Migrants often face a variety of health challenges in their host countries, depending on the circumstances of their migration and a host of obstacles such as language barriers, lack of knowledge about the health care system, lack of health insurance and fear of deportation.

During this pivotal election year, when immigration is a hot political topic, it’s important for journalists to help news consumers better understand the specific health challenges that immigrants and refugees encounter in the U.S. and humanize their stories to counter stereotypes, misconceptions and misinformation.

For instance, some states claim that immigrants, especially those who lack legal documentation, are a financial burden on the health care system. However, research suggests the opposite, showing that immigrants, particularly those who lack legal documentation, may subsidize the U.S. health care financing system.

“Immigrants’ substantial contributions to health care funding (despite their relatively low incomes) may be associated with their high labor force participation rate, particularly among men who have recently arrived in the US. Hence, they and their employers (whose benefit payments are widely considered part of the employee’s earned compensation) contribute to health insurance premiums as well as payroll and other taxes,” write the authors of a 2022 study published in JAMA Network Open, noting that “immigrants contributed $58.3 billion more in premiums and taxes in 2017 than insurers and government paid for their health care, and US-born citizens incurred a net deficit of $67.2 billion.”

Immigration is not an issue unique to the United States.

Today, more people than ever live in a country other than the one in which they were born, according to the United Nations. As of July 2020, there were an estimated 281 million international migrants, making up 3.5% of the global population. That’s compared with 2.8% in 2000 and 2.3% in 1980, according to the UN.

In 2022, there were 21.2 million noncitizen immigrants in the U.S., accounting for roughly 7% of the country’s population, according to a June 2024 policy brief by the Kaiser Family Foundation, now called KFF. About 40% are people who lack the legal documents needed to stay in the country.

Immigrant health is strongly shaped by the social, economic and political conditions of their host country, write Michael D. Stein and Sandro Galea in the 2020 book “Pained: Uncomfortable Conversations about the Public’s Health.”

“Legal status in the host country, for example, is associated with access to a broad range of health services and resultant better health,” they write. “Perhaps unsurprisingly, aggressive anti-immigration policies create poor health for the population they target. For example, family separation and detention at our borders traumatize families, deepening the mental health needs of this vulnerable group.”

In addition, as we explain below, research shows many immigrants and refugees experience traumatic events before, during and after their migration, which can lead to mental health problems such as post-traumatic stress disorder, depression and anxiety.

Children and pregnant women often face challenges in accessing pediatric and prenatal care. There is also research on the health risks associated with the types of jobs that immigrants and refugees hold.

But first, a primer on terminology and level of access to health care based on immigration status:

Immigrants, migrants, refugees and asylum seekers

The terms “refugee,” “asylum seeker” and “immigrant” are often used in discussions about people moving from one country to another, but they have distinct meanings based on the reasons for their move and individuals’ legal status.

Immigrant

An immigrant is a person who makes the decision to leave their home country and moves to another country with the intention of settling there, according to the International Rescue Committee, a humanitarian aid nongovernmental organization.

Immigrants move for various reasons, including economic opportunities, family reunification or a desire for a change in lifestyle. Unlike refugees or asylum seekers, immigrants do not typically flee persecution or immediate life-threatening situations. Their move can be either permanent or temporary, and they may go through legal channels to obtain residency rights, work permits or citizenship in the host country.

The AP Stylebook says immigrant, “rather than migrants, is most commonly used for people established in the U.S., which usually is their final destination. It also is used when another specific country is the final destination.”

Migrant

There’s no internationally accepted legal definition for the term ‘migrant.’ But the term generally refers to people who are staying outside of their home country and are not asylum seekers or refugees, according to Amnesty International, a global non-governmental organization focused on human rights.

“While dictionary definitions sometimes distinguish ‘immigrants’ — people who are, or intend to be, settled in their new country — from ‘migrants’ who are temporarily resident, ‘immigrant’ and ‘migrant’ (as well as ‘foreigner’) are often used interchangeably in public debate and even among research specialists,” according to The Migration Observatory at the University of Oxford.

The UN defines an international migrant as any person who has changed their country of residence, regardless of legal status or the nature and motive of their move.

The AP Stylebook says the term also “may be used for those whose reason for leaving their home country is not clear, or to cover people who may also be refugees or asylum-seekers.”

Refugee

A refugee is forced to leave their country to escape war, persecution or natural disaster. Refugees have a well-founded fear of persecution for reasons of race, religion, nationality, political opinion or membership in a particular social group. Many have been forced to flee with little more than the clothes on their back, according to the UN Refugee Agency UNHCR, formerly the United Nations High Commissioner for Refugees. Today, there are 43.4 million refugees around the world.

People go through a process known as refugee status determination in their host country to establish whether their circumstances make them refugees, according to the UN Refugee Agency.

Refugees have a right to international protection, according to Amnesty International. Those rights and protections include the right not to be expelled from their host country, the right to non-discrimination, the right to housing, education and work, according to the UN Refugee Agency.

To become a refugee in the United States, a person has to apply for protection while outside the U.S., while to become an asylum seeker, the application for protection must be submitted from inside the U.S. or at the border, according to the Migration Policy Institute, a nonpartisan policy and research organization. 

Asylum Seeker

An asylum seeker is someone who is seeking international protection from persecution and serious human rights violations in their home country, according to the UN Refugee Agency and Amnesty International. Their request for refugee status, or complementary protection status, has yet to be processed, or they may not yet have requested asylum but they intend to.

“Seeking asylum is a human right. This means everyone should be allowed to enter another country to seek asylum,” according to Amnesty International.

The length and outcome of this process can vary greatly depending on the laws of the host country and the specifics of the individual’s case. Not all asylum seekers will be found to be refugees, but all refugees were once asylum seekers, according to the UN Refugee Agency.

According to the AP Stylebook, “Asylum, under U.S. and international law, is permission granted to refugees to remain within the country to which they have fled. It is not intended for people leaving for economic reasons.” In addition, “In the United States, people fleeing their home countries who do not qualify for asylum may be eligible for ‘withholding of removal’ or the U.N. Convention Against Torture, which offer similar protections.”

“People who are likely to be asylum-seekers or refugees should not be referred to as migrants,” according to the UN Refugee Agency. “To do so can undermine the legal protections afforded to refugees under international law.”

Asylee

Journalists may come across the term “asylee,” referring to a person who has been granted asylum, but the AP Stylebook recommends against using the word. “We would say she was granted asylum,” according to the Stylebook.

Illegal immigration

The term refers to “entering or living in a country without authorization in violation of civil or criminal law,” according to AP Stylebook. Except in direct quotations, use “illegal” only to refer to an action, not a person, the Stylebook advises: “’illegal immigration’ but not ‘illegal immigrant’.”

Also, “do not use the terms alien, unauthorized immigrant, irregular migrant, an illegal, illegals or undocumented (except when quoting people or government documents that use these terms),” according to the AP Stylebook.

Access to U.S. health care based on immigration status

Health and health care access issues are not the same for all noncitizen immigrants. In the U.S., health care coverage of immigrants is based on their immigration status, as defined by the federal government. This HealthCare.gov page defines the terminology and coverage options.

Immigrants who are lawfully in the U.S. have a five-year waiting period to enroll in Medicaid, a government program primarily serving people with low incomes, or the Children’s Health Insurance Program (CHIP). CHIP is a state-federal insurance program that provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but not enough to buy private insurance. In some states, CHIP covers pregnant women, according to HealthCare.gov.

Migrants who lack legal documentation to stay in the country can’t enroll in any federally-funded coverage, including Medicaid, CHIP, Medicare and the Affordable Care Act marketplace, according to KFF.

Refugees and those granted asylum seeker status don’t have to wait five years before enrolling in Medicaid and CHIP, according to HealthCare.gov. Others, including asylum seekers who haven’t been granted asylum status don’t qualify for Medicaid or CHIP, according to KFF.

But some states have tried to close the health coverage gap, especially for children and pregnant people.

So far, 22 states have extended insurance coverage to pregnant people regardless of immigration status through CHIP, according to KFF. Ten states — California, Connecticut, Illinois, Maine, Massachusetts, New Jersey, New York, Oregon, Rhode Island, and Washington — offer extended postpartum coverage for a year regardless of immigration status.

Meanwhile, 35 states, plus D.C., provide Medicaid coverage to children and pregnant people who are in the U.S. legally, without the five-year waiting period, according to HealthCare.gov

As of June 2024, 12 states — California, Connecticut, Illinois, Maine, Massachusetts, New Jersey, New York, Oregon, Rhode Island, Utah, Vermont, Washington — and D.C. cover children through CHIP regardless of immigration status, according to KFF.

The National Immigration Law Center also has maps of states that provide health coverage to immigrant children and pregnant people and a state-by-state list of medical assistance programs available to immigrants.

Six states — California, Colorado, Illinois, New York, Oregon, Washington — plus D.C. have expanded coverage to adults regardless of immigration status, as long as they fall within Medicaid’s income criteria.

In May 2024, the Biden Administration published a new regulation that will include individuals with Deferred Action for Childhood Arrivals (DACA) status as lawfully present in the U.S., so that they will be eligible to gain insurance coverage through the ACA Marketplace, starting this November.

“From a social justice standpoint, we really see legal status as a social determinant of health,” said Dr. Alan Shapiro, during a panel on covering immigrants at the Association of Health Care Journalists’ annual conference in New York City in June. Shapiro is the co-founder and chief strategy officer of Terra Firma National, which provides a range of services to immigrant families.

In a 2023 KFF report based on a joint survey with the LA Times, including 3,358 immigrants 18 years and older, nearly 80% said that they were in good to excellent health, while 20% reported being in fair or poor health. Nearly one in five of those with household incomes below $40,000 per year reported a health condition that required ongoing treatment, compared with about one in ten of those with higher incomes.

“Although most immigrants are healthy and employed, many face challenges to accessing and using health care in the U.S. due to higher uninsured rates, affordability challenges, linguistic and cultural barriers, and immigration-related fears, which has negative implications for their health and financial security,” according to the survey.

Advice for journalists

At the recent AHCJ panel on covering immigration, experts advised journalists to remind their audiences that many people leave their home countries out of necessity for survival.

“Cover migration differently than it’s been covered,” said Shapiro, who is also an assistant professor of pediatrics at Albert Einstein College of Medicine. “I don’t think there’s enough talk about the country conditions and what children and families are really struggling with in their home countries, and I think if the public knew more about how terrible life is for children and families there, and how little protection there is, there would be a lot more empathy and sympathy for [them].”

Dr. Laura Vargas, an assistant professor of psychiatry at the University of Colorado’s Institute of Behavioral Science, who has spent much time speaking to migrants at the U.S.-Mexico border advised journalists to explain the flow of firearms from the U.S. to Latin American countries, a trend that has fueled violence in the region. She has published several studies on the health and mental health of immigrants from Latin America.

“Firearms facilitate the criminal gangs, who are sometimes outgunning the police force and other local law enforcement,” said Vargas. “There’s rampant criminal activity in terms of extortion, robberies, territorial disputes among criminal gangs.”

Those conditions create instability for families and affect the health and mental health of adults and children.

“There’s a lack of future for children and families,” she said. “There’s no employment, and if you graduate with a degree, there’s no job available for you.”

It’s also critical that journalists build trust with the communities they’re covering. At Documented, a nonprofit news site devoted to covering New York City’s immigrants and policies that affect their lives, the staff created a WhatsApp channel to connect with migrants and asylum seekers after learning that the app was the main source of information and communication for them, said Rommel Ojeda, a bilingual journalist, filmmaker and a community correspondent for Documented.

The channel, which has more than 6,000 members, prioritizes privacy by masking phone numbers and offers anonymity to people who agree to be interviewed.

“All of that is to say that we were able to build trust and the trust gave us access so that we can report better,” said Ojeda. “And when I say we can report better, it’s because we can go into the community and really ask for the nuances of each individual who’s talking to us.”

Research roundup

Insurance and Health Care Outcomes in Regions Where Undocumented Children Are Medicaid-Eligible
Julia Rosenberg, Veronika Shabanova, Sarah McCollum and Mona Sharifi. Pediatrics, September 2022.

The study: The study investigates the impact of expanded Medicaid eligibility on children in immigrant families and children who are not in immigrant families. The researchers uses data from the 2019 National Survey of Children’s Health, a nationally representative cross-sectional survey, to compare health care outcomes in states that provide Medicaid eligibility to children regardless of their documentation status (“extended-eligibility states”) with the states that don’t (“nonextended-eligibility states”). There were six extended-eligibility states plus Washington, D.C., at the time of the study. The primary aim was to assess how residing in these different regions affects the rates of uninsured people and health care use among children.

The findings:

• Children in extended-eligibility states had a significantly lower rate of being uninsured (3.7%) compared with those in states that didn’t offer extended eligibility (7.5%).
• Children in immigrant families were more likely to be uninsured compared to those who were not from immigrant families, even if they lived in an extended-eligibility state.
• Children in extended-eligibility states were less likely to forgo medical care (2.2% compared with 3.1%) and dental care (17.1% compared with 20.5%) compared with those in states that didn’t offer extended eligibility.
• There were similar rates of emergency department visits between children in extended- and nonextended-eligibility states.

The takeaway: The study highlights that expanding public health insurance eligibility to all children, regardless of documentation status, is associated with lower rates of being uninsured. “This builds upon the evidence that policies which expand insurance access can improve enrollment within and beyond the target expansion demographic through a ‘welcome mat’ effect,” the authors write. The findings also suggest that states with restrictive health insurance policies for migrant children who lack legal documents to stay in the country may face higher rates of being uninsured and poorer health care use, impacting long-term health and social equity, they add.

Companion commentary: Children in Immigrant Families Deserve Health Care, by Fernando S. Mendoza et al., published in the journal Pediatrics in August 2022.

California’s Health4All Kids Expansion And Health Insurance Coverage Among Low-Income Noncitizen Children
Brandy J. Lipton, Jefferson Nguyen and Melody K. Schiaffino. Health Affairs, July 2021.

The study: Implemented in May 2016, California’s Health4AllKids expanded Medicaid eligibility to all low-income children regardless of their immigration status. The research uses data from the 2012 to 2018 American Community Survey to evaluate the impact of this expansion on health insurance coverage rates among noncitizen children in California compared with eleven states (Delaware, Hawaii, Illinois, Massachusetts, Minnesota, New Jersey, New Mexico, New York, Ohio, Rhode Island, and Washington) plus Washington, D.C.

The findings:

• The rate of noncitizen children lacking health insurance coverage dropped by 34%, translating to a 9 percentage-point increase in any coverage and a 12 percentage-point increase in Medicaid coverage.
• Before the expansion, noncitizen children were significantly less likely to have health insurance compared with citizen children. The Health4All Kids program effectively reduced this disparity by more than half, showcasing the impact of inclusive health policies.
• The study found no significant evidence of a substantial shift from private to public insurance coverage, indicating that the expansion primarily reduced the uninsured rates rather than substituting one form of coverage for another.

The takeaway: “Our analysis provides some of the first evidence on the effects of expanding Medicaid and CHIP to undocumented children. Findings suggest that these policies have the potential to reduce coverage disparities by immigration status,” the authors write.

Publicly-Funded Services Providing Sexual, Reproductive, and Maternal Healthcare to Immigrant Women in the United States: A Systematic Review
Tanvi Jain, Jessica LaHote, Goleen Samari and Samantha Garbers. Journal of Immigrant and Minority Health, June 2022.

The study: The authors review published research about the availability and impact of publicly funded sexual, reproductive and maternal health services on immigrant women in the U.S. The review examines nine studies published from December 2007 to August 2020, focusing on the use of services such as Medicaid, CHIP, and other federally or state-funded programs, particularly among Latina immigrants.

The findings:

• Immigrant women, especially those who lack legal documentation to stay in the country or with low income and education, had higher rates of adequate prenatal care when they had access to Medicaid or CHIP. Six of the nine studies reviewed indicated improved prenatal care adequacy due to access to these programs.
• Immigrant women faced significant barriers to accessing sexual, reproductive, and maternal health services, including cost, language barriers, fear of deportation and lack of knowledge about available services. These barriers often led to delayed or inadequate prenatal care, which can result in severe health outcomes.
• Policies like the “public charge” rule negatively impacted immigrant women’s access to sexual, reproductive, and maternal health services, with many avoiding enrollment in Medicaid due to fear of jeopardizing their immigration status. This led to later initiation of prenatal care and fewer prenatal visits. Public charge is a federal law that determines if a non-citizen applying for a visa or permanent residence is likely to rely on the government for support in the future.

The takeaway: The study underscores the importance of inclusive and comprehensive publicly-funded sexual, reproductive, and maternal health services for immigrant women in the United States. Access to Medicaid and CHIP significantly improves prenatal care adequacy, but numerous barriers still prevent many immigrant women from using those services. Anti-immigrant policies exacerbate challenges, leading to poorer health outcomes. “Similar to women born in the US, immigrant women with low income and educational attainment would most benefit from publicly-funded programming,” the authors write.

More on research funding: Funding for Refugee Health Research From the National Institutes of Health Between 2000 and 2020 by Mehak Kaur, Lana Bridi and Dahlia Kaki, published in JAMA Network Open in January 2024.

The Health of Undocumented Latinx Immigrants: What We Know and Future Directions
India J. Ornelas, Thespina J. Yamanis and Raymond A. Ruiz. Annual Review of Public Health, April 2020.

The study: The authors aim to explore the health outcomes and determinants for Latino migrants who lack legal documentation to stay in the country. The study highlights the social, political and economic factors that impact their health and identifies gaps in current research.

The findings:

• Social and political factors significantly influence the health of migrants who lack legal documentation to be in the country. Factors vary across different stages of migration and are influenced by the immigrants’ country of origin, how they entered the U.S., and changes in their legal and health status over time.
• The study notes that conducting research with migrants who lack legal documentation is challenging due to their precarious living conditions, unstable employment, frequent changes in contact information, and low literacy levels. However, strategies like conducting research at community-based organizations and using social media for communication can help overcome those challenges.

The takeaway: “Public health practitioners can continue to support and advocate for programs and policies that create healthful social and political environments for undocumented Latinx immigrants,” the authors write. They also call for additional research.

Delve deeper: Traumatic Experiences and Place of Occurrence: An Analysis of Sex Differences Among a Sample of Recently Arrived Immigrant Adults from Latin America, by Laura X. Vargas, et al., published in PLOS One in June 2024.

US Immigration Policy Stressors and Latinx Youth Mental Health
Kathleen M. Roche, Rebecca M. B. White and Roushanac Partovi. JAMA Pediatrics, May 2024.

The study: The authors investigate how immigration-related stressors affect parent-child relationships and the subsequent mental health of Latino adolescents. The study includes adolescent-mother duos surveyed at three different time points over four years — 2018, 2020, and 2022, conducted in a suburban Atlanta, Georgia, school district, involving Latino adolescents aged 11 to 16 years.

The findings:

• Immigration-related stressors, such as mothers’ anti-immigrant worries and adolescents’ experiences of family member detention or deportation, were linked to disruptions in parent-child relationships.
• Specifically, anti-immigrant worry was associated with increased parent-child conflict, leading to higher odds of symptoms such as aggression and impulsivity in adolescents.
• For girls, family member detention or deportation led to reduced parental support, which in turn was linked to increased depression and anxiety.

The takeaway: “Our research signals the need for school personnel to address stressors faced by Latinx students and families and for health care institutions to advocate for policies expanding access to affordable, culturally competent mental health services, including for children of immigrants. Congress and both state and local lawmakers have the power to enact policies that reduce risks faced by children in immigrant families. Inclusive immigration policies prioritizing the best interests of children and their families may help protect the mental health of this country’s Latinx youth, the vast majority of whom are US citizens,” the authors write.

Additional reading

• Assessment of Immigrants’ Premium and Tax Payments for Health Care and the Costs of Their Care
  Mark J. Ommerborn, et al. JAMA Network Open, November 2022.
• Health and Health Care Experiences of Immigrants: The 2023 KFF/LA Times Survey of Immigrants
  Drishti. Pillai, et al. KFF, September 2023.
• Medical Care for Newly Arrived Displaced Persons
  Radhika Jain, Geren S. Stone and Matthew G. Gartland. NEJM Evidence, October 2023.
• State-Level Anti-Immigrant Sentiment and Policies and Health Risks in US Latino Children
  Natalie Slopen, et al. Pediatrics, August 2023.
• Understanding the Role of Immigration Status in U.S. Health Coverage: From Barriers to Pathways
  Robert Wood Johnson Foundation, November 2023.
• Living in an Immigrant Family in America: How Fear and Toxic Stress are Affecting Daily Life, Well-Being, & Health
  Samantha Artiga and Petry Ubri. KFF, December 2017.
• The Mental Health of Migrants Living in Limbo: A Mixed-Methods Systematic Review with Meta-Analysis
• Marianne Côté-Olijnyk, J. Christopher Perry, Marie-Ève Paré and Rachel Kronick. Psychiatry Research, July 2024.
• Immigrant and Refugee Health Curricula in US-Based Medical Training: A Scoping Review to Inform Integration Into Pediatric Residency Programs
  Lisa Gantz et al. Academic Pediatrics, July 2024.
• The Impact of Detention on the Health of Asylum Seekers: An Updated Systematic Review: A Systematic Review
  Trine Filges, Elizabeth Bengtsen, Edith Montgomery and Malene Wallach Kildemoes. Campbell Systematic Reviews, July 2024.
• Migrants Come to the U.S. with Trauma. A Broken Mental Health System Adds Stress.
  Anika Nayak and Divya K. Chhabra. Harvard Public Health, February 2024.
• The Health Coverage of Noncitizens in the United States, 2024
  Matthew Buettgens and Urmi Ramchandani. Urban Institute, May 2023.
• 7 Ways to Inform News Coverage of the Southern US Border The Journalist’s Resource, January 2023.

Additional resources

Migration Policy Institute

• This primer on U.S. public benefits (including health care) is a useful resource in sifting through immigrant eligibility by program as well as immigrant legal status.
• The State Immigration Data Profiles have a wealth of data on the immigrant population in the U.S. and state levels, including health insurance coverage for immigrants and U.S.-born overall and by U.S. citizenship status.
• This data tool that looks just at the unauthorized segment of the immigrant population at U.S., state, and top county levels.

Protecting Immigrant Families

Human Rights Watch: Refugees and Migrants

American Immigration Council

ACLU: Immigrants’ Rights

Conscious Style Guide: Ethnicity, Race + Nationality

The post How migrants, asylum seekers and refugees seek health care in the US: A primer and research roundup appeared first on The Journalist's Resource.

Reporters who cover immigration know it is a beat that intersects almost every other beat — economics, education, health, culture, national security and even sports.

The story of people moving across national borders has been told throughout human history. It bubbles up to the nation’s attention at certain moments, often when elected officials debate or disagree on immigration issues or policies, and it becomes a political story.

Recently, the national story of immigration at the southern U.S. border has focused on Title 42, which gives the U.S. Surgeon General the authority to prevent people from entering the U.S. for public health reasons, such as the presence of a communicable disease in another country. The Centers for Disease Control and Prevention invoked Title 42 in March 2020, shortly after COVID-19 reached the U.S. — the first time since the authority was made law during World War II that it had been extensively used.

U.S. authorities have since used Title 42 to expel nearly 2.5 million migrants at the southern border, compared with roughly 1,300 expulsions at the northern border. President Joe Biden’s administration has continued to use Title 42 for expulsions, while broadening pathways for migrants to legally stay in the U.S.

The current status of Title 42 is complicated. The Biden administration intended to rescind Title 42 in mid-2022, but in December the Supreme Court allowed those border restrictions to continue at the request of Republican attorneys general in 19 states. The back-and-forth over Title 42, across presidential administrations and through the courts, is indicative of the human, political and legal complexities related to movement across borders.

To help new and experienced journalists alike cover the breadth and depth of the story of immigration at the U.S.-Mexico border, we reached out to five people who know a lot about how the system works. They have studied immigration as academics, served as legal counsel for migrants, or reported on immigration:

• Leah Boustan, a professor of economics at Princeton University and co-author of the 2022 book, “Streets of Gold: America’s Untold Story of Immigrant Success.”
• Linda Dakin-Grimm, an attorney who has served as pro bono counsel in dozens of immigration proceedings since 2016.
• Camilo Montoya-Galvez, the immigration reporter for CBS News.
• Robert Tsai, a professor of law at Boston University who has written on the history of immigration law in the U.S. during the 20^th century.
• Mariely Valentin-Llopis, an adjunct lecturer at Florida International University and author of the 2021 book, “Reporting Immigration Conflict: Opportunities for Peace Journalism.”

Here’s what they said.

1. Seek a firm foundation of knowledge on U.S. immigration.

Whether you are a journalist assigned an immigration story or a reporter dedicated to the immigration beat, “you’ve got to ground yourself in something before you can tell a story,” Dakin-Grimm says.

Appendix II of Dakin-Grimm’s 2020 book, “Dignity and Justice: Welcoming the Stranger at Our Border,” is a comprehensive overview of the U.S. immigration system. It explains the federal agencies involved, paths to citizenship and important definitions, such as the difference between an asylum seeker and refugee.

3. Convey the lengthy and rich history of immigration to the U.S.

For most of the middle of the 20^th century, the story of immigration into the U.S. was not a news story for most American media outlets. New York Times national editor Jia Lyn Yang recounts why in the prologue of her 2020 book, “One Mighty and Irresistible Tide”:

“The country did not regard immigration as worthy of discussion because, quite simply, there were not many immigrants. A 1924 law passed by Congress had instituted a system of ethnic quotas so stringent that large-scale immigration was choked off for decades. The quotas aimed to limit not only the volume of people entering the country but the type. In order to keep America white, Anglo-Saxon and Protestant, the laws sharply curtailed immigration from southern and eastern Europe and outright banned people from nearly all of Asia. More immigrants entered the country in the first decade of the twentieth century than between 1931 and 1971.”

The nation’s strict federal immigration quotas were eliminated in 1965 with the Immigration and Nationality Act, a sometimes-forgotten pillar of President Lyndon Johnson’s Great Society domestic legislative agenda, which included the Civil Rights Act of 1964 and the Voting Rights Act of 1965.

“Not everyone thinks about that as one of the important civil rights laws,” Tsai says. “But at the time [Johnson] certainly did. And the same civil rights coalition that helped push through the Voting Rights Act and the Civil Rights Act also looked at immigration as an inequality question.”

The history of immigration in the U.S. is long and winding — it is why there are so many books on the topic — and details or broad strokes of that history may not be conducive to the goals of a single news story. Yet, context is often critical, Tsai says. For example, if a politically powerful person expresses a policy affinity toward strict immigration quotas, it would be relevant to remind readers about quota laws from past eras and the political and social situations that led to them.

This example, from the third chapter of Boustan’s book, co-written with Stanford economist Ran Abramitzky, is why past is prologue — why it is important to remind audiences how the nation arrived at this moment in the immigration debate:

“Another unintended consequence of Johnson’s sweeping immigration reform was the new attention paid to the category of undocumented immigration. The 1965 bill imposed entry quotas on Mexican and Canadian immigrants for the first time, setting the stage for more than fifty years of policy focus on illegal border crossings, primarily at the southern border. In the same year, Congress phased out the Bracero guest worker program, imagining that eliminating guest workers would preserve agricultural jobs for US-born workers. Yet, with the program shuttered, many of the same Mexican immigrants who had arrived a few years before on Bracero contracts crossed the border, except they were now reclassified as ‘illegal’ immigrants and thus had reason to stay in the United States rather than hazard more border crossings.”

Context can also take the form of data. For example, when it comes to undocumented immigration, visa overstays regularly and widely outpace the number of migrants arriving at the U.S.-Mexico border, according to the Center for Migration Studies.

In a comprehensive explainer on Title 42 published in January 2023, Montoya-Galvez includes data covering two decades showing a spike in migrant apprehensions at the southern U.S. border after Title 42 was invoked in 2020. It is a clear and effective way to provide long-view historical context, showing the role that COVID border restrictions have had in the highest apprehension levels since the early 2000s.

“I don’t think any editor for a major mainstream outlet is looking for an essay on the historical context behind every immigration policy rollout,” says Montoya-Galvez. “But I do think there are ways that we can include some historical context that is, from our perspective, key to discussing any part of the system. For example, when we talk about any type of congressional proposal on immigration, I think it would be a disservice to any audience to not highlight that Congress has not been able to reform the system in any significant way since the 1990s.”

TRAC, the Transactional Records Access Clearinghouse at Syracuse University, is a reliable source for immigration data, including Department of Homeland Security enforcement numbers and immigration court backlogs, wait times and other information that can inform public understanding of the legal side of the system.

The Immigration History Calendar is a crowdsourced repository of notable dates and events throughout U.S. immigration history that is worth bookmarking. Scroll to the bottom of this article for more recommended reading and resources.

4. Note and explain the difference between law and policy.

In the immigration system, laws are rules and policies are how elected executors — state governors or U.S. presidents, for example — implement those rules. Policies can change when administrations change.

“Every president has the ability to affect how [federal] law is implemented in certain ways,” Dakin-Grimm says.

Federal policies that do not follow the law, or that interested parties think do not follow the law, often end up in federal court.

Laws are passed by legislatures — the U.S. Congress, for example — and are usually slower to change or update than policies. The Immigration Act of 1990, which raised the yearly number immigrants allowed into the country and prioritized highly skilled and educated workers, was the last time federal legislators took substantive action on immigration.

Dakin-Grimm recommends journalists remind audiences that policies, even those at the federal level with far-reaching consequences, may be tenuous in the long-term.

A straightforward example happened in late 2020, when Trump capped the number of refugees the U.S. would accept at 15,000 — a historically low number. Biden reversed course after he became president, upping the cap to 125,000.

A more complex example is Deferred Action for Childhood Arrivals, known as DACA, which became DHS policy in June 2012 under a directive from then-President Barack Obama.

DACA has allowed people whose parents brought them to the U.S. as children, without legal documents, to legally work, attend college and receive health insurance without fear of deportation. Obama’s successor, President Donald Trump, announced in September 2017 that his administration would phase out DACA.

Lawsuits followed, and DACA’s fate lay with federal judges.

The Supreme Court in June 2020 prevented the Trump administration from ending DACA, with Chief Justice John Roberts stressing the court’s ruling was not based on the merits of the policy but rather that the administration failed to provide a “reasoned explanation” for its termination.

By January 2021, President Joe Biden formally reinstated DACA through an executive order. In October 2022, U.S. District Judge Andrew Hanen reaffirmed a previous ruling that the current version of DACA is illegal, preventing new applications but allowing those already approved to continue to be in the program.

The DACA saga is a reminder that policies can change, or be put in peril, with a pen stroke from a judge or elected official.

5. Observe how news media that report in other languages cover immigration.

News outlets that report primarily in a language other than English can offer a different fundamental perspective for journalists who report in English, says Valentin-Llopis.

That focus is a natural byproduct of the audiences that Spanish-language news media serve, but it is nonetheless food for thought for English-language outlets covering immigration in areas that also have large immigrant populations.

6. Think of immigration as an issue whose consequences reverberate across generations — like climate change.

Boustan and Abramitzky in their 2022 book write that “we need to design our immigration policy at the level of generations; the immigrants of today are the Americans of tomorrow.”

The scope of generations can be difficult to achieve in news coverage of a specific movement of people to and across borders, such as groups of Hondurans who moved northward toward the U.S. border in the late 2010s, in part because they were unable to survive on farmland made arid from climate change.

Boustan suggests that, in recent years, coverage of climate change itself has taken a grander view, widening the scope to consider the human and economic toll of a warming planet in the decades ahead. This expansive type of news coverage can be instructive in covering immigration as a generational issue. There is a big story, an “incredibly important existential story,” she says, beyond any particular movement of people.

For example, there are long-term demographic and labor issues at play, Boustan says. Which global economic powerhouse will have the people needed to do the work to keep its economy churning in the future? The population of China, for example, recently shrunk for the first time in over half a century. With people in advanced economies living longer than ever, which countries will have the labor force to provide the services and care that older populations need?

The framing of a story or series on the interplay between demographics and labor doesn’t necessarily have to revolve around a world-power-versus-world-power narrative, Boustan says. The core question is: Will there be enough workers to do the jobs that cannot be replaced by technology — care for older people, child care, and so on? With new arrivals to the U.S. a potential source to fill some of that labor demand, this is a question waiting for more journalistic insights.

7. Avoid horse race reporting about immigration.

Boustan and Abramitzky analyzed political speeches about immigration in the Congressional Record and find that prior to World War II, “Republican and Democratic representatives … were equally likely to give anti-immigration speeches.” Since then, they find that congressional speeches about immigration have become more pro-immigration on the whole, but also more polarized. They write in their book:

“From the types of words that representatives use in their speeches, it is clear that Republicans and Democrats view immigrants through different lenses. Republicans are increasingly likely to use words related to crime, illegality, and violence in their speeches about immigration, whereas Democrats use terms related to family and community.”

Valentin-Llopis suggests reporting that resembles horse race journalism — for example, focusing on the rhetorical back-and-forth among politicians — is overdone and ultimately not illuminating for audiences who want to understand the full scope of immigration issues. She further suggests there is a lack of coverage, and holding to account of, political leaders in countries in Central America and other regions where many immigrants to the U.S. have recently come from.

Holding politicians accountable includes noting their use of politicized terminology. Montoya-Galvez, in addition to reporting on the stories of immigrants, is also tasked with covering U.S. policy and politics around immigration. He advises taking care with the language that elected officials sometimes use: An “invasion” of migrants, for example. “Invasion,” he notes, has a precise definition unrelated to anything happening with migrants at the southern border.

Journalists should not ignore such language, since elected officials are “in positions of power,” Montoya-Galvez says. “But I do think there are ways that we can characterize their criticism, which is mainly that they believe the [presidential] administration has been too lenient on this issue. We can describe these policy disagreements without having to rely on these, in some ways, dehumanizing and not accurate criticisms of what’s happening.”

Recommended reading

Research

“Computational Analysis of 140 years of US Political Speeches reveals more positive but increasingly polarized Framing of Immigration.” Dallas Card, et. al. Proceedings of the National Academy of Sciences, July 2022.

“COVID-Related Restrictions on Entry into the United States under Title 42: Litigation and Legal Considerations.” Congressional Research Service, December 2020.

“Do Human Capital Decisions Respond to the Returns to Education? Evidence from DACA,” Elira Kuka, Na’ama Shenhav and Kevin Shih. American Economic Journal, February 2020.

“An Investigation of the Conceptualization of Peace and War in Peace Journalism Studies of Media Coverage of National and International Conflicts,” Valerie Gouse, Mariely Valentin-Llopis and Beryl Nyamwange. Media, War & Conflict, November 2018.

“Media Production in a Transnational Setting: Three Models of Immigrant Journalism,” Moses Shumow. Journalism, February 2014.

“Unintended Consequences of US Immigration Policy: Explaining the Post-1965 Surge from Latin America,” Douglas Massey and Karen Pren. Population Development Review, July 2012.

From The Journalist’s Resource

How the news media portray Latinos in stories and images: 5 studies to know. Aug. 8, 2020.

Mental health issues among immigrants: New research. Nov. 16, 2018.

Covering immigration: What reporters get wrong and how to get it right. July 24, 2018.

Books

Streets of Gold: America’s Untold Story of Immigrant Success. Ran Abramitzky and Leah Boustan, 2022.

Reporting Immigration Conflict: Opportunities for Peace Journalism. Mariely Valentin-Llopis, 2021.

Dignity and Justice: Welcoming the Stranger at Our Border. Linda Dakin-Grimm, 2020.

The End of the Myth: From the Frontier to the Border Wall in the Mind of America. Greg Grandin, 2020.

One Mighty and Irresistible Tide: The Epic Struggle over American Immigration, 1924-1965. Jia Lynn Yang, 2020.

Conflicted: Voices of Central American Migrants. Catalina Rodríguez Tapia, 2020.

Practical Equality: Forging Justice in a Divided Nation. Robert Tsai, 2019.

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In the lead-up to the 2020 elections, the Journalist’s Resource team is combing through the Democratic presidential candidates’ platforms and reporting what the research says about their policy proposals. We want to encourage deep coverage of these proposals — and do our part to help deter horse race journalism, which research suggests can lead to inaccurate reporting and an uninformed electorate. We’re focusing on proposals that have a reasonable chance of becoming policy, and for us that means at least 3 of the 5 top-polling candidates say they intend to tackle the issue. Here we look at research on criminalizing unauthorized U.S. border crossing.

Candidates favoring repealing criminal penalties for unauthorized entry

Pete Buttigieg*, Bernie Sanders, Tom Steyer*, Elizabeth Warren*, Andrew Yang*

What the research says

Amid calls for immigration reform, some presidential candidates have taken aim at a previously obscure provision within federal law known as Section 1325, which makes it a crime to cross the U.S. border without going through controlled inspection areas. While research provides mixed evidence that the law has discouraged unauthorized immigration, studies document a range of negative consequences for migrants and their children, many of whom were born in the U.S. and are, therefore, citizens.

Key context

When Congress adopted Section 1325 in 1929, “improper entry by alien” became a federal misdemeanor punishable by fine and up to six months in prison for the first offense. A subsequent violation is a felony that carries a possible prison sentence of up to two years.

Most of the top-polling Democratic presidential candidates have said they want to decriminalize improper border crossing. On the other hand, three Democratic candidates — Michael Bennet, Joe Biden and John Delaney — support keeping Section 1325 on the books. Amy Klobuchar said at an event held at The Washington Post last year that she opposes eliminating border crossing penalties, the Post reported.

It’s unclear what position, if any, candidates Michael Bloomberg*, Tulsi Gabbard and Deval Patrick* have taken on the issue.

Since the law took effect, the federal government has gone through phases of relaxed and aggressive enforcement. Prosecutions of illegal entry rose sharply under President George W. Bush in 2005 and became even more common during President Barack Obama’s tenure, according to Syracuse University’s Transactional Records Access Clearinghouse, a research center that tracks cases and activity within U.S. immigration courts.

Journalist Roque Planas, who covers immigration for HuffPost, reported last year that, “Although the law criminalizing illegal entry was first passed in 1929, the Justice Department only began prioritizing those cases in 2005, as a way to funnel migrants into federal jails in areas that lacked bed space for those detained in the civil system. By the time Barack Obama took office in 2009, immigration prosecutions had skyrocketed to the point that they had overtaken half the federal criminal docket. They continued to take up half the federal criminal caseload through his presidency.”

Prosecutions have further increased under President Donald Trump. Section 1325 became the basis for his zero-tolerance immigration policy, announced in 2018 and used to justify separating immigrant children from adult family members who had been charged with violating the law.

The number of improper entry cases filed in U.S. Attorney’s Office districts along the southwestern border more than doubled from about 27,000 in fiscal year 2017 to about 62,000 in fiscal year 2018, according to a report the U.S. Government Accountability Office released in December 2019.

The U.S. is not alone in treating unauthorized border crossing as a crime. More than 120 other countries impose criminal sanctions for unauthorized entry, according to an August 2019 report from the Law Library of Congress. In France, for example, individuals who are caught entering the country without permission face spending a year in prison if convicted, the report explains. Meanwhile, in Malaysia, entering the country without a valid entry permit or pass could result in a five-year prison sentence and receiving a whipping “of not more than six strokes.”

The number of immigrants living in the U.S. without permission has fallen since its peak of 12.2 million in 2007, the Pew Research Center estimates. There were an estimated 10.5 million people living here without authorization in 2017, about 5 million from Mexico, Pew reported in 2019. Almost 2 million were from Central America.

Many of the immigrants who are not supposed to be in the U.S. have called it home for years. About two-thirds of the adults who were living here without authorization in 2017 had been in the country more than a decade, according to Pew.

The U.S., however, removes hundreds of thousands of immigrants a year, a significant portion of whom have prior criminal convictions, according to the U.S. Department of Homeland Security. In fiscal year 2018, the federal government removed 337,287 immigrants, including 149,440 with prior convictions, according to a DHS report published this month. The report does not indicate how many of these individuals had been in the U.S. without authorization. It also does not offer details about the crimes for which they were convicted, including where they were committed.

Of those removed in 2018, 74% of immigrants from South America, 89% of immigrants from Oceania and 43% of immigrants from North America had criminal backgrounds.

The American public appears to have mixed feelings about immigration. While a Gallup poll conducted in June 2019 found that 57% of respondents think immigrants have improved food, music and the arts and 43% believe they have made the economy better, 42% said immigrants have had a negative impact on taxes and “the crime situation.” More than 60% of Americans who participated in a different Gallup poll in 2006 said unauthorized immigration should be a crime.

When a nationally representative sample of registered voters was asked about illegal immigration in July 2019, 41% said immigrants who cross the border without permission should be subject to criminal prosecution. Thirty-two percent of those who participated in that online poll, from The Hill newspaper and market research and consulting firm HarrisX, said illegal border crossing should carry civil fines, and 27% of respondents were unsure whether either approach is the correct one.

Recent research

In 2015, the DHS’ Office of the Inspector General released a report that questions the effectiveness of a federal initiative known as Streamline, which targets individuals who enter the country’s southwestern border without permission and refers them to the Department of Justice for criminal prosecution.

Operation Streamline, the precursor to the Streamline initiative, was launched in 2005 to deter improper entry and end the Border Patrol’s longstanding practice of apprehending individuals who were not supposed to be in the U.S. and then releasing them into surrounding U.S. communities until their cases could be heard by an immigration court. Under Streamline, which covers a larger geographical region than Operation Streamline, migrants convicted of illegal border crossing are processed for removal after serving their sentences.

The Border Patrol had claimed that Streamline was a more effective way to curb illegal entry than simply returning migrants to the other side of the border. According to the agency’s data, immigrants who had been criminally prosecuted were less likely to try again to cross the border between ports of entry

In fiscal year 2012, for example, 10.3% of immigrants who were criminally prosecuted and removed from the U.S. tried to cross the border again, according to the Inspector General’s report. The following year, 9.26% did. When immigrants who did not have authorization to be here were simply returned to the other side of the border and released, 27.06% tried to cross again in fiscal year 2012, and 28.61% did in fiscal year 2013.

In its report, the Inspector General’s office pointed out that the Border Patrol’s data did not offer a complete picture because it did not take into account an immigrant’s attempts to enter the country over multiple years. “By the Border Patrol’s metric,” the authors of the report write, “an alien attempting to cross the border at the end of a fiscal year and making a second attempt at the beginning of the next fiscal year would not be considered a recidivist.”

A study published in 2015 in the Journal on Migration and Human Security also raises questions about whether criminalizing border crossings discourages illegal entry. For the study, researchers examined data gathered during survey interviews with more than 1,100 adult migrants who had been recently returned to Mexico after entering or attempting to enter the U.S. without permission. Researchers discovered that imposing criminal sanctions on illegal entry did not dissuade migrants from making plans to try again. Those who had been prosecuted and returned to Mexico were as likely to say they intended to try again in the future as migrants who were not prosecuted prior to removal.

The researchers write that migrants who have family in the U.S. and consider it home are willing to endure physical hardships and criminal penalties to return. “The idea that the cost of migration can be too great, the danger too perilous, and the punishments too harsh to keep people from reuniting with their loved ones needs to be rejected,” the researchers write.

A newer study that relies on data from the same survey finds that Mexican migrants who were prosecuted for illegal entry were 47% less likely to say they intended to try again within the next week than migrants who were not prosecuted before their removal. However, the deterrent effect appears to be short-lived, especially among migrants with strong ties to the U.S., the researchers explain in their paper, which appeared in the International Migration Review in 2018.

In fact, despite the threat of a criminal charge, 55% of all the Mexican migrants surveyed said they planned to try to cross again in the future, and another 22% were undecided.

But a 2019 working paper from the National Bureau of Economic Research finds that sanctions, including criminal sanctions, imposed by the U.S. Customs and Border Protection between 2008 and 2012 did discourage unlawful entry among a group of Mexican nationals. The authors used fingerprint data to track male migrants aged 16 to 50 years old who had been apprehended six or fewer times while attempting to enter the U.S. without permission. The researchers looked at whether these migrants were less likely to try again after facing one or more sanctions.

They found that “exposure to penalties reduced the 18-month re-apprehension rate for males by 4.6 to 6.1 percentage points.”

While there is conflicting evidence that criminal penalties discourage unauthorized immigration, a growing body of research highlights the negative consequences of criminalizing border crossing for migrants and their families.

In “What Part of ‘Illegal’ Don’t You Understand? The Social Consequences of Criminalizing Unauthorized Mexican Migrants in the United States,” Daniel E. Martínez of the University of Arizona and Jeremy Slack of the University of Texas at El Paso examine the harms of holding migrants in the same prisons where violent offenders and individuals convicted of human and drug smuggling are serving time.

There, they are exposed to illicit social networks such as drug trafficking organizations and prison gangs, Martínez and Slack write in the journal Social & Legal Studies in 2013.

“Policies that systematically criminalize and incarcerate people at high rates, such as Operation Streamline, are exposing economic migrants to criminal networks and certain norms and values that they may have otherwise never been exposed to,” they write. They add that prosecuting improper border crossing might deter some migrants from coming to the U.S. while also “funneling other migrants into the previously unfamiliar and violent world of drugs and crime.”

Numerous studies over the years have documented the hardships faced by many migrant children, including poverty, poor health, inadequate housing and a constant fear that one or more family members will be suddenly deported. In “U.S. Immigration Policy and Immigrant Children’s Well-Being: The Impact of Policy Shifts,” published in 2011 in the Journal of Sociology & Social Welfare, researchers explain how the federal government’s more aggressive stance against illegal entry has made children’s lives more difficult.

“Workplace raids leave hundreds of children without one or both of their parents within minutes, as undocumented workers are immediately detained,” the authors write. “Detention in immigration facilities and deportation to Mexico results in significant family disruption. The disruption of undocumented families, when parents are separated from their children, results in increased symptoms of mental health problems among children.”

Migrants who are in the U.S. without permission are particularly vulnerable to violence and exploitation, partly because they are afraid to call the police or draw attention to themselves, asserts a study published in the Annual Review of Law and Social Science in 2012. “This lack of protection from the criminal justice system makes immigrants particularly attractive targets for victimization,” the researchers explain.

Multiple studies find that the federal government’s aggressive enforcement practices — and the news media’s coverage of it — have helped shape immigrants’ views of themselves and how others see them.

Deisy Del Real of the University of Southern California explains in Immigration and Health that many Americans conflate Mexican origin with “undocumented immigrant.” She conducted in-depth interviews with 52 young adults in California who were either Mexican American or immigrants who came to the U.S. from Mexico without permission. She found that almost all of them had experienced social rejection and discrimination when others assumed they were unauthorized or discovered they were.

In the resulting paper, published in 2019, Del Real notes that one young woman told her that “strangers, children, and coworkers regularly reminded her that undocumented Mexicans in the U.S. are as valuable as ‘trash.’” Del Real concludes that so-called “Mexican illegality stigma” is especially harmful for undocumented young adults “because it deteriorates their self-regard, sense of control over their lives, and financial stability that can disrupt their transitions into parenthood and the workforce.”

When Joanna Dreby of the University at Albany, State University of New York interviewed 110 children of Mexican immigrants living in Ohio and New Jersey, she learned that they also associated immigration with “illegality,” regardless of their family’s legal status.

“With news programs highlighting the worst case scenarios of families caught up in enforcement politics, children in Mexican immigrant families believe that all immigrant families are at risk,” Dreby writes in a paper published in the Journal of Marriage and Family in 2012. “Misunderstandings about immigration and their immigrant heritage are perhaps the most devastating effect of the threat of deportability on children and children’s identity.”

Further reading

Why Border Enforcement Backfired
Douglas S. Massey, Jorge Durand and Karen A. Pren. American Journal of Sociology, 2016.

The gist: “The authors show how border militarization affected the behavior of unauthorized migrants and border outcomes to transform undocumented Mexican migration from a circular flow of male workers going to three states into an 11 million person population of settled families living in 50 states.”

Remittances: Background and Issues for Congress
Martin A. Weiss. Report from the Congressional Research Service, Updated 2019.

The gist: “This report focuses on remittances, transfers of money and capital sent by migrants and foreign immigrant communities to their home country … The United States is the destination for the most international migrants and is by far the largest source of global remittances.”

Unauthorized Aliens in the United States: Policy Discussion
Andorra Bruno, Report from the Congressional Research Service, 2014.

The gist: “How to address the unauthorized immigrant population remains a key point of disagreement in discussions about immigration reform legislation. … It remains to be seen in the current environment if agreement can be reached on the unauthorized immigrant issue — whether on a legalization-focused strategy that involves establishing new adjustment of status mechanisms and/or amending current law, or on a primarily departure-based approach, or on some combination of the two.”

Expert sources

Leisy J. Abrego, professor in Chicana/o studies, UCLA.

Mathew Coleman, professor of geography, The Ohio State University.

Deisy Del Real, postdoctoral fellow, University of Southern California.

Joanna Dreby, associate professor of sociology, University at Albany, State University of New York.

Daniel E. Martínez, assistant professor of sociology, University of Arizona.

Ricardo D. Martínez-Schuldt, assistant professor of sociology, University of Notre Dame.

Douglas S. Massey, Henry G. Bryant Professor of Sociology and Public Affairs, Princeton University.

Cecilia Menjívar​, Foundation Distinguished Professor, University of Kansas.

Victor Romero, professor of law, Penn State Law.

Jeremy Slack, assistant professor of geography, University of Texas, El Paso.

Maria-Elena Young, research scientist, UCLA Center for Health Policy Research.

*Dropped out of race since publication date.

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On Aug. 14, the U.S. Department of Homeland Security issued a rule to restrict immigrants’ ability to obtain legal permanent residency, based on whether they have received government benefits. The rule is due to go into effect Oct. 15.

The rule considers immigrants who receive benefits such as the Supplemental Nutrition Assistance Program (SNAP) and Medicaid likely to become “public charges.” (Also known as food stamps, SNAP is a program that offers low-income adults a form of debit payment to purchase groceries at authorized retailers.) Per a definition from the U.S. Citizenship and Immigration Services, the term “public charges” refers to individuals who are “likely to become primarily dependent on the government for subsistence, as demonstrated by either the receipt of public cash assistance for income maintenance, or institutionalization for long-term care at government expense.” These individuals would be denied green cards, which provide a legal means for immigrants to remain in the country permanently.

This new rule is an expansion of a policy that has existed since 1882. Currently, immigrants can be considered public charges if they are in long-term institutional care or if they rely on Supplementary Security Income, which supports people who are disabled, blind, or aged.

“The public charge rule is affecting people who have been admitted legally to the U.S., but they have not yet become citizens,” says health policy researcher Leighton Ku, a professor and director of the Center for Health Policy Research at George Washington University. “The public charge rule is basically saying that people who are participating in Medicaid, SNAP or public housing may find that they cannot become lawful permanent residents — that is, they can’t get a green card.”

This roundup of research looks at the public charge rule from a variety of angles. First, we summarize research that examines the economic mobility of immigrants as well as their health care expenditures compared with the rest of the U.S. population. Overall, the research finds that immigrants account for a disproportionately smaller share of health care expenditures than the U.S.-born population.

Next, we summarize research predicting health care-related effects of the new rule — repercussions that might affect both immigrants and U.S.-born individuals who seek medical care at community health centers, children with special medical needs born to immigrant parents and people who rely on home health care provided disproportionately by immigrants.

Ku says that some of the research is preliminary, because of the recency of the rule. It’s worth noting that some of the work has not yet been published in peer-reviewed journals. “If you have a cutting edge issue, you don’t want to wait for six months to a year to two years for something to get out,” Ku explains. Two pieces of scholarship included in this roundup — a working paper and an academic policy brief — haven’t been peer reviewed. (To learn more about the differences between peer-reviewed research, working papers and white papers, consult our tip sheet).

As journalists work to communicate the potential impacts of the public charge rule, Leah Zallman, who is director of research at the Institute for Community Health, a primary care physician at Cambridge Health Alliance and an assistant professor of medicine at Harvard Medical School, offers the following advice:

“I think the biggest thing that journalists can do is be really clear and concise about who the rule applies to and who it does not,” she says. “This does not apply to people who have their green card. It does not apply to citizens. And even among the people for whom it does [apply], there are a lot of exclusions.”

For example, she notes, the rule does not count Medicaid received by pregnant women or individuals under age 21 as a benefit that would render these groups ineligible for permanent residency.

Zallman adds that it is also important to clarify misperceptions about which benefits are included in the new public charge rule.

The Department of Homeland Security lists the following as benefits that would render recipients ineligible for permanent residency under the new public charge rule:

• Any federal, state, local, or tribal cash assistance for income maintenance
• Supplemental Security Income (SSI)
• Temporary Assistance for Needy Families (TANF)
• Federal, state or local cash benefit programs for income maintenance (often called “General Assistance” in the state context, but which may exist under other names)
• Supplemental Nutrition Assistance Program (SNAP, or formerly called “Food Stamps”)
• Section 8 Housing Assistance under the Housing Choice Voucher Program
• Section 8 Project-Based Rental Assistance (including Moderate Rehabilitation)
• Public Housing under section 9 the Housing Act of 1937, 42 U.S.C. 1437 et seq.
• Federally funded Medicaid (with certain exclusions)

She also suggests journalists stress that the rule hasn’t yet gone into effect and that it might be delayed due to ongoing litigation. Additionally, the rule stipulates that benefits that individuals have received in the past will not be held against them – only when the public charge rule goes into effect does receipt of benefits become a potential issue.

The Economic Mobility of Immigrants: Public Charge Rules Could Foreclose Future Opportunities
Ku, Leighton; Pillai, Drishti. Center for Health Policy Research at George Washington University’s Milken Institute School of Public Health working paper, November 2018.

This paper challenges an assumption underlying the new public charge rule. “At its heart, the policy is based on the belief that the United States should screen out and exclude low-income immigrants, especially those who use public benefits, because they may remain poor in the future and fail to contribute to the nation’s economy,” the authors write.

To test this assumption, the authors analyze data from the 2016 American Community Survey (ACS), a large, nationally representative survey conducted by the Census Bureau. They model how immigrants’ income changes over time as compared with non-immigrants. They find that while immigrants start out with lower incomes than U.S.-born individuals of the same age, they eventually catch up. “With time and experience, immigrants’ job skills, language proficiency and social capital accumulate and the gap between the U.S born and immigrants gradually converges, on average within about twenty years,” the authors write.

Further, when comparing immigrants and non-immigrants with less than a high school education, immigrants — who start off with relatively lower incomes — are able to close the income gap faster than their peers with more education. These less educated immigrants are able to close the gap separating them from similarly situated U.S. citizens within six or seven years, on average. “The economic mobility of less educated (and low income) immigrants is especially strong,” the authors write.

“Policies that make it harder for recent low-income immigrants to remain in the U.S. ignore the upward progress that immigrants have as they assimilate into the mainstream, which has been part of the immigrant experience for generations,” they conclude.

Medical Expenditures on and by Immigrant Populations in the United States: A Systematic Review
Flavin, Lila; Zallman, Leah; McCormick, Danny; Boyd, J. Wesley. International Journal of Health Services, August 2018.

This review looks at the state of the research on health care expenditures of U.S. immigrants and U.S.-born individuals. “A common misperception among U.S. policymakers and the general public is that immigrants use more health care assets than those born in the United States, thereby draining our country’s medical resources,” the authors write. This paper addresses that misperception through a systematic review of the literature. After evaluating the relevancy of 188 papers related to the topic, the researchers ultimately decided to summarize 16 studies published between 2000 and 2017.

Key findings:

• Immigrants’ overall health care expenditures were between one-half to two-thirds that of U.S.-born individuals.
• Per capita public health care expenditures (e.g., Medicaid and Medicare) were lower for immigrants than for U.S.-born citizens.
• Further, immigrants, including those without documentation, contributed $14 billion more to Medicare’s Trust Fund than they withdrew.
• In 2003, immigrants who had lived in the U.S. for less than 10 years had annual health care expenditures of $1,380, on average. U.S.-born individuals had expenditures of $3,156.
• Immigrants account for a disproportionately small percentage of health care expenditures relative to the U.S.-born population. While they account for 12% of the population, they account for 8.6% of total U.S. health care expenditures, per an analysis of data collected between 1999 and 2006. Undocumented immigrants account for 5% of the population and 1.4% of total medical expenditures, according to analysis of data from 2000 to 2009.
• The majority of emergency Medicaid users were immigrants without documentation. Their expenditures accounted for less than 1% of Medicaid’s total budget.
• “While annual U.S. medical spending in 2016 was a staggering $3.3 trillion, immigrants accounted for less than 10% of the overall spending — and recent immigrants were responsible for only 1% of total spending,” the authors conclude. “Given these figures, it is unlikely that restrictions on immigration into the United States would result in a meaningful decrease in health care spending.” Further, the study authors add that restricting immigration would “financially destabilize” aspects of the health care economy, such as Medicare, to which immigrants contribute more than they withdraw.
• “Latino immigrants were 20% less likely to have health insurance than their non-Latino white U.S.-born counterparts,” the authors write. “Even when immigrants were insured, they had lower health care expenditures.” They suggest that immigrants “may constitute a low-risk pool that subsidizes the insurance market for U.S.-born individuals.”

How Could the Public Charge Proposed Rule Affect Community Health Centers?
Ku, Leighton; et al. Geiger Gibson / RCHN Community Health Foundation Research Collaborative Policy Issue Brief, November 2018.

This study comes from scholars at the Milken Institute School of Public Health at the George Washington University who have received support from the RCHN Community Health Foundation, a non-profit devoted to supporting community health centers through investment, outreach, education and research.

Federally-funded community health centers are legally required to serve all community residents, regardless of insurance status. Reimbursements from Medicaid — a health insurance program for people who don’t have sufficient income or resources to otherwise attain health insurance — are the single largest source of revenue for these centers. Accordingly, as Medicaid enrollment rises, community health centers are likely to see increased Medicaid revenue. Recent policy reforms provide evidence to this effect: Community health centers in states that did not expand Medicaid eligibility following policy changes that took effect in 2014 tend to be smaller and serve fewer patients than those in expansion states.

Because the new “public charge” rule would consider Medicaid enrollment a factor in denying green card applicants permanent residency, the authors of this study predict that many people – including U.S. citizens — will disenroll from the program. The authors go on to estimate potential effects on community health centers.

The researchers estimate that about 5.3% of the 13.3 million Medicaid beneficiaries who received care at community health centers in 2017 — that’s 709,000 individuals — were immigrants who entered the country legally but were not yet citizens. The researchers suggest that members of this group might disenroll from Medicaid due to the public charge rule. They add that citizen family members and family members who entered the country legally but are not yet citizens might also disenroll, bringing the estimate of people who might disenroll up to 2.6 million people.

The researchers estimate community health centers could lose between $346 million and $624 million in Medicaid revenue in a year as a result of the new “public charge” rule.

They indicate that if half of the immigrants who entered the country legally and used community health centers in 2017 disenrolled from Medicaid, community health centers would lose $346 million in a year. The centers, however, will continue to serve all, and so the researchers expect demand to stay the same while reimbursement revenue decreases (self-pay for services received at community health centers depends on income). In turn, health centers might reduce staff and hours, scale back services or close entirely. The researchers estimate that 295,000 fewer patients will receive care in a year due to potential cutbacks related to decreased revenue.

Higher estimates, which take family members into account, predict a $624 million yearly revenue loss as well as reductions in patient capacity. Centers would be able to provide care to over half a million fewer patients over one year. These estimates affect the entire community, regardless of immigration status. “Health centers care for everyone in the community without regard to citizenship status or other personal characteristics not related to health care need,” the authors write. “Because the communities in which health centers operate also tend to have sizable immigrant populations, policies that either directly or indirectly implicate their Medicaid enrollment are likely to produce significant spillover effects.”

Trends in Food Insecurity and SNAP Participation Among Immigrant Families of U.S.-Born Young Children
Bovell-Ammon, Allison; et al. Children, 2019.

This research finds that despite their eligibility, many immigrant parents whose children are U.S. citizens do not participate in the federal Supplemental Nutrition Assistance Program (SNAP), commonly known as food stamps. The study involved 37,570 caregivers of young children who were interviewed in emergency rooms and primary care clinics in cities across the U.S. to determine their food security status and participation in SNAP. Of the caregivers in the sample, 21.4% were immigrants.

The findings indicate a sharp decline in participation among immigrant families in the first six months of 2018. Lead researcher Allison Bovell-Ammon spoke with Journalist’s Resource in November 2018, after she presented her findings at the American Public Health Association’s annual meeting. She said her findings document a “chilling effect” in immigrant communities in which fear prevents immigrants from accessing social programs despite their continuing eligibility. This matches anecdotal reports from frontline providers, she added.

Bovell-Ammon’s research finds that among foreign-born mothers in the study who had been in the United States for less than five years, SNAP participation stood at 43% in 2017. It then dropped to 34.8% in the first half of 2018. For families in the study that had been in the U.S. for more than five years, SNAP participation grew to 44.7% in 2017 and then dropped to 42.7% in 2018. Throughout the period studied, SNAP participation was higher among families with U.S.-born mothers than with immigrant mothers.

Meanwhile, food insecurity rates grew among all groups from 2007 to 2018.

“Food insecurity is associated with poor health outcomes from the prenatal period all the way through old age,” Bovell-Ammon told Journalist’s Resource. “SNAP is effective at reducing food insecurity, which improves health,” she added.

Forgoing Food Assistance out of Fear: Simulating the Child Poverty Impact of Making SNAP a Legal Liability for Immigrants
Laird, Jennifer; Santelli, Isaac; Waldfogel, Jane; Wimer, Christopher. Socius, 2019.

This study estimates the effects of the public charge proposal on SNAP enrollment. The authors look at data came from the 2017 Current Population Survey, conducted by the Census Bureau and the Bureau of Labor Statistics. They estimate the effects on children if between 2% and 35% of adult noncitizens seeking green cards cancel their SNAP benefits for the entire household.

At the lower end of the range, the authors estimate that about 300,00 people will disenroll in SNAP in response to changes to the public charge rule. Over one-third of this group consists of U.S. citizen children, the authors specify. At the high end of the range, they estimate that up to 7.9 million people — including almost 2 million children, most of whom are U.S. citizens — will lose access to SNAP.

“The typical SNAP household with noncitizens would have to increase their income by more than 10 percent to make up for their lost SNAP benefit,” the authors calculate. If this is not possible, the authors predict an increase in the country’s child poverty rate.

Implications of Changing Public Charge Immigration Rules for Children Who Need Medical Care
Zallman, Leah; et al. JAMA Pediatrics, July 2019.

This study estimates how many children might lose benefits through programs such as Medicaid and the Children’s Health Insurance Program (CHIP) and Supplemental Nutrition Assistance Program due to changes to the public charge rule. The authors looked at nationally representative survey data on 4,007 children under age 18. Included were children who were insured by Medicaid and CHIP or resided in a household where at least one household member reported receiving SNAP. Kids who lived with at least one non-citizen adult were considered by the researchers to be at risk of losing benefits. The researchers made their estimates by drawing on a similar, past scenario: In 1996, the federal government made changes to Medicaid eligibility requirements; subsequently, immigrant parents – and their children — dropped out of the program.

The researchers estimate that 8.3 million children currently enrolled in Medicaid and CHIP or receiving SNAP benefits are at risk of disenrollment. About 5.5 million of these kids have specific medical needs, which the authors define as a medical diagnosis or disability or need for a specific treatment.

Zallman and her colleagues emphasize that because the public charge rule does not apply to individuals under age 21, children will be needlessly deprived of health care because of fear and confusion.

The authors add that their analysis might underestimate the number of children at risk of losing benefits. “Because of widespread fear and confusion, some immigrant families in which all members are citizens might also disenroll from benefits,” they write. “Similarly, our estimates of the number who may disenroll are based on scenarios from welfare reform that denied federal benefits to some immigrants but did not impose specific sanctions; because the proposed public charge rule explicitly threatens families’ immigration status, disenrollment rates might be higher than we estimate.”

Care for America’s Elderly and Disabled People Relies on Immigrant Labor
Zallman, Leah; et al. Health Affairs, June 2019.

This study analyzes nationally representative survey data collected on 180,084 adults in 2017 to understand the composition of the “direct care” workforce. The data came from the 2018 Current Population Survey, conducted by the Census Bureau and the Bureau of Labor Statistics. The researchers define direct care occupations as those in the personal and home care field, including home health aides and nursing and psychiatric aides. For the purposes of their analysis, respondents who were born outside the U.S. were considered immigrants. The survey did not collect information about documentation status, so the researchers used a method that has been applied previously to this dataset in labor economics and health care research to estimate proportions of unauthorized immigrants.

Key findings:

• In 2017, 27.5% of direct care workers were immigrants.
• Immigrants with legal, noncitizen status accounted for 9% of direct care workers. Naturalized citizens made up 13.9% and unauthorized immigrants totaled 4.3% of direct care workers. For reference, the paper cites the following statistics: immigrants with legal noncitizen status comprise 5.2% of the U.S. population, naturalized citizens make up 6.8% and unauthorized immigrants account for 3.6%.
• Immigrant health care workers were more likely than U.S.-born workers to be employed by home health agencies (13.1% vs. 7.9%) and in settings such as private households and residential facilities that do not have nursing services.
• The authors write that these findings emphasize immigrants’ disproportionate role in providing health care support for people in the U.S. “In light of current shortages, high turnover rates, low retention rates, growing demand for direct care workers, and immigrants’ already disproportionate role in filling such jobs, policies that curtail immigration are likely to compromise the availability of care,” the authors write. “Moreover, the anti-immigrant rhetoric and policies that restrict immigration threaten the health and well-being of immigrants who are entrusted with the care of the nation’s elderly and disabled people.”

Looking for more research? We’ve written about a study that finds enrollment in the Supplemental Nutrition Assistance Program (SNAP) and the Affordable Care Act declined among Hispanic citizens of the United States after a new immigration enforcement program took effect.

The post The potential health effects of the ‘public charge’ immigration rule appeared first on The Journalist's Resource.

For reporters looking to broaden their immigration coverage, journalist Maria Hinojosa has a recommendation: “I haven’t seen a lot of coverage of immigrant mental health issues for mainstream journalists,” Hinojosa, the executive producer of the long-running NPR show Latino USA, said in a recent interview with Journalist’s Resource.

As it turns out, many public health scholars have been researching the mental health effects of being an immigrant or refugee in America today.

“We don’t always acknowledge the sacrifices that migrants take in leaving their homelands — how they risk so much in terms of safety and stability and opportunity,” said Cindy Sangalang, an assistant professor of social work at California State University, in a phone interview with Journalist’s Resource. “Going on this journey can be at a cost to their mental health, and these things can potentially worsen as other stressors increase once they’re here in the United States.”

In the third week of November, public health professionals from across the country gathered in San Diego for the American Public Health Association’s annual meeting. Among the hundreds of research presentations were several that focused on immigrant mental health. Researchers presented published, peer-reviewed studies and working papers and gave reports on early stage research.

Journalist’s Resource contacted a few scholars presenting at the meeting on the topic of immigrant health. Here, we’ve summarized their research, which covers topics from mental health to participation in health and social services. We also highlight a new working paper on mental health among Muslim college students in the United States. Most of the research has not yet been published in peer-reviewed journals, but, where possible, we’ve linked to publicly accessible versions of the work.

“Trauma, Post-Migration Stress, and Mental Health: A Comparative Analysis of Refugees and Immigrants in the United States”
Sangalang, Cindy; et al. Journal of Immigrant and Minority Health, 2018.

In an interview with Journalist’s Resource, lead author Cindy Sangalang explained that her research was motivated by the “record high” number of displaced migrants around the world. She explained that U.S. legal definitions place distinctions between refugees and immigrants, but in reality now “boundaries are starting to blur.”

“In the context of what’s going on right now, a lot of migrants who might be seen as fleeing for economic reasons might be encountering violence,” Sangalang said, making reference to the fact that refugees are often labeled as such because they are fleeing conflict or persecution.

In light of this context, Sangalang was interested in comparing the experiences of Asian refugees and Latino immigrants both coming to the U.S. Do Latino immigrants report traumas and stresses similar to those experienced by refugees during migration and resettlement?

Analyzing survey and interview responses from over 3,200 respondents, the authors found that Asian refugees and Latino immigrants both experienced pre- and post-migration trauma and associated mental disorders and distress, including depressive disorders.

Further, discrimination increased the risk for mental disorders and distress among both groups. She added that current immigration policies contribute to a “broader climate that facilitates more experiences of discrimination,” which, in turn, could exacerbate mental health concerns.

Sangalang concluded that the findings indicate that pre- and post-migration trauma among immigrants, and Latino immigrants in particular, is more common than previously thought.

“How Does the Election of an Anti-Immigrant Presidential Candidate Affect Health and Social Service Utilization? Findings from Southeast Michigan”
Fleming, Paul J.; et al. University of Michigan School of Public Health working paper, 2018.

This study investigated the effects of the 2016 presidential election on health and social service utilization among immigrants in southeastern Michigan. To do so, the researchers conducted and analyzed 29 in-depth interviews with staff members at two Federally Qualified Health Centers – community health centers that provide care to all people, regardless of income or insurance status. These employees are familiar with the immigrant communities they serve and their concerns. The researchers found that in the weeks after the election, staff perceived a decrease in the number of immigrants using their services. In the year after the election, staff noted downturns that corresponded with immigration enforcement actions within the community. Staff also reported that clients asked about arranging for power of attorney and making plans for the care of their children in the event that they were deported.

In a phone call with Journalist’s Resource, lead author Paul Fleming, an assistant professor at the University of Michigan School of Public Health, suggested a few policy interventions to support immigrants’ access to health and social services. He suggested social service agencies and clinics that serve immigrants prioritize creating not only welcoming spaces, but also safe spaces, where protecting clients is the primary goal. Staff should know how to respond to immigration enforcement officers if they arrive at clinics, Fleming said. Further, he suggested, clinics should post signs with critical information in multiple languages and offer the services of interpreters. Fleming said that health and social service agencies should adapt to this new climate of fear by finding new ways to reach clients, including offering services over the phone or through video, using trusted community members at schools, churches or other organizations as a go-between, and expanding or providing transportation. (Allowing immigrants who have entered the country without permission to have driver’s licenses, so that they can drive themselves to critical appointments, is another policy suggestion Fleming made.)

Fleming also noted that clinicians and researchers can influence policy by offering public comment on legislation that could impact immigrant communities. This might involve sharing stories about the effects immigration policies have had on their clients.

“Rise in Mental Health Problems Among Muslim Young Adults in the United States Following the 2016 Election”
Abelson, Sara; et al. University of Michigan School of Public Health working paper, 2018.

This research looks at data collected from the Healthy Minds Study, the largest national study of college student mental health. The Healthy Minds Study has been distributed annually since 2007. It uses a number of standardized mental health questionnaires to measure depression, generalized anxiety and eating disorders. The researchers were interested in the number of responses that corresponded to a clinically moderate-to-severe diagnosis.

More than 107,000 students from 132 colleges and universities participated in the study. At schools with more than 4,000 students, the survey was sent to a random sample of students. At smaller schools, all students were invited to participate.

The data analyzed in this study spans the three semesters prior to and the three semesters following the 2016 presidential election. Author Sara Abelson and her colleagues were interested in changes in reported mental health symptoms for Muslim and non-Muslim college students before and after the election.

What they found was that regardless of religion, students reported significantly worse mental health after the election. However, the prevalence of students with a mental health concern increased more among Muslims than non-Muslims – there was an 11.5 percent increase among Muslims, and a 5.3 percent increase among non-Muslims.

While proving a causal link between the election and worse mental health outcomes among Muslim students is difficult, Abelson said in an interview that “we were not aware of other things happening in that time that would have uniquely driven up the rate among Muslim students.”

She added that more research is needed to understand the intervening mechanisms that have led to increases in mental health concerns among Muslim students. Among the outstanding questions: Is discrimination increasing? How is the climate on campus changing?

She noted that irrespective of the driving mechanism, for doctors, therapists and social workers on campus, this research identifies a key population for further outreach.

“White Privilege: Comparing Fear of Crime, Bullying, Detainment and Deportation between University Students of Color and White University Students”
Grinshteyn, Erin; Couture, Marie-Claude; Valencia-Garcia, Dellanira. APHA annual meeting presentation, 2018.

For this study, conducted in 2017, researchers asked 1,415 students at the University of San Francisco to rate their fear of 11 different crimes and aggressions, as well as bullying, detainment and deportation, on a scale of one to 10, with zero being no fear and 10 indicating maximum fear. They compared the responses of white students with those of students of color. They found that median fear scores were higher for students of color than for white students. For example, students of color were more afraid of hate crimes, hate speech, threats and physical assault. They also had higher median scores for aggregate fear of crime than white students. Proportionally, more students of color reported being afraid of bullying many times a day or every day than white students. A smaller proportion of students of color reported never being afraid of bullying on and off campus as compared with white students. Students of color were also more likely to feel worried about themselves, friends and family being detained and deported.

The research presented did not look at changes in fear over time. However, lead author Erin Grinshteyn, an assistant professor at the University of San Francisco, said in a phone call with Journalist’s Resource that national ratings of fear in general have remained fairly stable since 1980. Meanwhile, crime rates have decreased.

Grinshteyn said this merits further research and analysis to understand why people are afraid. But first and foremost, she believes that fear should be addressed as a public health issue. At present, fear remains something like a specter: felt but unaddressed, she said.

“Trends in Food Insecurity and SNAP Participation Among Immigrant Families of U.S. Born Young Children”
Bovell-Ammon, Allison; et al. APHA annual meeting presentation, 2018.

This research finds that despite their eligibility, many immigrant parents whose children are U.S. citizens do not participate in the federal Supplemental Nutrition Assistance Program (SNAP), commonly known as food stamps. . The study involved 35,207 mothers who were not born in the U.S. but have children who were.

The findings indicate a sharp decline in participation among immigrant families in the first six months of 2018. In a phone call with Journalist’s Resource, lead researcher Allison Bovell-Ammon said that the findings document a “chilling effect” in immigrant communities in which fear prevents immigrants from accessing social programs despite their continuing eligibility. This matches anecdotal reports from frontline providers, she added.

Bovell-Ammon’s research finds that among foreign-born mothers who had been in the United States for less than five years, SNAP participation stood at 43 percent in 2017. It then dropped to 34.8 percent in the first half of 2018. For families that had been in the U.S. for more than five years, SNAP participation grew to 44.7 percent in 2017 and then dropped to 42.7 percent in 2018.

Meanwhile, food insecurity grew among immigrant families who had been in the United States for less than five years from 9.9 percent in 2007 to 17.8 percent by 2017. It increased from 10.8 percent to 17.5 percent in the same time span among families who had been in the United States for more than five years.

Other research has documented similar effects: A 2018 working paper by Marcella Alsan of Stanford Medical School and Crystal Yang of Harvard Law School finds that enrollment in SNAP and the Affordable Care Act declined among Hispanic U.S. citizens after the Secure Communities immigration enforcement program took effect.

“Food insecurity is associated with poor health outcomes from the prenatal period all the way through old age,” Bovell-Ammon told Journalist’s Resource. “SNAP is effective at reducing food insecurity, which improves health,” she added.

“Undocumented Immigrant Youth are Denied Equitable Access to Higher Education, a Barrier to Better Long-Term Health Outcomes”
Diaz, Mayra; Reyes, Katherine; Cabuslay, Edith. APHA annual meeting presentation, 2018.

The San Mateo County, California Health System conducted focus groups with 55 individuals, most of whom identified as undocumented or preferred not to report their immigration status, in order to understand the impact of immigration laws and the rescinding of the federal Deferred Action for Childhood Arrivals (DACA) policy on education and health.

Those who participated in the focus groups reported signs of depression and anxiety among children in their community. In particular, they said that older children who previously would have qualified for DACA shared feelings of hopelessness and low self-esteem. Some children are so upset they “refuse to continue their studies,” according to the abstract.

The authors conclude that anti-immigration laws and the rescinding of DACA have had profound negative effects in San Mateo County. They also said lower educational attainment could have public health implications in the future.

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Maria Hinojosa is an award-winning journalist best known for her work as anchor and executive producer of the long-running weekly NPR show Latino USA. For the 2018-2019 academic year she is the Walter Shorenstein Media and Democracy Fellow at the Shorenstein Center on Media, Politics and Public Policy, of which Journalist’s Resource is a project.

JR recently took the opportunity to sit down with Hinojosa and learn more of her thoughts on reporting on the Latino community and immigration in the current American political climate. “It means as a journalist being prepared to shed your biases, or at least kind of look at them in the light of day,” Hinojosa said.

For reporters looking to broaden their immigration coverage, Hinojosa has a recommendation: stories about mental health issues, which, she says, are widespread among immigrants and the broader Latino community.

“I haven’t seen a lot of coverage of immigrant mental health issues for mainstream journalists,” Hinojosa said. “There has to be an understanding that there is a low-level psychological impact of living in a country… where an administration is actively trying to perform erasure on your existence.”

Telling the story of immigrant mental health requires reporters to establish trust with their sources while also maintaining appropriate boundaries.

“I think, frankly, the only way that I’ve been able to crack this story of immigrant mental health is actually building a tremendous amount of trust. And that takes a lot of time,” she said. “I guess for senior editors that means giving your journalists the opportunity and time to do that and recognize that it’s a valuable part of this story.”

While good reporting requires empathy, active listening and establishing a certain level of intimacy, “covering mental health issues is always a challenge because you have to be careful of boundaries,” Hinojosa said. “I would hate for somebody to think that I am their therapist or I am their best friend… So you have to be careful, right? You’re not giving counsel to them.”

That said, she believes reporters need to heed a tenet often applied to both medicine and journalism: Do no harm. And that may mean giving sources information about mental health resources.

“If you’ve created an open line of communication, this subject then may say, ‘I’m feeling incredibly suicidal today,” she said. “What does a journalist do in that moment? This is a question that I haven’t had to face very often, but my immediate reaction is that when that happens, my part of ‘do no harm’ means I cannot in good conscience let somebody tell me that they’re going to kill themselves and not do anything about it. So there’s a line … I can’t come to your house and hold your hand and get you into the hospital, but I can say, here’s a number to call, you know, please reach out to somebody.”

She added that mental health organizations can also be useful sources to journalists. “There are organizations that are specifically dealing with people of color and mental health issues, and so, you know, go there,” she said.

Hinojosa also offered the following tips for how to avoid common pitfalls in media coverage of the immigrant community – and how to get the story right.

What to avoid: Using common terms (like “illegal immigrants”) that dehumanize broad populations.

“For decades, immigrants in our country have been called by the most respected journalism organizations in our country as being illegal human beings,” she said.

Even after the Associated Press stopped sanctioning the term “illegal immigrant” in 2013 Hinojosa noted that “many news organizations had a big problem with, and still have a big problem with, making a judgement, a statement, about not using that term because they feel that if you don’t use the term ‘illegal immigrant,’ then somehow you are an activist journalist. And that’s where you’re getting it wrong, and the reason why is because a person is not an illegal person, an action is illegal, so from the very basics of grammar it is incorrect.”

How to get it right: Actively challenge these common terms in your reporting, and consider whether there are better descriptions.

“This is a very difficult thing for journalists to do, because we so deeply do not want to be perceived as being political in one way or another,” Hinojosa said. “But I posit that what we are living through today in the United States of America requires a very different kind of mindset than what we might consider normal.”

Along with “illegals,” Hinojosa believes the term “family separation” is a misleading understatement.  “In the case of children being, in quotes, ‘separated,’ this is a government term. For example, families being separated at the border, it’s a government-approved term,” she said. “It is a factual term to describe what is happening, but there’s something else.  It’s actually children being ripped apart from the arms from the hands of their mothers and fathers, it is children being torn apart, it is families being violently divided… These statements that I’m making here are very uncomfortable for every journalist… I, though, am reticent to use the government’s terms to describe what’s going on and I feel that it is precisely my role as an independent journalist to question the terms that these things are being given.”

What to avoid: Contributing to Latino invisibility in the media by missing opportunities to bring immigrants’ stories into your work.

“Ana Maria Archila, who is one of the two women who stood in an elevator and stopped Senator Flake from going up and confirming the nomination of Brett Kavanaugh… is actually an immigrant from Colombia,” Hinojosa noted. “Until we interviewed her… no one had up until that point asked her [about that], even to just say ‘so where were you born, so you’re an immigrant, you speak with an accent,’ not in a bad way, but just to inquire,”  she added.

“It’s just another way in which the immigrant side of a story is made invisible and not important. And I’m not saying it has to be like, oh my gosh, she’s an immigrant, but simply to recognize the complexity of her character… she is just deemed unable to speak for herself in the national news and an opportunity to hear a Latina with an accent talking about her political activism, [is], you know, gone.”

How to get it right: Ask about immigrants’ backgrounds, but be sensitive and accommodating.

“Sometimes I think that journalists feel like they cannot ask about a person’s background,” she said. “I think that part of what journalists have to learn how to do is to ask these questions with a certain level of awareness and sensitivity so the question is not, ‘So, where are you really from?’ but rather, ‘Tell me a little bit more of your backstory.’

“There has to be also an element of sensitivity, because you never know what the immigration status of the person may be, and you have to allow them the opportunity to define themselves how they want to be defined, whether they are undocumented, whether they were being anonymous, whether they have papers, whether they, like me, are immigrants who became American citizens. Allow people to identify themselves to you. And I think that we have to understand now that all bets are off and this is where it’s a very challenging time for journalists in the sense that if people go public with their stories they are at risk… and it adds another layer to our job because, you know, giving anonymity to somebody or changing somebody’s name is a challenge for us, but we have to be willing to play in those spaces or else we will have no immigrant voices.”

In addition to her own LatinoUSA, Hinojosa highlighted the following media outlets for their exemplary work, and also mentioned a few reporters who she considers important sources for immigration coverage:

• Latino Rebels
• NBC News Latino
• Adolfo Flores, BuzzFeed News
• Tina Vazquez, Rewire
• Elise Foley, Huffington Post
• Hannah Drier, ProPublica
• Roque Planas, Huffington Post
• Maria Sachetti, Washington Post

For more about reporting on immigration, check out these tips from Angilee Shah, senior editor for Global Nation.

The post Covering the Latino immigrant community: Tips from Maria Hinojosa appeared first on The Journalist's Resource.

Define American is a nonprofit media and culture organization working to change the narrative about immigration in the United States. The organization was founded by Jose Antonio Vargas, a former Washington Post reporter who, seven years ago, revealed his status as an undocumented citizen in a New York Times Magazine essay. Its latest campaign is #SourcesMatter, launching Sept. 22, which pushes the news media to reconsider the ways they achieve balance in stories on immigration. The main message of the campaign: Choose your sources responsibly.

“We started looking at the media as sort of a conduit for mainstreaming and legitimizing some ideas that have traditionally been rooted in hate groups,” said Kristian Ramos, the organization’s communications director, in a recent call with Journalist’s Resource. “Once we started looking at that, we sort of took a step back and started looking at sourcing and the language used.”

Ramos and his colleagues looked at the number of times the New York Times, the Washington Post, USA Today and the Los Angeles Times quoted three organizations that have been criticized heavily by the Southern Poverty Law Center (SPLC): the Federation for American Immigration Reform (FAIR), the Center for Immigration Studies (CIS) and NumbersUSA. Comparing these citations between the first six months of 2016 with the first six months of 2018, they saw a drastic jump – from 16 times to 102.

Two of these groups, FAIR and CIS, are designated as “hate groups” by the SPLC, which defines a hate group as “an organization that – based on its official statements or principles, the statements of its leaders, or its activities – has beliefs or practices that attack or malign an entire class of people, typically for their immutable characteristics.” The SPLC was founded in 1971 to protect civil rights through the law. As part of their efforts they monitor the activities of over 1,600 extremist groups across the country.

“We’ve seen a real shift in the quoting of these organizations, and in particular an embrace and uncritical use of a lot of terminology that was once considered the language of hate groups,” Ramos said.

Ramos offered the concept of “self-deportation” as an example. “Self-deportation is an idea that comes from the Tanton Network of FAIR, CIS and NumbersUSA,” he said. “It basically means you make the lives of immigrants so awful that they leave the country.” In 2012, when Mitt Romney advanced the policy during a presidential debate, the media “really pounced” on him for using the language, Ramos said. For example, the editorial board of the Washington Post published an op-ed headlined “The ‘self-deportation’ fantasy.”

“Fast forward to 2018, the government of the United States is currently employing a policy of self-deportation and it’s treated as a serious policy — it’s treated as something that is a legitimate policy for the United States, and that includes separating children at the border, that includes a lot of these raids,” Ramos continued.

What changed? “Well, a lot of these groups … a lot of their staff ended up going into the administration,” Ramos said. “And so you have reporters now reporting on the policy of the government, the immigration policy, without being critical or providing analysis of where the policy came from.”

Ramos offered a few tips for reporters on how they can balance their stories with opposing viewpoints – and do so responsibly:

• If you’re looking to balance the viewpoints in your immigration stories, seek quotes from both conservative and liberal organizations – but avoid citing organizations that have been classified as hate groups by the SPLC, Ramos said. For example, he recommended the Cato Institute, the LIBRE Initiative and the Heritage Foundation as organizations with conservative viewpoints that don’t promulgate hate.
• If you must get a comment from someone affiliated with an organization the SPLC characterizes as a hate group, disclose their affiliation in your story, Ramos said.
• If the source also has connections to the White House administration or Congress, make that disclosure, too. At the very minimum, Ramos said, if you can’t disclose that they’re affiliated with a group on SPLC’s list, you should disclose their political connections.
• Consider the origins of terms like “self-deportation” and “chain migration” and what they might be dog whistling (chain migration is a euphemism for family-based migration). “This is sort of a semantics thing, but it’s important for people to know that this language is rooted in hate groups and policies that are designed to keep immigrants from entering the country legally,” Ramos said.

“I think absolutely you should have opposing views and views that are for a policy,” Ramos said. “But I think it’s incumbent upon journalists to do their due diligence and make sure they’re not quoting hate groups in the process, or disclose that they’re a hate group, or disclose that they have ties to the administration, or find another source that has not been labeled a hate group. If you’re going to get a source for a story, the advice would be to do the research on their background in immigration to provide that context for the story.”

Correction:  An earlier version of this article included Numbers USA on a list of organizations classified as “hate groups” by the SPLC.  We regret the error and have updated the article to correct it. 

Looking for more? Journalist’s Resource has additional tips on covering immigration, as well as summaries of studies about hate speech and immigrants’  health. 

Photo by Alex Steffler obtained from Flickr and used under a Creative Commons license.

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