Skip to content
Grantmakers In Health
  • About
    • Staff
    • Board of Directors
    • Mission and Values
    • Join Our Team
    • Annual Reports & Form 990s
  • Our Work
    • Focus Areas
      • Health Equity and Social Justice
      • Access and Quality
      • Community Engagement and Empowerment
      • Philanthropic Growth and Impact
      • Population Health
    • Policy and Advocacy
    • Learning Communities
    • Strategic Plan
    • Strategic Guidance
    • Terrance Keenan Institute for Emerging Leaders
    • Awards
  • Publications
    • News and Updates
    • GIH Bulletin
      • GIH Bulletin Signup
    • Health Policy Update
    • Reports and Surveys
    • Grantmaker Profiles
    • Views from the Field
    • Issue Focus
    • Editorial Submission Guidelines
  • Events
    • GIH Annual Conference
    • Upcoming
    • Past Events
  • Resources
    • Trustee Resources
    • Philanthropy Careers
      • Submit a Position
    • Health Philanthropy Search
    • Directory of Philanthropy Consultants
  • Partner With GIH
  • Support GIH
  • Funding Partner Portal
  • Philanthropy Careers
  • Contact GIH
    • Funding Partner Portal
    • Partner Directory
  • Funding Partner Portal
  • Partner Directory
Sign In
Grantmakers In Health
  • Philanthropy Careers
  • Contact GIH
  • Bulletin Signup
  • About
    • Staff
    • Board of Directors
    • Mission and Values
    • Join Our Team
    • Annual Reports & Form 990s
  • Our Work
    • Focus Areas
      • Health Equity and Social Justice
      • Access and Quality
      • Community Engagement and Empowerment
      • Philanthropic Growth and Impact
      • Population Health
    • Policy and Advocacy
    • Learning Communities
    • Strategic Plan
    • Strategic Guidance
    • Terrance Keenan Institute for Emerging Leaders
    • Awards
  • Publications
    • News and Updates
    • GIH Bulletin
      • GIH Bulletin Signup
    • Health Policy Update
    • Reports and Surveys
    • Grantmaker Profiles
    • Views from the Field
    • Issue Focus
    • Editorial Submission Guidelines
  • Events
    • GIH Annual Conference
    • Upcoming
    • Past Events
  • Resources
    • Trustee Resources
    • Philanthropy Careers
      • Submit a Position
    • Health Philanthropy Search
    • Directory of Philanthropy Consultants
  • Partner With GIH
  • Support GIH
  • Funding Partner Portal
  • Philanthropy Careers
  • Contact GIH
    • Funding Partner Portal
    • Partner Directory

Immigration as a Social Determinant of Health

Views from the Field
Posted March 9, 2018
VFF-Chin-Mar-2018-min
Morgan-Hynd
VFF - Chin - Mar 2018
Kathy Ko Chin, President and CEO, Asian & Pacific Islander American Health Forum

As an immigrants’ rights advocate working on health policy, I and my organization, the Asian & Pacific Islander American Health Forum (APIAHF), are constantly faced with the concept that people of color are perpetual foreigners, not “real” Americans. This is despite the five generations of Chinese Americans and countless other immigrants who have been contributing to this country for centuries.

The bedrock of our immigration policy is exclusion. The Chinese Exclusion Act of 1882 was the first-ever federal legislation to ban an entire population solely on the basis of race or national origin and was not repealed until the 1940s. Anti-immigrant sentiment continues to run through our laws, from the rise of anti-immigrant policies of the 1990s to the overwhelmingly anti-immigrant rhetoric permeating our society today.

For the two-thirds of Asian Americans and Pacific Islanders (AAPIs) who are immigrants, their status determines almost every facet of daily life. There are many different immigration statuses: young DREAMers, documented and undocumented, green card holders, and those who live in the United States under a special agreement known as the Compact of Free Association (COFA).

For many immigrants, federal law serves as the gatekeeper to their health, with policies blocking coverage options that they financially support through taxes. Prior to 1996, immigrants of various statuses were included in public programs like Medicaid. The “welfare reform” of 1996 came with a cost: the arbitrary classifications of “qualified” or “non-qualified” status. Now, immigrants must wait five years to become “qualified” before they are eligible for Medicaid or the Children’s Health Insurance Program (CHIP).

State-based eligibility for lawfully present immigrant children and pregnant women became law in 2007 through the Legal Immigrant Children’s Health Improvement Act (ICHIA). Under ICHIA, 22 states opted to provide Medicaid and CHIP coverage during the “five-year ban.” In 2009, CHIP reauthorization included ICHIA and the number of states extending coverage increased to 33 (Schwartz 2016).

The Affordable Care Act (ACA) significantly expanded coverage by making all “lawfully present” immigrants eligible for tax credits and/or cost-sharing subsidy. However, the ACA completely restricts undocumented immigrants from the Marketplace. The Obama Administration also removed eligibility for Deferred Action for Childhood Arrivals (DACA) recipients, undermining their precarious legal status—long before the Trump Administration proposed to eliminate the program altogether.

One thing is clear: our system is exclusionary and leaves millions without the resources, help, or care they need, based on their immigration status. Yet, the future is not entirely bleak, as expanded coverage under the ACA and continued adoption of ICHIA in states like Utah and Arizona show small, but significant steps toward health equity for immigrants.

If we intend to create a truly equitable society, immigration status should not be a social determinant of health. Funders can support proactive strategies to improve care by supporting research on immigrant health needs, reshaping the narrative of who deserves health care, and directly influencing decisionmakers on the allocation of health resources. To do this, they will need to pay close attention to demographics and data, and help to ensure immigrants’ access to health coverage and care.

Demographics

The health care needs of immigrants are influenced by country of origin and specific cultures. Asian Americans, Native Hawaiians and Pacific Islanders speak more than 100 different languages and trace their heritage to more than 50 different countries and ethnic groups. Fifty years from now, immigrants from Asian countries will make up the largest percentage of foreign-born in the U.S. for the first time, though Latinos will continue make up a significant portion (U.S. Census Bureau). Where immigrants live is also changing, with immigrants moving beyond expected metro areas into, for example, Atlanta, Las Vegas and Detroit.

Data

Identifying the health care needs of immigrant communities requires better data, not just at a national level, but disaggregated by race and ethnic groups and by geographic level. For example, aggregated as one single group before the 2013 ACA expansion, AAPIs had the highest rates of coverage and the lowest rates of uninsurance. But disaggregated data revealed that Korean Americans had the highest rates of uninsurance (24 percent) in the country, followed by Bangladeshis and Pakistanis (each 23 percent) (APIAHF, 2016). In order to reveal disparities and address health equity, we need data to point the way.

The upcoming 2020 Census provides a pivotal opportunity to collect data that informs federal policies, regulations, funding, and Congressional districts. Unfortunately, current data collection is not adequately disaggregated to see community disparities like the above example. Furthermore, proposed questions about immigration status coupled with the current climate will undermine an accurate count, as many immigrants will fear participating.

Access to Coverage and Care

By building the evidence on immigrant health needs, we can advance improvements to immigrant coverage and care. On local, state, and national levels, we need to understand the impact of the new anti-immigrant policies on health care utilization, such as immunization rates, mental health, participation in public nutrition assistance and health insurance, as well as attitudes about health care and well-being. Access for one population should not be pitted against access for another; it is critical to provide health care access to all, including immigrants of any immigration status.

I truly believe that data, evidence, and stories that demonstrate the effects of our everyday realities will drive policy change. Immigrants shape the fabric of our country, and philanthropy’s resources are needed to support the analysis and compilation of this evidence into a compelling and succinct case that helps all of us to move beyond our current policies and strive for improvement in immigrant health and health care.


References

Schwartz, Sonya. ICHIA Option: Which States Cover Legal Immigrant Children in Medicaid/CHIP? Georgetown University, March 24, 2016.

U.S. Census Bureau. “American Community Survey.” September 1, 2016.

APIAHF analysis 2016 American Community Survey 1-year estimates, Table S0201.

Focus Area(s): Health Equity and Social Justice

Related Topic(s): Health Equity
Share this

Newsletter Sign Up

Want to sign up for the GIH Bulletin? Click here to get on the list.

Explore Focus Areas

  • Health Equity and Social Justice
  • Community Engagement and Empowerment
  • Philanthropic Growth and Impact
  • Access and Quality
  • Population Health
  • Policy and Advocacy

Explore Topics

Access (287) Advocacy Strategies (244) Behavioral Health (201) Children and Families (212) Civic Engagement (150) Climate and Environmental Health (47) COVID-19 (146) Federal Policy (30) Governance and Operations (314) Health Equity (399) Healthy Eating and Active Living (160) Housing (20) Integrative Health (59) Journalism (5) Justice Reform (7) Messaging (9) Misinformation (12) Older Adults (137) Oral Health (54) Palliative Care (5) Policy Agenda (64) Public Health (6) Quality (189) Rural health (23) Social Determinants of Health (11) Trust-based Philanthropy (14) Trustee Resources (13) Violence Prevention (20) Workforce (17)

Join the largest national network of health funders.

GIH Funding Partners are a diverse constituency of over 200 informed, connected philanthropic organizations.

Join GIH
Navigation
  • About
    • Staff
    • Board of Directors
    • Mission and Values
    • Join Our Team
    • Annual Reports & Form 990s
  • Our Work
    • Focus Areas
      • Health Equity and Social Justice
      • Access and Quality
      • Community Engagement and Empowerment
      • Philanthropic Growth and Impact
      • Population Health
    • Policy and Advocacy
    • Learning Communities
    • Strategic Plan
    • Strategic Guidance
    • Terrance Keenan Institute for Emerging Leaders
    • Awards
  • Publications
    • News and Updates
    • GIH Bulletin
      • GIH Bulletin Signup
    • Health Policy Update
    • Reports and Surveys
    • Grantmaker Profiles
    • Views from the Field
    • Issue Focus
    • Editorial Submission Guidelines
  • Events
    • GIH Annual Conference
    • Upcoming
    • Past Events
  • Resources
    • Trustee Resources
    • Philanthropy Careers
      • Submit a Position
    • Health Philanthropy Search
    • Directory of Philanthropy Consultants
  • Partner With GIH
  • Support GIH
  • Funding Partner Portal
  • Philanthropy Careers
  • Contact GIH
    • Funding Partner Portal
    • Partner Directory
Contact

1100 Connecticut Avenue NW
Suite 1100
Washington, DC 20036

202.452.8331

Email GIH

Press Contact

Annual Reports and Form 990s

Connect

LinkedIn

Facebook

Instagram

Youtube

Threads

Stay Informed

Sign up for the GIH Bulletin and other announcements

Search

© 2025 Grantmakers In Health | Privacy Policy

Website hosted by Yoko Co

Scroll To Top