Challenges for Adult Undocumented Immigrants in Accessing Primary Care: A Qualitative Study of Health Care Workers in Los Angeles County.

Matthew Yu,A Taylor Kelley,Jessica D Gipson,Anish Mahajan,Anna U Morgan,Andrew Duong

doi:10.1089/heq.2020.0036

Abstract

Purpose: Amid increasingly restrictive federal immigration and health care policies in the United States, access to health care for undocumented immigrants is highly dependent on the extent to which local and state policies and programs address the needs of this population. In Los Angeles County (LA County), home to the nation's largest undocumented immigrant population, supportive policies are in place, yet little is known about how undocumented immigrants navigate available services.Methods: To gain insight into how federal, state, and local policies overlay and contribute to the experience of health care seeking among undocumented immigrants in LA County, we interviewed 19 key informant health care workers involved in the delivery of health care services, using a purposive snowball sampling approach.Results: Three key themes emerged: (1) health care workers at all clinics sampled reported primary care appointments are readily available for undocumented immigrants; however, primary care services remain underutilized; (2) fear, misinformation, and misperceptions of coverage and immigration policies—most commonly related to the revised Public Charge Rule—may reduce program enrollment and access; and (3) frontline health care workers feel ill-equipped to address patient fears and misinformation.Conclusion: Although county programs were perceived to improve access by covering health care costs and ensuring appointment availability, new restrictive immigration policies, such as the revised Public Charge Rule, and widespread misinformation present challenges that threaten the success of these programs. Future study to improve undocumented immigrant access to care should focus on addressing barriers resulting from these policies.

Highlights

Purpose: Amid increasingly restrictive federal immigration and health care policies in the United States, access to health care for undocumented immigrants is highly dependent on the extent to which local and state policies and programs address the needs of this population
In Los Angeles County (LA County), home to the nation’s largest undocumented immigrant population, supportive policies are in place, yet little is known about how undocumented immigrants navigate available services
To gain insight into how federal, state, and local policies overlay and contribute to the experience of health care seeking among undocumented immigrants in LA County, we interviewed 19 key informant health care workers involved in the delivery of health care services, using a purposive snowball sampling approach

Summary

Introduction

Undocumented immigrants face unique challenges in the U.S health care system.[1,2,3,4,5,6] They are ineligible for federal insurance programs in the Affordable CareAct (ACA), resulting in the lowest health care coverage rates of any segment of the U.S population.[2,3,7] Lack of coverage has led to harmful delays in care, increased acute care utilization, and poor health outcomes.[4,5,6,8,9,10,11,12,13,14,15,16,17]In addition, recent changes and even proposed changes to immigration policies and practices have engendered fear within immigrant communities, resulting in further negative health and social impacts.[18,19,20,21,22,23,24] These policies, in addition to other challenges (e.g., language, discrimination, and stigma), result in a formidable health care environment for undocumented immigrants.[1,25,26,27]Exclusion of undocumented immigrants from federal health care coverage has prompted a wave of strategies and interventions at local and state levels. Undocumented immigrants face unique challenges in the U.S health care system.[1,2,3,4,5,6] They are ineligible for federal insurance programs in the Affordable Care. Recent changes and even proposed changes to immigration policies and practices have engendered fear within immigrant communities, resulting in further negative health and social impacts.[18,19,20,21,22,23,24] These policies, in addition to other challenges (e.g., language, discrimination, and stigma), result in a formidable health care environment for undocumented immigrants.[1,25,26,27]. Exclusion of undocumented immigrants from federal health care coverage has prompted a wave of strategies and interventions at local and state levels

Methods

Results

Discussion

Conclusion