Amid Tensions, Legal Immigrants Fear Signing Up for Obamacare

This was published as a Wall Street Journal Think Tank column on July 30, 2014.

The wave of unaccompanied undocumented minors entering the U.S. has captured national attention. But a new Kaiser Family Foundation survey reveals a very different immigration issue.

In California, legal immigrants entitled to health coverage under the Affordable Care Act (ACA) are afraid to enroll because they worry that doing so would expose an undocumented relative to investigation and deportation. That’s despite assurances from the government that any information gathered about immigrant families from ACA coverage applications will not be used toward immigration enforcement.

In the survey, 54% of California’s documented and undocumented Hispanics who remained uninsured after the ACA’s first open-enrollment season, and 37% who are here legally and eligible for ACA coverage, said they worry that seeking coverage would bring attention to relatives’ immigration status. By many standards, California had great success in its first ACA open enrollment: 58% or 3.4 million of its previously uninsured population enrolled. But 62% of its remaining uninsured are Latinos; of those, 32% are eligible for coverage and 29% are undocumented and not eligible for coverage. Many come from families with mixed legal status. Bridging the fear gap is critical to providing the coverage for which legal immigrants are eligible. It also will be important to meeting overall goals for covering the uninsured in California and other states with large immigrant populations.

The Department of Homeland Security issued a policy memo in October 2013 that said the government “does not use information about such individuals or members of their household that is obtained for purposes of determining eligibility for… coverage as the basis for pursuing a civil immigration enforcement action against such individuals or members of their household.” The memo was internal, but President Barack Obama reiterated the policy in a town hall with Spanish-speaking media in March.

In the past, efforts have been made to avoid deterring immigrants from signing up for public benefits. Given the tensions today over immigration issues, it is not surprising that some legal immigrants fear that signing up for health coverage could affect someone in their family who is undocumented. A sustained communications effort by government officials and public figures who are respected among Latinos would help to reassure immigrants eligible for coverage under the ACA. The Kaiser survey also found that contact with outreach workers was one of the strongest predictors of enrollment. That may be even more true for the Latino community, where people need to hear from experts they trust that it’s okay to sign up for health insurance.