Roundtable #7 | Health Care for Undocumented Immigrants

Section One: Barriers to Health Care Access for Undocumented Immigrants

U.S. legislative acts pertaining to health care rights have historically limited undocumented immigrants’ access to such benefits. While alternative paths to access are available at the moment, they are far from sufficient for undocumented immigrants seeking treatment. The immigration status of undocumented immigrants in the United States has effectively barred them from enrolling in national programs such as Medicaid, Medicare, and the Children’s Health Insurance Program (CHIP), as well as from purchasing coverage through the Affordable Care Act (ACA) marketplaces. Apart from being excluded from typical health care benefits, undocumented immigrants have also suffered from a lack of health insurance. Among the nonelderly population in 2018, 45 percent of undocumented immigrants were uninsured, which is considerably higher than the rate for lawfully present immigrants and citizens. [1] Consequently, undocumented immigrants often either face delays in necessary treatment or no treatment at all. This lack of health coverage ultimately results in worse long-term health outcomes that may eventually become too complex and expensive to treat. [2]

Two major legislative acts deny undocumented immigrants in the United States health  benefits: (1) the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), and (2) the Affordable Care Act (ACA). The former act greatly limits the provision of many federal, state, and local public services to undocumented immigrants. At a federal level, PRWORA broke new ground by finding that previous “eligibility rules for public assistance and unenforceable financial support agreements have proved wholly incapable of assuring that individual aliens not burden the public benefits system” and that it is “a compelling government interest to remove the incentive for illegal immigration provided by the availability of public benefits.” [3] With respect to state and local public benefits, the act declared that undocumented immigrants do not qualify for any health-related benefits provided by an agency or for appropriated funds of a state or local government. [4] Moreover, the ACA does not provide health care coverage to undocumented immigrants either. This was not an accidental omission, but rather a conscious effort to placate opponents of the act who falsely claimed that undocumented immigrants consume a disproportionate amount of health care benefits. In his speech to a joint session of Congress in 2009, therefore, President Barack Obama explicitly reiterated that the ACA would not benefit undocumented immigrants. [5]

While PRWORA and the ACA greatly limit health care access for undocumented immigrants, there are a number of alternative avenues to treatment. The Emergency Medical Treatment and Labor Act (EMTALA) makes it clear that emergency medical care must be provided irrespective of citizenship or residency. [6] Since hospital emergency rooms are required to examine all patients who are present for care, undocumented immigrants are guaranteed emergency treatments until their conditions stabilize. [7] In non-emergency situations, undocumented immigrants may also receive regular low-cost health care services at local community health centers. Nonetheless, this care is often limited to preventive and primary care, which poses challenges for immigrants in need of specialty services. [8] 

One final form of health care available to undocumented immigrants involves private coverage on the individual market outside of the ACA marketplaces. It is worth noting, however, that many undocumented immigrants cannot afford this type of coverage due to  low incomes and the absence of subsidies to offset coverage costs. In 2011, only 29 percent of unauthorized immigrant adults aged nineteen and over reported private coverage while the other 71 percent reported no health insurance coverage at the time they answered the survey. [9]

The ongoing COVID-19 pandemic has only exacerbated such pre-existing health inequalities, especially since no provisional measures have been introduced to expand health care access. Despite the efforts of the Centers for Medicare and Medicaid Services to expand coverage for telehealth services, undocumented immigrants are not eligible to receive such high-quality care because emergency treatments do not cover these services. [10] Although emergency and low-quality health care are attainable options for undocumented immigrants, true health equity hinges on reforming both PRWORA and the ACA to incorporate more inclusive and equitable provisions. 

Regarding the current health care benefits that undocumented immigrants are entitled to receive, these rights are largely encapsulated in the two-pronged approach of federal programs combined with state initiatives. Nevertheless, the former’s obscure eligibility rules only create further confusion while the latter’s efforts fall short of adequate coverage.

Vincent Wang

Cambridge Roundtable Collaborator

Section Two: The Current Health Care Rights of Undocumented Immigrants 

Most undocumented immigrants in the United States face a dire situation when it comes to their right to health care. A portion of the challenges they face stem from their unfamiliarity with the rights they have at their disposal. Contrary to popular belief, under Section 330 of the Public Health Service Act, undocumented immigrants are not required to disclose their immigration status when seeking federal health services available through programs like Federally Qualified Health Centers (FQHCs). [1] Despite the availability of such services, however, undocumented immigrants still tend to remain unaware or wary of seeking them out. [2] This has been attributed to federal policy in the United States, which has generally long remained hostile to undocumented immigrants. While certain states have attempted to rectify these obstacles to health care coverage for undocumented immigrants, the majority of state efforts are scattershot; even the most comprehensive state policies fall short of sufficient coverage. 

At the federal level, undocumented immigrants seeking health care access face two primary problems: a lack of access and a lack of guidance. Federal programs like FQHCs are the exception rather than the rule. While undocumented immigrants are not expressly barred from accessing health care through private health care providers, eligibility limitations for most federally funded health programs often restrict their access to public health care options. [3] These restrictive requirements are harmful for undocumented immigrants, who are already disadvantaged by their limited money, time, and English proficiency. Indeed, undocumented workers earn hourly wages that are, on average, 42 percent lower than those of native-born US citizens and documented immigrants. [4] With high annual health care costs that average $11,582 per person, the United States creates a particularly pernicious environment for undocumented immigrants who have neither the financial means of affording private health care nor the legal means of qualifying for public health care. [5] 

In addition to facing high costs, undocumented immigrants frequently lack proper guidance on how to navigate the services they have access to. This problem starts at the administrative level. Due to the frequent shifts in federal laws governing undocumented health care coverage, administrative staff at immigrant-serving organizations and federal health service programs are constantly forced to learn and adjust to new eligibility rules. [6] Confusion among program administrators leads to greater confusion among undocumented immigrants who depend on their guidance. [7]

Efforts to address these problems have been taken on at the state level. However, health care coverage for undocumented populations varies considerably from state to state, with only a few states providing partial coverage. For example, through Medicare and provisions within the Children's Health Insurance Program (CHIP), 16 states have used the option of providing prenatal care to undocumented mothers to extend CHIP coverage to their unborn children. [8] Other states, such as Minnesota and Arizona, have utilized community health outreach programs to cover indigent populations, of which undocumented immigrants are a subset. [9] While these coverage efforts may be piecemeal, six states—California, Illinois, Massachusetts, New York, Oregon, and Washington—along with the District of Columbia have gone one step further by extending statewide Medicaid coverage to all income-eligible children regardless of immigration status. [10] These expansions have given undocumented income-eligible children access to numerous services, including  regular check-ups and immunizations, which the government does not finance for other undocumented immigrants who typically only have access to emergency services. [11]

Among these state-level health care initiatives, California has gone the furthest to expand coverage beyond just undocumented children. As of July 2019, California became the first state in the nation to provide publicly funded health care coverage for undocumented young adults. [12] This expansion fully covers low-income, undocumented young adults ages 25 and younger through the state’s Medicaid program, Medi-Cal. [13] Prior to its passage, California routinely sparred with the Trump administration over the expansion’s legality as the $315 million effort to pay for undocumented young adults relied on funding assistance from the federal government. [14] However, the aforementioned Emergency Medical Treatment and Labor Act (EMTALA) permits state reimbursement for emergency care and labor, in addition to delivery care, for undocumented immigrants. These provisions gave  California a firm legal foundation for billing the federal government. [15] Moreover, beyond insuring undocumented young adults, Governor Gavin Newsom has indicated his intention to extend health care coverage to undocumented seniors. In January 2020, the governor released a proposed budget that would cover 27,000 undocumented adults 65 and older. [16] Above all other states, evidently, California continues to lead the fight to secure health care for undocumented immigrants.

Even though certain states have undoubtedly taken steps to expand health care access to undocumented immigrants, these efforts often fall short of full or adequate coverage. The expansion of CHIP and Medicaid coverage, for instance, only applies for undocumented children. On the other hand, while inclusive in their coverage, community health outreach programs are limited in their outreach capacity and organizational funding. As a result, even states like California fall short of covering all undocumented immigrants. Unfortunately, the ongoing COVID-19 pandemic has only further exacerbated state and federal failures to secure undocumented health care coverage. While health care rights for the general undocumented population were already wholly inadequate to begin with, the active deprivation of these rights for detained immigrants poses an even more pressing concern. 

David Jung

Roundtable Contributor

Section Three: Medical Deportations for the Undocumented in the Era of COVID-19

In light of their limited access to health care, undocumented patients are at particular risk for medical deportation during the COVID-19 pandemic, especially in hard-hit areas such as South Texas. The Rio Grande Valley along the Mexican border contains “four out of the five metro areas with the worst death rates.” [1] This locality has one of nation’s largest concentrations of undocumented immigrants and, consequently, a massive presence of agents from the U.S. Immigration and Customs Enforcement (ICE) and the U.S. Customs and Border Protection (CBP),  which includes the Border Patrol. This, combined with the region’s high death rate, forces undocumented immigrants to weigh the benefits of prioritizing their own health versus the costs of possibly interacting with immigration officials. Thus, it is vital to examine the protections that undocumented patients have against ICE and CBP within the larger policy framework surrounding medical deportation.

Treatment for COVID-19 often requires extended hospital stays, scarce equipment, and expensive drugs. For decades, undocumented immigrants in need of such costly care have been at risk for medical deportation. In Montejo v. Martin Memorial Medical Center, a 2004 court case heard by the District Court of Appeals of Florida, the guardian of Luis Alberto Jimenez sued the hospital for deporting Jimenez to Guatemala. [2] Jimenez had suffered a traumatic brain injury and required sustained intensive care. As an undocumented immigrant, he did not have access to public health programs such as Medicaid, and the hospital attempted to reduce expenses by having him treated in Guatemala. This deportation order was eventually reversed due to a lack of “substantial evidence” that Jimenez could receive care in Guatemala and because “the trial court lacked subject matter jurisdiction to authorize the transportation.” [3] By this time, however, Jimenez had already been deported to Guatemala, and the Montejo decision ultimately established no true protections for undocumented patients against deportation. Cases like Jimenez’s are so widespread that some companies specialize in medical deportations. [4] Although this means of seeking profit is ethically questionable, the mere existence of these companies demonstrates the vulnerability of undocumented hospital patients.  

In recent years, the increased presence of ICE and the Border Patrol  in hospitals has placed undocumented immigrants at even greater risk for medical deportation. Although ICE and CBP are technically separate, the Trump administration’s zero-tolerance policy for illegal immigration has pushed each agency to encroach on the other’s operations. Both ICE and CBP define hospitals as a “sensitive location,” which restricts agents from conducting operations there without approval from certain officials. [5] However, this restriction is fairly easy to circumvent. As per its official policy, ICE can still conduct operations at sensitive locations in “exigent circumstances,” such as when the target poses “an imminent danger to public safety.” [6] This relatively vague provision empowers agents to “carry out an enforcement action covered by this policy without prior approval from headquarters,” leaving agents with an alarming degree of discretion. [7] Especially after the Trump administration passed its zero-tolerance policy, the presence of ICE and Border Patrol in hospitals has increased, with Border Patrol now averaging sixty-nine trips per day to hospitals across the country. [8] Combined with this expanded presence, a lack of legal protection against deportation puts undocumented patients at particular risk for not only deportation but also contraction of COVID-19. 

Amid the ongoing pandemic, ICE has directly endangered the health of undocumented immigrants by neglecting to maintain hygenic detention centers and by using CDC guidance to rapidly deport people who are already in custody. Conditions in detention centers have never been habitable, but the lack of sufficient sanitation and room for social distancing in the age of COVID-19 makes detainees especially susceptible to contracting the virus. [9] In fact, conditions in these facilities are so poor that there is a federal class action lawsuit in southern Florida calling for the release of regional detention center inmates. [10] Beyond maintaining unsafe detention centers, ICE has also exploited the CDC’s characterization of undocumented immigrants as a “public health risk” by deporting thousands already in custody. [11][12] The xenophobic rhetoric of the CDC order allows the federal government to blame undocumented immigrants for COVID-19, while the consequent surge in deportations increases the spread of the virus.

As COVID-19 continues to spread, it is important to remember that undocumented patients have no legal protection against deportation. The increased presence of ICE and Border Patrol in hospitals only further deters this already vulnerable group from seeking the care they need. In order to effectively combat COVID-19, instead of rapidly deporting those whom the CDC considers a “public health risk,” the government must ensure that all members of the undocumented immigrant community feel safe seeking health care when necessary.

Aidan Aguilar

Roundtable Contributor

Section Four: The Future of Health Care for Undocumented Immigrants

This section examines the various instruments that govern health care for undocumented immigrants in the US. More specifically, it argues that family separation and indefinite detention potentially violate international law. Recognising that international law may ultimately not be the most effective protective mechanism, this section also draws brief comparisons with domestic policies implemented in the The Netherlands and Thailand.  

From an international law perspective, there is no single instrument that specifies the exact set of health care rights undocumented immigrants should enjoy. [1] Article 12(1)24 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) establishes the “right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” [2] The universality of this guarantee is reaffirmed by the right to non-discrimination under the International Covenant on Civil and Political Rights (ICCPR). [3] Under these two provisions, undocumented migrants are entitled to the same quality health care as a state’s nationals. In practice, however, differential treatment on the basis of nationality is widely implemented. Both migration and health care spending are understandably sensitive issues, with different states applying widely varied domestic policies to their unique migration patterns and health care needs. Health care services are always scarce, and states have the discretion to allocate them as they see fit. Independent of migration, this is exemplified by the contrast between universal health care in the UK and the primarily private health care system in the US.

While facets of international law have attempted to prevent such discretion from resulting in cruelty or mistreatment, harsh domestic anti-immigrant policies often violate it. As noted extensively in this roundtable, undocumented migrants face considerable barriers to health care in the US. Two immigration practices in particular—family separation and indefinite detention—are especially damaging to migrant health and arguably contravene international law.

Under the Trump administration’s “zero-tolerance” immigration enforcement policy, children are purposefully separated from their parents at the US border. [4] Despite the administration’s purported reversal of the policy, numerous reports suggest that separation continues to take place. Furthermore, reunification efforts have been largely ineffective given the lack of records on  earlier separations. [5] While deportation has an adverse impact on the health across the board, the medical trauma experienced by adult victims is amplified when it comes to children, whose afflictions range from anxiety and headaches to long-term neurological changes. [6] The health impact of deportation is even worse for medically vulnerable children (i.e. the disabled, developmentally challenged or chronically ill). Ordinarily dependent on their parents, these children are thrust into a hostile environment where their medical needs go unmet. Article 9.1 of the Convention on the Rights of the Child (CRC) prohibits such separation except when it is in the child’s “best interests.” [7] Family separations not only demonstrate a blatant disregard for their interests, but also actively harm them. Strikingly, no concrete justification was given for the family separation policy, which many believe serves the sole purpose of deterrence. 

The recent removal of the 20-day Flores Settlement limit on detention pending asylum applications has also led to the seemingly indefinite detainment of numerous undocumented migrants. [8] While detainment is already inherently traumatic, detainees are also often subject to subpar medical care, ranging from insufficient feeding supplies for infants to delayed cancer treatment for adults. [9] ICCPR Article 9, which indefinite detention clearly violates, contains only one exception in Article 4: times of “public emergency which threaten[s] the life of the nation.” [10] Countermeasures must only be performed “to the extent strictly required by the exigencies of the situation.” [11] C. v. Australia clarifies that “less intrusive means to meet the relevant objectives must be considered.” [12] Indefinite detention has been justified by the need to ensure that migrants attend their asylum hearings, which seems to fall short of a threat to the “life of the nation.” Additionally, excessive or uncertain detention may also raise issues of cruel, inhuman or degrading treatment prohibited by the UN Convention Against Torture, which the US has ratified. Indeed, the Committee against Torture has repeatedly warned against the use of prolonged or indefinite immigration detention. [13][14]

Taking a global view, approaches to migrant health care vary greatly between countries. It is worth comparing U.S. immigration policy to countries that utilize vastly different approaches. Undocumented migrants in the Netherlands must pay for health care, but if they cannot afford it, their health care provider can seek reimbursement for eighty to one-hundred percent of the cost of care. [15] This applies to the full range of health services, including non-emergency hospital care and even nursing homes. The Dutch approach may provide a balanced solution to the much-feared cost issues surrounding migrant health care, though the high migrant numbers in the US could lead to a higher cost burden. Nonetheless, one might easily question how long such financial considerations should be allowed to overshadow burgeoning health needs. The latter has been prioritized in Thailand, which extended its Universal Coverage Scheme in 2013 to put migrants on the same footing as citizens. This decision was motivated by Thailand’s recognition of the growth of its migrant population as well as the high level of integration between migrant and local populations, which makes widely accessible health care vital in stemming communicable diseases like HIV. [16][17] While Thailand’s approach is indeed unique, it does prompt the question of whether the US could — and should — soften its stance towards the more than 10 million undocumented migrants living amongst American communities. [18]

Ultimately, undocumented migrants are up against a multitude of systemic legislative, political, and cultural barriers in the U.S. Realistically, while international law can often have a strong normative effect, it is ultimately beholden to the will of sovereign states. In this case, an argument may be made that effective change must come from within. 

Isaac Ong

Cambridge Roundtable Collaborator

All Roundtable Sections edited by Jessica Lin

Sources

Section One

[1] Samantha Artiga and Maria Diaz, Health Coverage and Care of Undocumented Immigrants, Kaiser Family Foundation (2019), online at https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-and-care-of-undocumented-immigrants/ (Visited Nov 19, 2020).

[2] Health Coverage of Immigrants, Kaiser Family Foundation (2019), online at https://www.kff.org/racial-equity-and-health-policy/fact-sheet/health-coverage-of-immigrants/ (Visited Nov 19, 2020).

[3] Jeffrey Kullgren, Restrictions on Undocumented Immigrants’ Access to Health Services: The Public Health Implications of Welfare Reform, 93 American Journal of Public Health 1, 1630 (2003).

[4] Saltanat Liebert and Carl Ameringer, The Health Care Safety Net and the Affordable Care Act: Implications for Hispanic Immigrants, 73 Public Administration Review 1, 810. (2013). 

[5] id

[6] EMTALA Fact Sheet, American College of Emergency Physicians, online at https://www.acep.org/life-as-a-physician/ethics--legal/emtala/emtala-fact-sheet/ (Visited Nov 19, 2020).

[7] Mark Kuczewski, Health insurance to undocumented immigrants? It’s only fair to all of us, The Hill (2019), online at https://thehill.com/opinion/immigration/451937-health-insurance-for-undocumented-immigrants-its-only-fair-to-all-of-us (Visited Nov 19, 2020).

[8] Samantha Artiga and Maria Diaz, Health Coverage and Care of Undocumented Immigrants, Kaiser Family Foundation (2019), online at https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-and-care-of-undocumented-immigrants/ (Visited Nov 19, 2020).

[9] Ryan Capps, James Bachmeier, Michael Fix and Jennifer Van Hook, A Demographic, Socioeconomic and Health Coverage Profile of Unauthorized Immigrants in the United States, Migration Policy Institute 1, 7 (2013).

[10] Whitney Duncan and Sarah Horton, Serious Challenges and Potential Solutions For Immigrant Health During COVID-19, Health Affairs (2020), online at https://www.healthaffairs.org/do/10.1377/hblog20200416.887086/full/ (Visited Nov 19, 2020).

Section Two

[1] 42 C.F.R. § 56.111.

[2] Sonal Ambegaokar, Opportunities for Maximizing Revenue and Access to Care for Immigrant

Populations, Partnership for Public Health Law, online at http://www.astho.org/Public-Policy/Public-Health-Law/Access-to-Care-for-Immigrant-Populations-Overview (visited January 1, 2021). 

[3] id

[4] Amy Hsin & Francesc Ortega, What Explains the Wages of Undocumented Workers? (2019), EconoFact, online at https://econofact.org/what-explains-the-wages-of-undocumented-workers (visited January 1, 2021). 

[5] Historical (2019), Centers for Medicare & Medicaid Services, online at

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical (visited January 1, 2021).

[6] Krista M. Perreira et. al, Barriers to Immigrants’ Access to Health and Human Services Programs (2012), Urban Institute, online at https://aspe.hhs.gov/system/files/pdf/76471/rb.pdf (visited January 1, 2021). 

[7] id

[8]  Tricia Brooks, Lauren Roygardner and Samantha Artiga, Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2019: Findings from a 50-State Survey (2019), Kaiser Family Foundation, online at https://www.kff.org/report-section/medicaid-and-chip-eligibility-enrollment-and-cost-sharing-policies-as-of-january-2019-findings-from-a-50-state-survey-medicaid-and-chip-eligibility/#:~:text=This%20count%20includes%20Nevada%2C%20which,provided%20as%20of%20January%202019 (visited January 1, 2021). 

[9] Amanda Salami, Immigrant Eligibility for Health Care Programs in the United States (2017), National Conference of State Legislatures, online at https://www.ncsl.org/research/immigration/immigrant-eligibility-for-health-care-programs-in-the-united-states.aspx (visited January 1, 2021). 

[10] Michael Ollove, More Immigrant Children in U.S. Illegally to Receive Health Care (2017), online at https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2017/08/08/more-immigrant-children-in-us-illegally-to-receive-health-care (visited January 1, 2021). 

[11]  Amanda Salami, Immigrant Eligibility for Health Care Programs in the United States (2017), National Conference of State Legislatures, online at 

https://www.ncsl.org/research/immigration/immigrant-eligibility-for-health-care-programs-in-the-united-states.aspx (visited January 1, 2021). 

[12] Bobby Allyn, California is 1st State To Offer Health Benefits To Adult Undocumented Immigrants (2019), NPR, online at https://www.npr.org/2019/07/10/740147546/california-first-state-to-offer-health-benefits-to-adult-undocumented-immigrants (visited January 2, 2021). 

[13] 67. S.B. 104, Sess. of 2019 (Cal. 2019)

[14] Angela Hart, California relies on federal funds to expand undocumented health coverage (2019), POLITICO, online at https://www.politico.com/states/california/story/2019/06/15/california-relies-on-federal-funds-to-expand-undocumented-health-coverage-1061599 (visited January 2, 2021). 

[15] 42 C.F.R. § 413, 482, 489

[16] Governor's Budget Summary (2020), California Department of Finance, online at 

http://www.ebudget.ca.gov/2020-21/pdf/BudgetSummary/HealthandHumanServices.pdf (visited January 2, 2021). 

Section Three

[1] Fernandez, Manny, Mitch Smith, and James Dobbins. “5 South Texas Communities Have the Country’s Highest New Infection Rates.” The New York Times, August 14, 2020, sec. U.S. https://www.nytimes.com/2020/08/13/us/coronavirus-south-texas.html.

[2] Montejo v. Martin Memorial Medical Center, Inc., 874 So. 2d 654 (n.d.).

[3] id

[4] Dwyer, James. “When the Discharge Plan Is Deportation: Hospitals, Immigrants, and Social Responsibility.” Bioethics 25, no. 3 (March 2009).

[5] U.S. Customs and Border Protection. “Do the Department of Homeland Security’s Policies Concerning Enforcement Actions at or Focused on Sensitive Locations Remain in Effect?”Accessed November 29, 2020. https://www.cbp.gov/faqs/do-department-homeland-security%E2%80%99s-policies-concerning-enforcement-actions-or-focused-sensitive

[6] Morton, John. Enforcement Actions at or Focused on Sensitive Locations. U.S. Immigration and Customs Enforcement, October 24, 2011. https://www.ice.gov/doclib/ero-outreach/pdf/10029.2-policy.pdf.

[7] id

[8] AP NEWS. “Border Patrol’s Growing Presence at Hospitals Creates Fear,” October 17, 2019. https://apnews.com/article/52a38ce1d4b84e289b8073b47674514e.

[9]Southern Poverty Law Center. “‘Many Will Die’: Federal Filing Demands Release of Immigrants Confined to Deadly Florida Detention Centers.” Accessed November 21, 2020. https://www.splcenter.org/presscenter/many-will-die-federal-filing-demands-release-immigrants-confined-deadly-florida.

[10] id

[11] ProPublica, Lomi Kriel, The Texas Tribune and ProPublica and Dara Lind. “ICE Is Making Sure Migrant Kids Don’t Have COVID-19, Then Expelling Them to ‘Prevent the Spread’ of COVID-19.” The Texas Tribune, August 10, 2020. https://www.texastribune.org/2020/08/10/coronavirus-texas-ice-migrant-children-deport/.

[12] “Order Suspending a Introduction of Certain Persons Where Communicable Disease Exists.” Center for Disease Control, March 20, 2020. https://www.cdc.gov/quarantine/pdf/CDC-Order-Prohibiting-Introduction-of-Persons_Final_3-20-20_3-p.pdf.

Section Four

[1] International Organization for Migration, Migration And The Right To Health: A Review Of International Law, IOM Online Bookstore (2021), online at https://publications.iom.int/books/international-migration-law-ndeg19-migration-and-right-health-review-international-law.

[2] United Nations General Assembly, International Covenant On Economic, Social And Cultural Rights, United Nations Human Rights Office of the High Commissioner (1966), online at https://www.ohchr.org/en/professionalinterest/pages/cescr.aspx.

[3] United Nations General Assembly, International Covenant On Civil and Political Rights, United Nations Human Rights Office of the High Commissioner (1966), online at https://www.ohchr.org/en/professionalinterest/pages/ccpr.aspx 

[4] Southern Poverty Law Center, Family Separation under the Trump Administration – a Timeline, Southern Poverty Law Center (2020), online at www.splcenter.org/news/2020/06/17/family-separation-under-trump-administration-timeline. 

[5] Molly O’Toole, Family Separations a Year Later: The Fallout — and the Separations — Continue, Los Angeles Times (2019), online at www.latimes.com/politics/la-na-pol-family-separation-trump-year-later-20190412-story.html. 

[6] Jessica Lussenhop, The Health Impact of Separating Migrant Children from Parents, BBC News (2018), online at www.bbc.com/news/world-us-canada-44528900. 

[7] United Nations General Assembly, Convention on the Rights of the Child, United Nations Human Rights Office of the High Commissioner (1989), online at www.ohchr.org/en/professionalinterest/pages/crc.aspx. 

[8] The World, Trump Administration Plans Rule Change That Allows Indefinite Detention for Migrants, The World (2019), online at www.pri.org/stories/2019-08-22/trump-administration-plans-rule-change-allows-indefinite-detention-migrants. 

[9] Human Rights Watch, Code Red, Human Rights Watch (2018), online at www.hrw.org/report/2018/06/20/code-red/fatal-consequences-dangerously-substandard-medical-care-immigration. 

[10] “International Covenant on Civil and Political Rights,” art. 9. Dec. 16. 1966, 999 U.N.T.S. 171, online at https://www.ohchr.org/en/professionalinterest/pages/ccpr.aspx

[11] “International Covenant on Civil and Political Rights,” art. 4. Dec. 16. 1966, 999 U.N.T.S. 171, online at https://www.ohchr.org/en/professionalinterest/pages/ccpr.aspx

[12] C. v. Australia, CCPR/C/76/D/900/1999, UN Human Rights Committee (HRC), 13 November 2002. 

[13] International Commission of Jurists, Migration and International Human Rights Law: A Practitioners’ Guide, International Commission of Jurists (2014), www.icj.org/wp-content/uploads/2014/10/Universal-MigrationHRlaw-PG-no-6-Publications-PractitionersGuide-2014-eng.pdf. 

[14] Concluding Observations on Sweden, CAT, UN Doc. CAT/C/SWE/CO/2, 4 June 2008, para. 12. 

[15] Dan Biswas et al., Access to Health Care for Undocumented Migrants from a Human Rights Perspective: A Comparative Study of Denmark, Sweden, and the Netherlands, 14 Health and Human Rights Journal 2 (2012), online at www.hhrjournal.org/2013/08/access-to-health-care-for-undocumented-migrants-from-a-human-rights-perspective-a-comparative-study-of-denmark-sweden-and-the-netherlands. 

[16] Kanitsorn Sumriddetchkajorn et al., Universal Health Coverage and Primary Care, Thailand, World Health Organization (2019), online at  www.who.int/bulletin/volumes/97/6/18-223693/en. 

[17] Wudan Yan, Only One Country Offers Universal Health Care To All Migrants, NPR (2016), online at www.npr.org/sections/goatsandsoda/2016/03/31/469608931/only-one-country-offers-universal-health-care-to-undocumented-migrants. 

[18] Elaine Kamarck & Christine Stenglein, How Many Undocumented Immigrants Are in the United States and Who Are They, Brookings (2020), online at www.brookings.edu/policy2020/votervital/how-many-undocumented-immigrants-are-in-the-united-states-and-who-are-they.