE) asking that a person who has been detained in a local facility and is suspected of being undocumented be detained for an extra 48 hours until ICE can take over custody of the person.

Our recent analysis of adults in large counties (i.e., population greater than 100,000) across the U.S. demonstrated that increasing issuance of detainer requests was associated with decreased enrollment in Medicaid and SNAP as well as changes in self-reported health status. Specifically, in 2019, U.S. adults in immigrant households living in a county with the highest level of detainer requests were less likely to be enrolled in Medicaid and SNAP compared to those living in counties with the lowest level of detainer requests despite being eligible for these programs.1 Additionally, a second analysis found that Latine adults living in a metropolitan area with the highest level of detainer requests had an increased likelihood of reporting fair or poor health, as opposed to good or excellent health, during the years 2017-2020.2 Given these consequences, local and state governments may see benefit in adopting policies that limit cooperation with federal immigration officials which can help people enroll in these needed benefits and protect against negative health consequences.

How Immigration Enforcement Can Impact Health and Wellbeing

Social safety net programs, such as Medicaid and SNAP, are generally unavailable to undocumented or recently immigrated individuals. However, family and community members of these ineligible individuals may be U.S. citizens and legal permanent residents who are eligible for these critical programs. Despite eligibility, enrollment rates, particularly among immigrants, remain low. In 2019, while approximately 50% of eligible US-born households were enrolled in SNAP, only about 46% of eligible immigrant households were enrolled.3 Similarly, in 2023, approximately 8% of US-born adults nationwide were uninsured whereas approximately 20% of lawfully present immigrant adults were uninsured.4 Criminalizing immigration policy and enforcement activities, as well as anti-immigrant rhetoric from politicians, can discourage participation in safety net programs because eligible immigrants may fear sharing information with the government and calling attention to people in their homes or communities who are at risk of deportation.5-8 This phenomenon, known as the ‘chilling effect’, can minimize someone’s likelihood of enrolling in public programs and can have more downstream effects on health. Programs such as SNAP and Medicaid provide a buffer against the health and social consequences of poverty so individuals may see their health status suffer absent these programs.9-13 Additionally, anti-immigrant policies or criminalizing activities that elevate deportation risk can increase stress for immigrants and their families, which can also impact one’s health.14,15

Research Sheds Light on the Potential Impact of Immigration Enforcement Policies and Activities

Our recent study provides support for the far-reaching consequences of immigration enforcement. This study by Kravitz et al. found that living in an area with increased issuance of I-247 detainer requests was associated with a decreased enrollment in both SNAP and Medicaid in the years 2011, 2016, and 2019.1 Specifically, on average in 2019, U.S. adults living in immigrant households who were eligible for Medicaid had a 50% likelihood of enrolling. Among these adults, living in an area with the highest level of detainer requests was associated with this likelihood of enrollment dropping to 46%.1 Additionally in 2019, adults in immigrant households had, on average, a 37% likelihood of being enrolled in SNAP but this fell to 29% in areas with the highest level of detainer requests.1 While detainer requests are just a request from ICE which local law enforcement may or may not comply with, increased issuance of detainers can still be impactful because it may indicate, in general, that more immigration enforcement is happening in that area. If enforcement activity increases, immigrants’ collective fear may also increase because of undocumented people’s heightened risk of being placed in ICE custody and being deported. Also, notably, it was found that people living in households exclusively composed of U.S.-born people also saw decreased enrollment.1

A second study by our team, led by Allie Eastus, MS, analyzed how detainer requests issued in metropolitan areas were associated with changes in self-reported health status, a more downstream health effect than safety net enrollment, among Latine adults in the U.S. from 2017-2020. Our study focused on Latines because this is the largest immigrant group in the U.S., which makes it a particularly important population regarding the impact of immigration enforcement.2 Our results demonstrated that increased detainer requests were associated with worsening health among Latine adults. Specifically, Latine adults in the U.S. during 2017-2020 had on average a 23% likelihood of reporting fair or poor health but this jumps to 28% among Latines living in a metropolitan area with the highest issuance of detainer requests, regardless of a person’s immigration status.2 These detainer requests can indicate increased immigration enforcement efforts in an area and heighten the fear and stress experienced by Latine adults.

Two other studies by our research group looked at immigration enforcement policies more broadly and found that these policies may have additional health and program enrollment consequences. A study by Chaparro et al. found that sanctuary policies, which protect immigrants from federal immigration authorities, and other policies which help immigrants integrate into U.S. society (i.e., immigrant-friendly policies) may be beneficial for Latine households. Specifically, we found that sanctuary counties in states with immigrant-friendly policies had a greater proportion of Latine households enrolled in SNAP compared with counties that do not have a sanctuary policy and which are located in unfriendly states.16 Finally, a study by Argibay et al. found that these types of immigration policies matter at a household-level, as well. In this study, we found that living in a sanctuary county and in a state with immigrant-friendly policies was associated with an increased likelihood of SNAP enrollment.17 Specifically, on average in 2019, a household that was home to at least one immigrant in the U.S. had a 26% likelihood of enrolling in SNAP but living in a sanctuary county in an immigrant-friendly state was associated with this likelihood increasing to 30%.17

Policy Implications

These recent studies, and the consistency of the findings across analyses, show how state and local immigration policies, as well as local enforcement activities, have direct and indirect implications for health among immigrants, their families, and their communities. These implications include enrollment in safety net programs as well as individual health status. States and localities can minimize the negative consequences of immigration policies and enforcement by

  • Implementing sanctuary policies,
  • Creating safeguards to protect personal information on public program enrollment forms,
  • Instituting policies which improve immigrants’ integration into state and local society, and
  • Increasing outreach to immigrant communities regarding safety net programs.

References

  1. Kravitz C, Auchincloss AH, Chaparro MP, Argibay S, Eastus A, Langellier BA. ICE Detainer Requests Were Associated With Lower Medicaid And SNAP Enrollment Among Eligible Adults, 2011–19: Article examines the association between ICE detainer requests and enrollment in Medicaid and SNAP among eligible adults. Health Affairs. 2024;43(9):1244-1253.
  2. Eastus A, Auchincloss AH, Pia Chaparro M, Argibay S, Kravitz C, Langellier BA. Detainer Requests Issued by ICE and Fair/Poor Self-Rated Health among Latines in the US, 2017–2020. Journal of Urban Health. 2024:1-5.
  3. Lacarte V, Hinkle L, Broberg BL. SNAP Access and Participation in U.S.-Born amd Immigrant Households: A Data Profile. 2023.
  4. Kaiser Family Foundation. Key Facts on Health Coverage of Immigrants. 2023. 
  5. Touw S, McCormack G, Himmelstein DU, Woolhandler S, Zallman L. Immigrant Essential Workers Likely Avoided Medicaid And SNAP Because Of A Change To The Public Charge Rule. Health Aff (Millwood). Jul 2021;40(7):1090-1098. doi:10.1377/hlthaff.2021.00059
  6. Vargas ED, Pirog MA. Mixed-Status Families and WIC Uptake: The Effects of Risk of Deporation on Program Use. Soc Sci Q. Sep 2016;97(3):555-572. doi:10.1111/ssqu.12286
  7. Cruz Nichols V, LeBrón AMW, Pedraza FI. Spillover Effects: Immigrant Policing and Government Skepticism in Matters of Health for Latinos. Public Administration Review. 2018;78(3):432-443. doi:https://doi.org/10.1111/puar.12916
  8. Cohen M, Schpero W. Household Immigration Status Had Differential Impact On Medicaid Enrollment In Expansion And Nonexpansion States. Health Affairs. 03/01 2018;37:394-402. doi:10.1377/hlthaff.2017.0978
  9. Pak T-Y, Kim G. Food stamps, food insecurity, and health outcomes among elderly Americans. Preventive Medicine. 2020/01/01/ 2020;130:105871. doi:https://doi.org/10.1016/j.ypmed.2019.105871
  10. Miller DP, Morrissey TW. SNAP participation and the health and health care utilisation of low-income adults and children. Public Health Nutrition. 2021;24(18):6543-6554. doi:10.1017/S1368980021003815
  11. Ettinger de Cuba SA, Bovell-Ammon AR, Cook JT, et al. SNAP, Young Children's Health, and Family Food Security and Healthcare Access. American Journal of Preventive Medicine. 2019/10/01/ 2019;57(4):525-532. doi:https://doi.org/10.1016/j.amepre.2019.04.027
  12. Tipirneni R, Kullgren JT, Ayanian JZ, et al. Changes in Health and Ability to Work Among Medicaid Expansion Enrollees: a Mixed Methods Study. Journal of General Internal Medicine. 2019/02/01 2019;34(2):272-280. doi:10.1007/s11606-018-4736-8
  13. Cawley J, Soni A, Simon K. Third Year of Survey Data Shows Continuing Benefits of Medicaid Expansions for Low-Income Childless Adults in the U.S. Journal of General Internal Medicine. 2018/09/01 2018;33(9):1495-1497. doi:10.1007/s11606-018-4537-0
  14. Friedman AS, Venkataramani AS. Chilling Effects: US Immigration Enforcement And Health Care Seeking Among Hispanic Adults: Study examines the effects of US immigration enforcement and health care seeking among Hispanic adults. Health Affairs. 2021;40(7):1056-1065.
  15. Vargas ED, Sanchez GR, Juárez M. Fear by association: perceptions of anti-immigrant policy and health outcomes. Journal of Health Politics, Policy and Law. 2017;42(3):459-483.
  16. Chaparro MP, Auchincloss AH, Argibay S, Ruggiero DA, Purtle J, Langellier BA. County- and state-level immigration policies are associated with Supplemental Nutrition Assistance Program (SNAP) participation among Latino households. Social Science & Medicine. 2023/09/01/ 2023;333:116141. doi:https://doi.org/10.1016/j.socscimed.2023.116141
  17. Argibay S, Auchincloss AH, Chaparro MP, Kravitz C, Eastus A, Langellier BA. Impact of county and state immigration policies on immigrant household enrollment in the supplemental nutrition assistance program. Journal of Migration and Health. 2024;9:100224.