Immigration Policy is Health Policy: Confronting the Health Costs of Anti-Immigrant Rhetoric

Immigrants have long been a driving force in shaping the United States, and immigrants’ influence continues to grow. In 2023, the U.S. foreign-born population reached a historic 47.8 million, marking a 1.6 million increase from the previous year—the largest surge in over two decades.¹ Each year, nearly 1 million people are granted lawful permanent resident status through immigrant visas issued to eligible individuals, such as spouses of U.S. citizens, refugees, workers, and minors accompanying or following to join.²

As the world’s top destination for international migrants, the U.S. thrives on the rich diversity, innovation, and fresh perspectives that immigrants bring. Immigrants also play a critical role in the economy, accounting for 22.6% of entrepreneurs, 23.1% of STEM professionals, and 15.6% of nurses as of 2022. ³ These numbers illustrate how deeply immigrants are woven into the fabric of American society and underscore their essential role in driving the nation’s continued progress.

Anti-Immigrant Rhetoric Is Increasing

As the 2024 election draws closer, the Republican Party’s anti-immigrant rhetoric has intensified, with blame being directed at immigrants—especially unauthorized immigrants⁴—for many of the country’s issues, including rising crime rates, wage stagnation, and the scarcity of jobs for the middle classes.⁵ According to the U.S. Department of Homeland Security, unauthorized immigrants are foreign-born noncitizens residing in the U.S. without legal status—whether through illegal entry, overstaying a visa, or being ineligible for permanent residency.⁶ In 2022, they made up 3.3% of the total U.S. population and 23% of the foreign-born population.⁷ However, much of the rhetoric leans heavily on fear-mongering and promoting a xenophobic narrative rather than focusing on the facts.

The Reality: Immigrants Contribute Greatly

In reality, unauthorized immigrants play a vital role in the U.S. economy. Data from 2022 shows that they made up 4.8% of the U.S. workforce, a higher proportion than their share of the total population.⁸ Their economic contributions were also significant, as they paid $96.7 billion in federal, state, and local taxes,⁹ with over a third of that amount going to payroll taxes that fund social safety net programs they are not eligible to access, such as Social Security, Medicare, and unemployment insurance.¹⁰ Furthermore, unauthorized immigrants fill many unmet labor demands, particularly in essential industries like construction and agriculture, where they are exposed to increased risks of adverse health outcomes, workplace injuries, and climate-related hazards.¹¹

A Legacy of Restriction: How Anti-Immigrant Policies Impact Healthcare Access

The ongoing anti-immigrant climate in the U.S. is part of a long-standing history,¹² and as a result, we have a wealth of information and research on the harmful health effects of these restrictive policies on the health of immigrants.¹³ In 1996, Congress passed the Personal Responsibility and Work Opportunity Reconciliation Act, which restricted access to federal- and state-funded services such as welfare, healthcare, retirement, and disability benefits for unauthorized immigrants.¹⁴ Although the goal was to “remove the incentive for illegal immigration,” these restrictions had little effect on deterring migration, particularly for those fleeing violence, but instead resulted in a sharp decline in public service use among eligible immigrants, shifting their healthcare focus from preventive care to higher-cost emergency services.¹⁵

Thus, increased immigration law enforcement in reality creates a “chilling effect,”¹⁶ reducing Medicaid participation among eligible immigrants and their families, including U.S.-born children, as many unauthorized parents, fearful of interacting with public agencies, choose not to enroll their children in health plans.¹⁷ While the Obama administration promoted diversity and recognized the contributions of immigrants, progress on immigration reform remained limited, and deportations reached unprecedented levels.¹⁸ Despite these challenges, the Affordable Care Act (ACA) and Medicaid expansion—though excluding unauthorized immigrants—benefited many Latino families, and with focused outreach and the use of bilingual health navigators, Latinos saw the largest gains in insurance coverage of any group.¹⁹

The Health Consequences of Anti-Immigrant Policies

Undoubtedly, anti-immigrant laws negatively impact immigrant health.²⁰ However, the relationship between these laws and health outcomes is indirect²¹ and can best be understood using the Social Determinants of Health (SDH) framework.²² Hostile environments created by punitive immigration policies foster stigma, increase discrimination, stress, and fears of deportation, and lead to heightened anxiety, fear, and depression, all of which can exacerbate pre-existing conditions like high blood pressure, diabetes, and increased body fat; contribute to more musculoskeletal injuries, decreased job performance, and limited economic opportunities for immigrant farm workers; create feelings of hopelessness, guilt, and despair among unauthorized youth; and reduce the likelihood of mixed-status families accessing essential services such as Medicaid and the Women, Infants, and Children (WIC) program due to the constant threat of deportation.²³

This stigmatization extends beyond immigrants and impacts all people of color, as immigration status is often conflated with race, further deepening the cycle of marginalization and health disparities.²⁴ It’s therefore essential for researchers, policymakers, advocates, and the general public—who wield the power of the vote—to stay vigilant against anti-immigrant rhetoric. This is especially crucial as public health institutions, often dependent on funding from right-wing states, may face pressure to produce evidence that aligns with predetermined policy agendas aimed at marginalizing and demonizing migrant communities.²⁵

Immigration Policy is Health Policy

Immigration policy is, without a doubt, health policy, and the well-being of immigrant communities is deeply connected to the health of the broader population. Since 1978, the American Public Health Association has consistently opposed anti-immigrant policies that exacerbate health disparities and undermine social justice.²⁶ When immigrants encounter barriers to healthcare, live in constant fear of deportation, or endure discriminatory policies, the consequences ripple beyond their individual lives to affect entire communities, public health systems, and even overall societal well-being. Infectious diseases do not respect borders, and untreated chronic conditions can strain public health systems, creating vulnerabilities that affect entire communities.

At its core, public health aims to foster a safe and healthy environment for everyone, regardless of immigration status. Addressing the unique challenges many immigrants face—such as limited healthcare access, unmet mental health needs, and the effects of structural racism—is not only an ethical obligation but also essential for the well-being of society as a whole. Organizations like the Interdisciplinary Association for Population Health Science (IAPHS) are instrumental in this effort, fostering scientific innovation and connecting population health scientists across disciplines to develop evidence-based solutions that can reduce health disparities and inform policy changes aimed at improving population health outcomes. Ultimately, migrant health is public health, and only through inclusive, compassionate policies can we achieve the goal of health for all.

¹ Mohamad Moslimani and Jeffrey S. Passel, “What the Data Says about Immigrants in the U.S.,” Pew Research Center (blog), September 27, 2024, https://www.pewresearch.org/short-reads/2024/09/27/key-findings-about-us-immigrants/. 

² Solveig A. Cunningham, Marie Sugihara, and Rebecca E. Jones-Antwi, “Experiences of Victimization before Resettlement and Chronic Disease among Foreign-Born People in the United States,” Population Studies, September 1, 2024, https://www.tandfonline.com/doi/abs/10.1080/00324728.2024.2371286.

³ American Immigration Council, “Take a Look: How Immigrants Drive the Economy in United States of America,” American Immigration Council, accessed October 18, 2024, https://map.americanimmigrationcouncil.org/locations/national/.

⁴Jonathan Kwan, “Words Matter: Illegal Immigrant, Undocumented Immigrant, or Unauthorized Immigrant?” Markkula Center for Applied Ethics, accessed October 18, 2024, https://www.scu.edu/ethics/focus-areas/more-focus-areas/immigration-ethics/immigration-ethics-resources/immigration-ethics-blog/words-matter-illegal-immigrant-undocumented-immigrant-or-unauthorized-immigrant/.

⁵Myah Ward, “We Watched 20 Trump Rallies. His Racist, Anti-Immigrant Messaging Is Getting Darker,” POLITICO, accessed October 18, 2024, https://www.politico.com/news/2024/10/12/trump-racist-rhetoric-immigrants-00183537. 

⁶Office of Homeland Security Statistics, “Estimates of the Unauthorized Immigrant Population Residing in the United States,” accessed October 18, 2024, https://ohss.dhs.gov/topics/immigration/unauthorized-immigrants/estimates-unauthorized-immigrant-population-residing.

⁷Jeffrey S. Passel and Jens Manuel Krogstad, “What We Know about Unauthorized Immigrants Living in the U.S.,” Pew Research Center (blog), July 22, 2024, https://www.pewresearch.org/short-reads/2024/07/22/what-we-know-about-unauthorized-immigrants-living-in-the-us/. 

⁸Passel and Krogstad.

⁹Carl Davis, Marco Guzman, and Emma Sifre, “Tax Payments by Undocumented Immigrants,” Institute on Taxation and Economic Policy, accessed October 18, 2024, https://itep.org/undocumented-immigrants-taxes-2024/.

¹⁰Alisha Rao, Drishti Pillai, and Samantha Artiga, “Key Facts on Health Care Use and Costs Among Immigrants,” KFF (blog), September 23, 2024, https://www.kff.org/racial-equity-and-health-policy/issue-brief/key-facts-on-health-care-use-and-costs-among-immigrants/. 

¹¹ Rao, Pillai, and Artiga.

¹² Ivan Light, “Nationalism and Anti-Immigrant Movements,” Society 33 (1996): 58-63.

¹³ Manalo-Pedro, L. E. Enriquez, J. R. Nájera, and A. Ro, “Anxious Activists? Examining Immigration Policy Threat, Political Engagement, and Anxiety among College Students with Different Self/Parental Immigration Statuses,” Journal of Health and Social Behavior 65, no. 3 (2024): 381–399, https://doi.org/10.1177/00221465241247541.

¹⁴ Office of the Assistant Secretary for Planning and Evaluation, “The Personal Responsibility and Work Opportunity Reconciliation Act of 1996,” August 31, 1996, https://aspe.hhs.gov/reports/personal-responsibility-work-opportunity-reconciliation-act-1996.

¹⁵ Kathleen R. Page and Sarah Polk, “Chilling Effect? Post-Election Health Care Use by Undocumented and Mixed-Status Families,” New England Journal of Medicine 376, no. 12 (March 23, 2017): e20, https://doi.org/10.1056/NEJMp1700829.

¹⁶Page and Polk.

¹⁷ Page and Polk.

¹⁸Ana Gonzalez-Barrera and Jens Manuel Krogstad, “U.S. Deportations of Immigrants Reach Record High in 2013,” Pew Research Center (blog), October 2, 2014, https://www.pewresearch.org/short-reads/2014/10/02/u-s-deportations-of-immigrants-reach-record-high-in-2013/.

¹⁹ Page and Polk, “Chilling Effect?”

²⁰ Rebecca Anna Schut and Courtney Boen, “State Immigration Policy Contexts and Racialized Legal Status Disparities in Health Care Utilization Among U.S. Agricultural Workers,” Demography 59, no. 6 (December 1, 2022): 2079–2107, https://doi.org/10.1215/00703370-10342687.

²¹ Brittany N. Morey, “Mechanisms by Which Anti-Immigrant Stigma Exacerbates Racial/Ethnic Health Disparities,” American Journal of Public Health 108, no. 4 (April 2018): 460–63, https://doi.org/10.2105/AJPH.2017.304266. 

²² Vicente Navarro, “What We Mean by Social Determinants of Health,” Global Health Promotion 16, no. 1 (March 1, 2009): 05–16, https://doi.org/10.1177/1757975908100746.

²³ Edward D. Vargas, Gabriel R. Sanchez, and Melina Juárez, “Fear by Association: Perceptions of Anti-Immigrant Policy and Health Outcomes,” Journal of Health Politics, Policy and Law 42, no. 3 (June 1, 2017): 459–83, https://doi.org/10.1215/03616878-3802940.

²⁴ Asad L. Asad and Matthew Clair, “Racialized Legal Status as a Social Determinant of Health,” Social Science & Medicine 199 (February 1, 2018): 19–28, https://doi.org/10.1016/j.socscimed.2017.03.010.

²⁵ James Smith, “Migrant Health Is Public Health, and Public Health Needs to Be Political,” The Lancet Public Health 3, no. 9 (September 1, 2018): e418, https://doi.org/10.1016/S2468-2667(18)30161-0.

²⁶ Morey, “Mechanisms by Which Anti-Immigrant Stigma Exacerbates Racial/Ethnic Health Disparities.”

References

American Immigration Council. “Take a Look: How Immigrants Drive the Economy in United States of America.” American Immigration Council. Accessed October 18, 2024. https://map.americanimmigrationcouncil.org/locations/national/.

Asad, Asad L., and Matthew Clair. “Racialized Legal Status as a Social Determinant of Health.” Social Science & Medicine, 199 (February 1, 2018): 19–28. https://doi.org/10.1016/j.socscimed.2017.03.010.

Cunningham, Solveig A., Marie Sugihara, and Rebecca E. Jones-Antwi. “Experiences of Victimization before Resettlement and Chronic Disease among Foreign-Born People in the United States.” Population Studies, September 1, 2024. https://www.tandfonline.com/doi/abs/10.1080/00324728.2024.2371286. 

Davis, Carl, Marco Guzman, and Emma Sifre. “Tax Payments by Undocumented Immigrants.” Institute on Taxation and Economic Policy. Accessed October 18, 2024. https://itep.org/undocumented-immigrants-taxes-2024/.

Gonzalez-Barrera, Ana, and Jens Manuel Krogstad. “U.S. Deportations of Immigrants Reach Record High in 2013.” Pew Research Center (blog), October 2, 2014. https://www.pewresearch.org/short-reads/2014/10/02/u-s-deportations-of-immigrants-reach-record-high-in-2013/. 

Kwan, Jonathan. “Words Matter: Illegal Immigrant, Undocumented Immigrant, or Unauthorized Immigrant?” Markkula Center for Applied Ethics. Accessed October 18, 2024. https://www.scu.edu/ethics/focus-areas/more-focus-areas/immigration-ethics/immigration-ethics-resources/immigration-ethics-blog/words-matter-illegal-immigrant-undocumented-immigrant-or-unauthorized-immigrant/. 

Light, Ivan. “Nationalism and anti-immigrant movements.” SOCIETY-NEW BRUNSWICK- 33 (1996): 58-63.

Manalo-Pedro, E., Enriquez, L. E., Nájera, J. R., and Ro, A. “Anxious Activists? Examining Immigration Policy Threat, Political Engagement, and Anxiety among College Students with Different Self/Parental Immigration Statuses.” Journal of Health and Social Behavior 65, no. 3 (2024): 381–399. https://doi.org/10.1177/00221465241247541.

Morey, Brittany N. “Mechanisms by Which Anti-Immigrant Stigma Exacerbates Racial/Ethnic Health Disparities.” American Journal of Public Health 108, no. 4 (April 2018): 460–63. https://doi.org/10.2105/AJPH.2017.304266. 

Moslimani, Mohamad, and Jeffrey S. Passel. “What the Data Says about Immigrants in the U.S.” Pew Research Center (blog), September 27, 2024. https://www.pewresearch.org/short-reads/2024/09/27/key-findings-about-us-immigrants/. 

Navarro, Vicente. “What We Mean by Social Determinants of Health.” Global Health Promotion 16, no. 1 (March 1, 2009): 05–16. https://doi.org/10.1177/1757975908100746. 

Office of Homeland Security Statistics. “Estimates of the Unauthorized Immigrant Population Residing in the United States.” Accessed October 18, 2024. https://ohss.dhs.gov/topics/immigration/unauthorized-immigrants/estimates-unauthorized-immigrant-population-residing.

Office of the Assistant Secretary for Planning and Evaluation. “The Personal Responsibility and Work Opportunity Reconciliation Act of 1996.” August 31, 1996. https://aspe.hhs.gov/reports/personal-responsibility-work-opportunity-reconciliation-act-1996. 

Page, Kathleen R., and Sarah Polk. “Chilling Effect? Post-Election Health Care Use by Undocumented and Mixed-Status Families.” New England Journal of Medicine 376, no. 12 (March 23, 2017): e20. https://doi.org/10.1056/NEJMp1700829. 

Passel, Jeffrey S., and Jens Manuel Krogstad. “What We Know about Unauthorized Immigrants Living in the U.S.” Pew Research Center (blog), July 22, 2024. https://www.pewresearch.org/short-reads/2024/07/22/what-we-know-about-unauthorized-immigrants-living-in-the-us/.

Rao, Alisha, Drishti Pillai, and Samantha Artiga. “Key Facts on Health Care Use and Costs Among Immigrants.” KFF (blog), September 23, 2024. https://www.kff.org/racial-equity-and-health-policy/issue-brief/key-facts-on-health-care-use-and-costs-among-immigrants/.

Schut, Rebecca Anna, and Courtney Boen. “State Immigration Policy Contexts and Racialized Legal Status Disparities in Health Care Utilization Among U.S. Agricultural Workers.” Demography 59, no. 6 (December 1, 2022): 2079–2107. https://doi.org/10.1215/00703370-10342687.

Solveig A. Cunningham, Marie Sugihara, and Rebecca E. Jones-Antwi. “Experiences of Victimization before Resettlement and Chronic Disease among Foreign-Born People in the United States.” Population Studies, September 1, 2024. https://www.tandfonline.com/doi/abs/10.1080/00324728.2024.2371286.

Vargas, Edward D., Gabriel R. Sanchez, and Melina Juárez. “Fear by Association: Perceptions of Anti-Immigrant Policy and Health Outcomes.” Journal of Health Politics, Policy and Law 42, no. 3 (June 1, 2017): 459–83. https://doi.org/10.1215/03616878-3802940. 

Ward, Myah. “We Watched 20 Trump Rallies. His Racist, Anti-Immigrant Messaging Is Getting Darker.” POLITICO. Accessed October 18, 2024. https://www.politico.com/news/2024/10/12/trump-racist-rhetoric-immigrants-00183537.