Health care for immigrants

DEFINITION: Professional medical and mental health services

SIGNIFICANCE: The access of recently arrived immigrants to health care in the United States has often been limited by cultural and language barriers, lack of information, and economic disparities. Thus, alternative medicines and traditional healers have become important parts of immigrant health care. Immigrants’ struggle for health care has continued into the twenty-first century, with ongoing efforts to incorporate immigrants and refugees into the American health care system.

Concern about the possible threats to public health that might be brought into the United States by new immigrants has long been a concern of US immigration law. The Immigration Act of 1891 required medical inspections of immigrants before they left their home countries and immediately after their arrival in the United States. Subsequent immigration acts during the 1890s and the early twentieth century barred diseased immigrants from the United States and expanded the categories of excludable immigrants.

Although the actual number of people who were deported for medical conditions around the turn of the twentieth century was quite small, memoirs and oral histories from that era reflect immigrants’ fear of medical inspection processes and physicians at American ports. In Ellis Island, through which about 70 percent of immigrants entered the United States during that time period, US Public Health Service officers examined new immigrants. With hundreds of newcomers arriving daily at the reception center, detailed and thorough examinations were often impossible, and physicians relied on various clues to weed out immigrants with physical or mental defects. Immigrants found to be suffering from contagious and dangerous diseases who could not earn a living due to their physical or mental conditions were detained for more thorough inspections and, afterward, often deported to their home countries, unless they recovered. Developments in medical technology, such as X-rays for tuberculosis and Wasserman tests for syphilis, aided inspections of immigrants between 1882 and the mid-1920s.

The American Health Care System

Immigrants from many places in Europe found the American health care system cold, distant, and frightening. Their cultural identities were often threatened by American hospitals and reform-minded individuals, who introduced them to new means of treatment and care but did not consider cultural confusions the immigrants might have experienced. Immigrants and their families did not want to commit themselves to hospitals because they were worried about possible long separations and even possible deaths through hospitalization.

Immigrants also received health care at dispensaries, alms houses, and private charities, which served diverse groups of people. Immigrant hospitals and medical facilities were built to provide health care with attention to immigrants’ cultural and medical needs. Reform-minded individuals and communities also partook in the establishment of various medical facilities for immigrants, in which Western medical practices and traditional cures were often combined. Immigrants also looked for alternative means of care and treatment from traditional healers within their own ethnic communities. One such example was ethnic pharmacies, where they could find more familiar and accessible treatments for their ills.

Immigrant Health Care Problems

In the twenty-first century, many immigrants were still experiencing the same kinds of health care problems that immigrants had experienced a century earlier, as suspicions of American health care providers and hospitals continued among immigrant populations. In particular, immigrants with no prior exposure to Western medical facilities were likely to fear encounters with the American health care system. Moreover, various immigrant groups have experienced inequalities in receiving health care. They lack information regarding where and how to get appropriate health care in their new home. Language and cultural barriers prevent them from seeking health care services and increase their distrust of American hospitals and other medical institutions. Although hospitals are required to provide interpretation and translation services for non-English-speaking immigrants, they are not always equipped to fulfill such needs. The geographical inaccessibility of medical facilities has also prevented economically disadvantaged newcomers from getting proper care.

Another important problem for immigrants has been the lack of health insurance, which is partly attributable to their lower levels of education and poverty rates. Lack of health insurance has posed unique problems for immigrant workers, who are typically more likely to get injured at work and to get injured more seriously than their native-born counterparts. This has been particularly true for Hispanic immigrant laborers, many of whom perform demanding physical work. When they are injured at work, they typically hesitate to take time off for medical treatment for fear of losing their jobs. Undocumented immigrant workers are even more reluctant to seek medical treatment, fearing exposure of their illegal immigration status and possible deportation. Even insured immigrants and their families have less access to health care than insured native-born American citizens, for nonfinancial reasons such as unfamiliarity with the American health care system.

Mental Health Care

Because of the stresses many immigrants encounter adjusting to life in the United States, their psychological well-being has become an important social and policy issue. Traumatic experiences in home countries, cultural and language barriers, and discrimination can all combine to aggravate the mental health problems of immigrants. While mental health care has been increasingly utilized in the United States, many immigrants are still unwilling to use such services because of their cultural norms and beliefs. In many Asian countries, for example, stigmas attached to mental illness inhibit people from seeking medical help.

Many immigrants are also handicapped by not having information about the availability of mental health care services. Moreover, the scarcity of mental health care providers who understand the cultural norms and languages of immigrant groups has prevented many immigrants from receiving proper care. Research has shown that immigrants often manifest their mental health problems in ways different from those of native-born Americans. For example, Asian immigrants are more likely than Americans to manifest mental distress through somatic symptoms. Medical health care providers who do not understand ethnic-specific symptoms of mental illness may not be able to offer timely medical interventions.

The mental health of Southeast Asians who have taken refuge in the United States since the 1960s has drawn special attention from health professionals and social workers. For example, Hmong refugees from the war-torn country of Laos are known to have suffered from posttraumatic stress disorder even before their arrival in the United States. However, due to their cultural and language differences and the lack of American medical professionals familiar with Hmong culture and language, these immigrants have generally not received proper treatment and care.

The languages of some immigrant cultures do not have words for mental illness, but this does not mean that the people themselves are immune from mental distress. Southeast Asian refugees frequently use traditional healers and therapies. When administered in conjunction with Western medical practices, such measures are of great benefit to mentally stressed immigrants. American health care professionals have consequently become increasingly aware of the importance of understanding cultural and ethnic differences and finding ways to provide better care for immigrants and refugees.

Cultural Negotiations in Health Care

Understanding cultural differences of immigrants is crucial to providing appropriate health care services. As was the case during the early twentieth century, immigrant hospitals and medical facilities in major American cities have continued to serve not only members of their own ethnic groups but also those of other immigrant groups. Immigrants are also active in cultural negotiations. In general, they have received less health care than native-born Americans, but they have tried hard to improve their conditions. In addition to visiting American hospitals for medical care, they have also utilized traditional and ethnic care systems within their immigrant communities, often receiving good results by using both systems. Increasingly, American health professionals have accepted alternative drugs and therapy systems brought to the United States by immigrants. They have shown greater respect for various measures adopted by immigrants to treat their minds and bodies, and been willing to work with non-Western medical practitioners. Growing numbers of medical professionals who understand the cultural and ethnic differences of immigrant patients have been improving available health care services for immigrants.

Welfare Policies and Immigration

Policy issues regarding heath care of immigrants have interested many Americans. Again, as was the case during the early twentieth century, concerns that immigrants may bring diseases into the country and drain taxpayer dollars to pay for their care have persisted into the twenty-first century. The federal Personal Responsibility and Work Opportunity Reconciliation Act and the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 both restricted Medicaid eligibility of immigrants, except in emergencies, during their first five years of residence in the United States.

California’s Proposition 187, which eliminated all public services except emergency health care for undocumented immigrants, started nationwide debates on health care and immigrants. Despite government efforts to restrict health care for undocumented immigrants, there have been continuing efforts to provide immigrants with health care, regardless of their legal status. State- and community-based programs, such as free clinics and nonprofit institutions, have served immigrants, both documented and undocumented. Educational efforts to inform immigrants of available resources have been launched as well.

Immigrants and refugees in the United States have often been misunderstood and unfairly stigmatized as potential health menaces. During the early twentieth century, Jewish immigrants from Eastern Europe were blamed for spreading trachoma, an eye disease that eventually leads to blindness. Italian immigrants were associated with polio epidemics. In late nineteenth-century San Francisco, Chinese immigrants were accused of bringing the bubonic plague. During the 1930s, Mexicans in Los Angeles were expelled for tuberculosis. During the 1970s, tuberculosis reemerged as the immigrant disease in many American urban centers. During the 1980s and 1990s, Haitian immigrants were widely associated with acquired immunodeficiency syndrome (AIDS). As a consequence, a large number of Haitians in the United States lost their jobs, housing services, and other opportunities due to their perceived association with the disease.

In addition to being stereotyped without concrete evidence, immigrants and refugees—in particular, those who are undocumented—have been blamed for draining health care resources of the United States. However, their cultural values and ethics have made positive contributions to American society as well. Various efforts to promote cultural understanding and knowledge of the immigrant population have been ongoing despite problems that have threatened the health care access of immigrants in the United States.

Though the Affordable Care Act (ACA), passed in 2010, expanded health care coverage for a wide range of Americans, including legal immigrants, the act excluded undocumented immigrants from taking advantage of the legislation to gain more access to health care. Nonprofit organizations attempted to provide medical care for undocumented immigrants and emergency care through Medicaid, and some states attempted to help undocumented immigrants purchase health care. For example, in June 2010, California passed a bill requesting that the federal government allow undocumented immigrants to buy private health insurance through the state's health exchange at no cost to the state or the federal government. Critics of the legislation argued that this rewards illegal immigration. California also passed a law allowing undocumented children from low-income families to receive care through the state's Medicaid program.

By 2023, approximately 50 percent of undocumented immigrant adults and 18 percent of lawfully present immigrant adults were uninsured, according to a Kaiser Family Foundation report. At the state level, the Children's Health Insurance Program (CHIP) and expansions in Medicaid improved the availability of health care to immigrants regardless of immigration status between 2010 and 2021, but many immigrants remained ineligible for coverage or failed to enroll out of fear of deportation. The administration of Joe Biden attempted to reduce this fear by increasing funding for Navigator programs, which aid in the enrollment process, but low enrollment rates remained a problem. Following the reelection of Donald Trump in 2024 and his strong anti-immigration stance, fears about immigrants' ability to access assistance programs, including health coverage, increased.

In 2025, Donald Trump proposed and began implementing significant policy changes that were expected to greatly impact immigrants, including new restrictions on health care access. Deferred Action for Childhood Arrivals (DACA) recipients became ineligible for Affordable Care Act (ACA) Marketplace health coverage, a change projected to affect around 500,000 people. Many lawfully present immigrants faced the loss of marketplace subsidies beginning January 2026, and further plans to restrict access to Medicaid and the Children's Health Insurance Program (CHIP) were announced for later in the year.

Bibliography

Conway, Lorie. Forgotten Ellis Island: The Extraordinary Story of America’s Immigrant Hospital. Collins, 2007.

"Coverage for Lawfully Present Immigrants." HealthCare.gov, Aug. 2025, www.healthcare.gov/immigrants/lawfully-present-immigrants. Accessed 22 Jan. 2026.

Fadiman, Anne. The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. Farrar, 1997.

Hoy, Suellen. Chasing Dirt: The American Pursuit of Cleanliness. Oxford UP, 1996.

Karlamangla, Soumya. "Gov. Brown Signs Bill That Could Help Immigrants Get Access to Health Insurance." Los Angeles Times, 10 June 2016, www.latimes.com/local/california/la-me-ln-brown-immigrant-coverage-20160610-snap-story.html. Accessed 22 Jan. 2026.

“Key Facts on Health Coverage of Immigrants.” Kaiser Family Foundation, 18 Mar. 2025, www.kff.org/racial-equity-and-health-policy/fact-sheet/health-coverage-and-care-of-immigrants/. Accessed 22 Jan. 2026.

Kraut, Alan M. Silent Travelers: Germs, Genes, and the “Immigrant Menace.” Johns Hopkins UP, 1995.

Kretsedemas, Philip, and Ana Aparicio, editors. Immigrants, Welfare Reform, and the Poverty of Policy. Praeger, 2004.

Markel, Howard. When Germs Travel: Six Major Epidemics That Have Invaded America and the Fears They Have Unleashed. Vintage Books, 2020.

"What Recent Policy Changes Mean for Immigrant Health Coverage." The Commonwealth Fund, 15 Oct. 2025, www.commonwealthfund.org/publications/explainer/2025/oct/what-recent-policy-changes-mean-immigrant-health-coverage. Accessed 22 Jan. 2026.