2023 Update on Key Federal Immigration Policies and Implications for Health

In recent months, there has been increased focus on immigration trends and the evolving landscape of immigration policies, amid increasing immigration activity at the U.S.-Mexico border. In 2021, there were 20.8 million noncitizens and 23.9 million naturalized citizens residing in the U.S., who accounted for about 6% and 7% of the total population, respectively. Noncitizens include lawfully present and undocumented immigrants. Many individuals live in mixed immigration status families that may include lawfully present immigrants, undocumented immigrants, and/or citizens, including the one in four children who have an immigrant parent. Over the last two years, there has been a surge in immigration activity at the border, with over 2 million encounters at the U.S.-Mexico border in 2022. Against this backdrop, there have been ongoing changes to several key immigration policies. reflecting actions by the Biden Administration and court rulings.

This issue brief provides the latest update on some key evolving immigration policies, including Title 42 as it applies to border enforcement, the Deferred Action for Childhood Arrivals (DACA) program, and the public charge rule and discusses the implications of these policies for the health and well-being of immigrants.

Title 42

Title 42 restrictions will lift when the COVID-19 public health emergency (PHE) declaration ends on May 11, 2023.

Title 42 of the Public Health Services Act is a public health authority that authorizes the Director of the Centers for Disease Control and Prevention (CDC) to suspend entry of individuals into the U.S. to protect public health. This authority was implemented by the Trump Administration in March 2020 in response to the COVID-19 pandemic to allow for quick expulsion of migrants, including asylum seekers, seeking entry into the U.S. at the land borders. After taking office, the Biden Administration continued to enforce Title 42, with new exceptions provided to unaccompanied minors, but announced plans to end the suspension of entry in 2022. Due to court challenges, the policy remained in place pending the Supreme Court hearing arguments on whether a coalition of states, including Texas, could challenge a lower court ruling that ordered the policy be lifted. However, on February 16, 2023, the Supreme Court canceled the hearing for these arguments, following filing of a brief from the Biden Administration arguing that the case would become moot since the Biden Administration announced an end to the COVID-19 public health emergency (PHE) on May 11, 2023, which will consequently end the Title 42 border restrictions as well.

In 2022, over 1 million, or almost half (45%), of all migrant encounters at the border were under Title 42 authority. A vast majority (89%) of the Title 42 expulsions were of single adults. Research shows Title 42 expulsions have negatively impacted the health and well-being of migrant families. Physicians suggest that being in close proximity with other individuals while being temporarily detained or transported back to Mexico, lack of medical screenings, and lack of provision of necessary medication can all have adverse impacts on physical and mental health.

It is expected that immigration activity at the border will increase if Title 42 is lifted, and the Biden Administration has outlined new actions it will take to enhance border enforcement. If Title 42 is lifted, it will be increasingly important to address health and health care needs in border areas, given the disparities and challenges in these areas, particularly in the Texas border region (Figure 1). The Biden Administration has announced plans to increase security and enforcement at the border to reduce unlawful crossings, expand “legal pathways for orderly migration”, invest additional resources in the border region, and partner with Mexico to implement the aforementioned plans.

Deferred Action for Childhood Arrivals (DACA) Program

Under current court orders, the government is not processing first-time DACA applications, but existing DACA approvals remain in place and can be renewed.

The DACA program was originally established under a Presidential Executive Order in June 2012 to protect certain undocumented immigrants who were brought to the U.S. as children from removal proceedings and receive authorization to work for renewable two-year periods. To be eligible, individuals must have arrived in the U.S. prior to turning 16 and before June 15, 2007; be under the age of 31 as of June 15, 2012; be currently enrolled in school, have completed high school or its equivalent or be a veteran; and have no lawful status as of June 15, 2012. The program has enabled over 900,000 immigrants to stay in the U.S., go to school, and contribute to the economy through gainful employment.

As of September 30, 2022, there were over 589,000 DACA recipients in the U.S. A majority (58%) of active DACA recipients live in California, Texas, Illinois, New York, and Florida, 54% are female, and 65% are between the ages of 21 and 30 years.