The COVID-19 public health and economic crisis in the United States has had particularly dire consequences for immigrant families as they are more likely to work in low-wage and front-line jobs without health insurance or family and sick leave.1,2 Immigrants represent a growing proportion of the Employed (17.4% in 2019) 3 and the majority in important sectors such as agricultural work. 4
Despite their importance to the economy and the disproportionate negative impact of the pandemic and economic crisis on immigrant families (defined as those with at least one foreign-born parent), many immigrants and U.S. citizenship spouses (1.4 million) and children (3, 7 million.)) In immigrant families were exempted from initial COVID-19 relief efforts.5 These exclusions built on existing restrictions restricting immigrants' access to the social safety net for families with mixed status (with at least one non-national).
The intensified anti-immigrant climate in the US has exacerbated the effects of restrictions on the public program. Recent surveys have shown that immigrant families are often reluctant to apply for social programs that can alleviate economic hardship and provide access to health care.6,7
26% of children in the United States live in immigrant families, so these restrictions have the potential to affect safety net access and the health of a sizable child population.8 Although 91 percent of children in immigrant families are U.S. citizens, 8 are 72 percent (13th , 7 million) live in mixed status families.9 While we therefore focus on the effects of immigration restrictions on citizen children, their access to the safety net is inextricably linked to, and needs to be explored through, their families' treatment in social policy.
In the US, immigrants are at greater risk of socio-economic adversity and stressors (e.g., poverty and occupational risks, which are social determinants of health) than the US-born population.10,11 The legality – or illegality – of Immigration status is another important social health factor. Different treatment according to legal status is a form of social stratification in which a lower legal status is associated with greater health risks (e.g. deportation and family separation). Immigrants with a more secure legal status continue to have negative exposures, albeit at a lower level.11–14
We propose that limited access to the social safety net due to legality is a form of structural discrimination that applies to immigrant families and that negatively affects children of U.S. citizens in those families by reducing human capital investment and opportunities for economic mobility . Although the stratification of legality is at first sight racially neutral, it has been racially justified and implemented12,15 and has different effects on Hispanics, who are much more likely to be low-income immigrants than other groups
A 2019 report by the National Academies of Sciences, Engineering, and Medicine showed that expanding existing social programs can significantly reduce child poverty, due to existing restrictions1 that disproportionately harm Hispanic children, as 54 percent have at least one immigrant parent have 8
As the country's leaders consider further economic facilitation to fight the pandemic and build fairer social policies17, a careful analysis of immigration restrictions and their potential negative effects on children is needed. EITC and the Supplemental Nutrition Assistance Program (SNAP) have beneficial effects on child and adult health.18,19 Therefore, lifting restrictions may improve the health of immigrants and their children.18
This article has three goals. First, we discuss the legality of immigration as one of the social determinants of health. We show that immigrant stratification and the restrictions imposed by legality extend to the treatment of immigrant families in US social policy. In turn, access to the social safety net is another important social health factor. Second, we use this framework of immigration stratification by legality to examine how exclusion of immigrants affects children of US citizens in mixed status families. We focus on three safety net programs: EITC and SNAP, which are two of the most effective programs for reducing child poverty, 16 and the Child Care and Development Block Grant Program (also known as Child Care Allowance). The Childcare Allowance Program is a much smaller poverty reduction program than EITC or SNAP, but it is an essential job support for low-income families. Third, we outline policy recommendations to remove restrictions that harm children in immigrant families.
Immigration status as a social determinant of health
The growing evidence shows the complex effects on immigrant health, including the social determinants of health in their country of origin and destination, as well as persistent ties with their country of origin after migration.20 US immigrants and their children see themselves in better health – and developmental situation confronts risks as non-immigrants.10 Conversely, they show health resilience to these negative factors, possibly because healthier people are more likely to migrate.20 For example, although infants of women with a low level of education generally have a lower birth weight, babies of immigrant women have less as a high school graduation have favorable birth weight results.21 Although immigrant children are more likely to have healthy birth weights, adverse childhood experiences can lead to poor results later on. For example, children of immigrant mothers have higher obesity rates than comparable children of US-born mothers. Immigrant mothers have healthier weights prior to pregnancy, but this protective factor against childhood obesity is later offset by risks related to their families' immigrant status – for example, food insecurity, which has been linked to obesity and has been linked to exclusion from nutrition programs .22, 23
“Illegality” as a social determinant of health
Racism and discrimination are increasingly recognized as social determinants of health.24 "Legality" or "illegality" – an expression of structural discrimination – is another social determinant of health that contributes to immigrants' vulnerability to ill health, injury and violence.14, 25,26 Health risks related to illegality that extend to citizenship children in mixed-status families include psychosocial distress (e.g. fear of deportation), direct physical threats (e.g. family separation) and difficult access to health promoting resources like healthcare. These stressors have been linked to negative effects on child development and health.27–30
When originally proposed by researchers in the 2000s, the construct of illegality as a social determinant of health focused on undocumented immigrant status. However, for about a decade or so, illegality has been suggested as a continuum of health vulnerability, reflecting the insecurity and restricted access and opportunities associated with lack of citizenship. These vulnerabilities extend to those with legal immigration status, not just those with undocumented status. Undocumented children face unique health vulnerabilities associated with immigration enforcement, but the same threat extends to citizen children in mixed-status families.12,31-34
Legality does not correspond to the dichotomy of legal versus undocumented status in terms of US immigration policy.
For this analysis, we define legality as an axis of stratification that divides immigrants into categories and assigns these categories different degrees of access to social policies and programs that have health implications (see online appendix, Figure 1) .35 However, legality does not. the dichotomy of legal and undocumented status as defined in US immigration policy.
The stratification by legal status symbolically reflects judgments about the merit of immigrant families. Lower earnings are associated not only with undocumented immigrant status, but also with more recent socio-politically codified classifications – for example, unskilled immigrants and recently qualified immigrants who are still below the five-year period (a five-year waiting period that begins if one has qualified immigration status) as well as American children who live with immigrants in unqualified and recently qualified immigrant categories (Appendix 1) .35 This stratification is not only symbolic but is also embedded in politics and is exclusive and discriminatory Effects. Legality also has implications for social inclusion as it reinforces the belief that immigrant families do not fully belong in the US and that legal immigrants, and even US citizens living with immigrants, earn less.
Illegality and exclusion of children from the safety net
US social policy has evolved to exclude not only undocumented immigrants, but also legal immigrants and US citizens from immigrant families.36 Restricted access to the safety net makes it difficult to access health-promoting resources (e.g. food aid), income supplements (e.g. food supplements) Tax reductions for lower-income families) and work aids (e.g. childcare) associated with better health outcomes.37
Previous work has provided a detailed description of various immigration restrictions in social programs.38 Here we offer a social determinant of the health framework to examine immigration restrictions as an expression of structural racism.
Historically, safety net programs have not consistently included criteria for admitting immigrants.39,40 Over time, US social policy has increased restrictions on different classes of immigrants. From the 1970s onwards, undocumented immigrants were denied access to social programs.39,40 To date, they are not entitled to most state benefits with very few exceptions, such as B. Emergency Medicine. 40
In addition, lawfully present immigrants also face many restrictions that limit their access to social programs. Until 1996, legal immigrants were treated essentially like US citizens for eligibility to social programs. Eligibility changed in 1996 when the Law on Reconciliation of Personal Responsibilities and Job Opportunities, known as "Welfare Reform," explicitly restricted access to most government benefits for legal immigrants.16,40,41 The law changed the treatment of legal immigrants in the United States USA radical social policy by creating a further stratification along a legality continuum.
Stratification by legal status includes legal immigrants, naturalized citizens, and even U.S. children and spouses living in mixed-status families (Appendix 1) .35 Children of citizens living in immigrant families are denied the full benefits of citizenship because their welfare is dependent on Status of their parents 42
Low-income immigrant families have more labor and a significantly higher poverty rate than non-immigrant families, but have less access to critical safety net programs, leading to economic hardship
Access restrictions to three Safety-Net programs
In this section, we show how three safety net programs (EITC, SNAP, and Child Care and Development Block Grant) allow US citizens to live in families with mixed status through exclusion criteria, benefit cuts, administrative burdens, and application of the public tax rule.
We will focus on three programs, but it is important to note that these types of restrictions apply to immigrant participation in almost any form of essential support for low-income families, such as: B. Housing allowances and additional security income. Figure 1 shows the differences in eligibility restrictions, benefit restrictions, applicability of public tax rules, and administrative burden imposed by different categories of immigrants in terms of the continuum of legality in the EITC, SNAP, and childcare allowance programs.
|Programs||Program benefits||Eligibility restriction for parents with a migration background||US citizens 'eligibility is limited by their parents' immigration status||Stricter income entitlement due to sponsor "deeming"||Benefit restrictions based on the proportion of ineligible non-nationals||Subject to the public tax rule c||Subject to the administrative burden|
|EITC||Cash: refundable tax credit||Social security number required for all family members||Yes||No||No||No||Yes|
|SNAP||Cashless: help with grocery shopping||Most skilled immigrants are subject to the five year old Barb||No||Yes||Yes||Yes (February 2020 – March 2021)||Yes|
|Grant for the development of the childcare block||Cashless: Help with buying childcare||None, authorization depends on the child||No||No||No||No||Yes|
Both stratification by legality and eligibility based on immigration status vary by program. Depending on the program, low-income children of US citizens may be eligible even if their non-citizens parents are not (examples of inclusive eligibility are SNAP and childcare allowances), while entire immigrant families may be considered ineligible due to the immigrant status of the parents even if the children or one of the spouses is a US citizen (an example of eligibility for exclusion is the EITC)
"Assessment" of the sponsors' income
Immigrants may also have stricter income criteria that harm entire immigrant families, including U.S. citizens.41 To enter the U.S., legal U.S. permanent residents have a sponsor who signs an affidavit that provides sufficient economic support pledges to keep sponsored immigrant income above 125% of the federal poverty line. In a practice called Deeming, which has become increasingly stringent after welfare reform, the sponsor's household income is included in the income eligibility determinations of the immigrant family16 (see Appendix 2c for more details) .35 Deeming often ineligible immigrants by serving their Increase incomes appear to be above the program threshold, which can result in children of US citizens living in immigrant families not having access to these programs.41 Of the programs examined here, the classification is considered to be SNAP.
The five-year bar
The social reform divided non-citizens into “qualified” and “unqualified” categories (Appendix shows 2a and 2b) 35 for most in-kind benefits such as SNAP. These categories do not correspond to the immigration status in the Immigration Act, but create a new hierarchy of immigrants according to degree of program access.40 Qualified immigrants include legal permanent residents (e.g. holders of a green card), refugees, asylum seekers and other categories. The Reconciliation of Personal Responsibility and Job Opportunities Act further subdivided qualified immigrants according to duration of qualification status (Appendix 1) .35 With few exceptions, qualified immigrants who had qualification status less than five years do not have access to federal safety net programs, even if they have would otherwise be justified. 40
Of the three programs examined here, the five-year period is for most adult immigrants to participate in SNAP. Intensive advocacy after welfare reform led to the realization that the restrictions were extremely criminal for SNAP. The five-year lock on SNAP benefits was lifted in 2003 for qualified immigrant children, but it continues to apply to their legal permanent residents, reducing the SNAP benefits received by immigrant families.40 Eligibility for a childcare and development block grant is based on the immigration status of the child and does not take into account the immigration status of the parents.
Social security numbers
Immigrant eligibility restrictions also apply to tax credits, which are the most effective poverty reduction programs.16 The EITC has the most restrictive eligibility along the legal status continuum – that is, citizen children are completely denied access to the EITC if even one parent lacks a social security number. 40 The EITC is not considered a government public benefit under the social security reform, but the tax law was changed during the social security reform to limit immigrants' eligibility to EITC by requiring all taxpayers and beneficiaries to have social security numbers. Prior to the social reform, immigrants who filed taxes could apply for tax credits if they were otherwise eligible. This included undocumented immigrants, most of whom work and pay taxes. 43
In some programs, benefit amounts for some immigrant families differ on the continuum of legality in penal ways. For example, the SNAP rules require family support to be divided according to the proportion of ineligible non-nationals in the household (e.g. undocumented immigrants or skilled immigrants who are below the five-year limit), 44 which reduces benefit amounts for the entire family including children of US citizens. 18
The public fee rule Public
Immigrants seeking permanent legal residence must demonstrate that they are unlikely to become a “public burden”, defined as primary reliance on government services (see Appendix 2c for details) .35 Prolonged reliance on public programs may result in a Immigrants labeled as a public prosecution.45 Research suggests that confusion and fear associated with a public prosecution have deterred immigrants from participating in safety net programs.46
The deterrent effect of the public donation rule was tightened in 2017 when a draft rule was expanded to include not only the use of cash programs but also some public in-kind benefits such as SNAP and Medicaid.7,45 Although the rule change included expanding the reach of public Fees was withdrawn in March 2021, 47 that the changes and associated perceptions likely have further reduced immigrant participation in public programs.7 National surveys show that even legal permanent residents, naturalized citizens, and US-born children and Due to widespread confusion and fear, spouses are foregoing benefits, including programs that are typically not addressed in the proposed changes.6,7
For immigrant families, the high administrative burden (the compliance costs associated with interacting with the government) 48 is a feature of policy making that is intended to have exclusive effects.15 It may reduce use in some programs, with potentially negative health consequences.37 Review procedures Citizenship and immigration status to determine eligibility is subject to state and local discretion, which may limit participation. For example, the regulations on childcare and development block grants make it clear that childcare grants are targeted at children, so their immigration status needs to be verified but the immigration status of parents cannot be taken into account. Of the thirteen states that make up 80% of the Hispanic population, twelve requested household member social security numbers in block grant applications for childcare and development, and seven of those states did not indicate that social security numbers were optional. The lack of clarity can discourage immigrant families from applying even though their children are eligible. 49
Less participation in the program
Due to eligibility, administrative burdens and other barriers to participation, immigrant families have significantly less participation in safety net programs.1,15,40 The scope and exclusionary effects of immigration restrictions are potentially large, with 36% of children living in poverty (3, 40) 5 million) in families with mixed status. 9
As shown in Figure 2, 56 percent of all income-entitled citizen families from income-entitled families receive the EITC, compared to 44 percent of families with at least one non-citizenship family member. Immigrant participation in SNAP is higher, but only 74% of eligible children living with non-nationalized adults participate in SNAP, compared to 84% of all eligible families. Childcare benefit participation for low-income children of immigrant mothers is only 6%, compared with 15% for children of US-born mothers. Appendix 3 contains more detailed results 35
Estimates of immigrant and non-immigrant participation in Income Tax Credit (EITC), Supplemental Nutrition Assistance Program (SNAP), and Childcare Subsidy Program
The SOURCE authors' analysis is based on data from the following sources: Dana Thomson, Senior Research Scientist, Child Trends, personal communication, March 24, 2021; Thomson D, Gennetian LA, Chen Y, Barnett H, Carter M, Deambrosi S. Government policies and practices regarding income tax credits can affect receipt among Hispanic families with children (Internet). Bethesda (MD): Children's Trends; 2020 Nov. (cited May 17, 2021). Available at: https://www.childtrends.org/wp-content/uploads/2020/11/EITCPolicy_ChildTrends_November2020.pdf; Vigil A. Trends in Supplemental Nutrition Assistance Program Participation Rates: Fiscal Year 2010 to Fiscal Year 2017 (Internet). Washington (DC): Mathematica Policy Research; 2019 Sept (cited May 17, 2021). Available at: https://mathematica.org/publications/fy-2010-to-2017-trends-in-supplemental-nutrition-assistance-program-participation-rates; Johnson AD, Han W-J, Ruhm CJ, Waldfogel J. Childcare allowance and schooling of immigrant children. Kind Dev. 2014; 85 (6): 2140–50. NOTE Details of program participation estimates are given in Appendix 3 (see Note 35 in text).
Neither inclusive pandemic recovery nor an inclusive social safety net is possible if policies exclude large sections of low-income families.
Neither inclusive pandemic recovery nor an inclusive social safety net is possible if policies exclude large sections of low-income families. The American Rescue Plan Act of 2021 made millions of children eligible for relief efforts like stimulus checks and the refundable child tax credit. However, the measures of the law are temporary.50 In the long term, the racial / ethnic inequalities enshrined in US social policy must be addressed.
Below we outline eight policy recommendations that will guide more inclusive social policies and aim to improve the social determinants of child health in immigrant families.
Eligibility for tax credits and pandemic cash should be based on the child's health and development needs, not the household's immigrant status. Restricting US citizens and lawful children's access to social programs based on the mixed immigration status of families, rather than necessity, is punitive and harmful to the health of the children.
Provide immediate aid in cash
In a national crisis, all children with social security numbers should be eligible for economic impact payments (or stimulus checks) even if their parents or parents without a social security number file taxes. Although this population was newly eligible for economic impact payments under the American Rescue Plan Act, the change came a year after the pandemic, after millions of children in immigrant families had suffered economic hardship and food insecurity.
Set the precedent for EITC eligibility for payments with economic impact
The exclusion of citizens and lawfully present children from the initial COVID-19 relief packages replicated existing EITC restrictions. At least otherwise qualified children with Social Security numbers should be eligible for the EITC – regardless of the form of identification their parents use on tax returns – in order to comply with the economic impact precedent under the American Rescue Plan Act. Beyond the pandemic, access to the EITC is important as the program reduces poverty and improves children's health. 51
Offer a child tax credit to all children of income taxpayers
Under the American Rescue Plan Act, an estimated 27 million children were newly eligible for the fully recoverable portion of the child tax credit, and the credit amount was also temporarily increased.50 There is growing interest in making these changes to the child tax credit permanent, which would have great poverty-reducing effects . Permanent changes should follow the child tax deduction eligibility rules before 2018 – i.e. H. Include children without a social security number – to avoid worsening the poverty gap between children without a social security number and their peers who have one.
Address performance levels
The level of benefits provided by the safety net program, particularly in relation to nutrition, should be based on the needs of the children and not on the families' immigration status.
The level of benefits provided by the safety net program, particularly in relation to nutrition, should be based on the needs of the children and not on the families' immigration status. Access to basic food is so important to child development that immigration restrictions are not justified. The most extreme eligibility restrictions under the Personal Responsibility and Work Compatibility Act were lifted in 2002, but middle-class and legally present children in families with unqualified members are still at a disadvantage when calculating the amount of benefits – that is, when the household does not includes eligible immigrants, the household benefit, and therefore the benefit per child, will be lower than if all household members were eligible. Benefits should be calculated based on the nutritional needs of children regardless of immigration status.
End of the five-year bar
Die fünfjährige Sperre für qualifizierte Einwanderer verschärft die finanzielle Not für Einwandererfamilien entlang des Kontinuums der Legalität, einschließlich Bürgerkindern. Die Aufhebung der Sperre würde den Zugang zum Sicherheitsnetz mit potenziellen gesundheitlichen Vorteilen verbessern.
Überprüfen Sie den Nutzen öffentlicher Gebühren erneut
Die Biden-Regierung hat die öffentliche Gebührenregel vor der vorgeschlagenen Änderung für 2020 auf den Status quo zurückgesetzt, die Programme mit wichtigen gesundheitlichen Vorteilen wie SNAP und Medicaid ausgeschlossen hätte. Die öffentliche Abgabenregel gilt jedoch weiterhin für den Erhalt von vorübergehender Hilfe für bedürftige Familien und zusätzlichem Sicherheitseinkommen – zwei wichtige Programme, die das Familieneinkommen ergänzen und die Armut verringern. Angesichts der potenziellen Gefahr der Vorschrift für Kinder und der öffentlichen Gesundheit52 sowie ihrer diskriminierenden Ursprünge und Umsetzung53 sollte die Pandemie zu einer Neubewertung des Nutzens öffentlicher Anklage in der US-amerikanischen Sozialpolitik führen.
Sozialpolitische Reformen sollten von einer soliden Öffentlichkeitsarbeit und Umsetzung begleitet werden, um den Verwaltungsaufwand zu verringern, der durch komplexe Förderfähigkeitsregeln, abschreckende Effekte aufgrund der Regel der öffentlichen Abgaben und Sprachbarrieren entsteht. Zum Beispiel kann der Sprachzugang in SNAP und im Child Care and Development Block Grant verbessert werden, für die Programminformationen und Anträge auf Spanisch nicht allgemein verfügbar sind.49,54
Das Sicherheitsnetz für Einwandererfamilien ist wesentlich eingeschränkter als das für vergleichbare Nichteinwanderungsfamilien. Für Kinder aus Einwandererfamilien, die überwiegend US-Bürger sind, hat dies gravierende negative Auswirkungen auf den Zugang zu Sozialprogrammen und potenziell negative Auswirkungen auf ihre Gesundheit.
Die COVID-19-Pandemie bietet eine einzigartige Gelegenheit, die schädlichen Auswirkungen der Schichtung nach Rechtsstatus zu verringern, beginnend mit der Gewährleistung des Zugangs zum Sicherheitsnetz für alle Kinder mit US-Staatsbürgern in Familien mit gemischtem Status. Kurzfristig lässt sich dies weitgehend nach der Behandlung von Migrantenfamilien in Programmen mit relativ inklusiven Angeboten und nach inklusiveren Anspruchsberechtigungen in der jüngeren Vergangenheit (z. B. vor der Sozialhilfereform, vor dem Steuergesetz 2017 und vor dem Jahr 2020) modellieren Änderung der Gebührenordnung). Längerfristig schafft die jüngste Durchführungsverordnung der Biden-Regierung zur Rassengerechtigkeit17 einen Rahmen, um Inklusion und Gerechtigkeit in die Behandlung von Einwandererfamilien in der US-Sozialpolitik einfließen zu lassen.
Die Autoren danken der WT Grant Foundation und der Spencer Foundation (einschließlich Children of Immigrants in the Post-Pandemic Economic Recovery Efforts and Safety Net, Grant Nos. 201535 and 202100092; Dolores Acevedo-Garcia, Principal Investigator; Pamela Joshi, co –Hauptprüfer).
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