My uncle’s death is what first shaped my understanding of how gaps in healthcare access can have devastating consequences. When he passed away in 2015, the loss my family and I felt was sudden and deeply confusing. I was only 14 years old, and we had been told that he was going to recover. His death left us with a sense of regret and unanswered questions, not fully understanding how his condition had worsened so quickly.

He was a green card holder working part-time who also picked up the responsibility of caring for my brothers and me while my parents were at work. He was not eligible for employer-sponsored insurance and did not qualify for coverage due to both his immigration status and employment classification. Over time, this lack of access to consistent medical care, combined with unhealthy lifestyle habits, contributed to a rapid decline in his health. He eventually developed heart disease, a condition that could have been better managed or even prevented with earlier access to appropriate medical support.⁶

His story is not unique. Higher rates of morbidity and mortality from preventable chronic illnesses among immigrant populations are often linked to limited access to medical services, which leads to lower use of preventive care.¹ Access to insurance plays a major role in this disparity, as differences in coverage largely explain why immigrants are less likely than non-immigrants to utilize primary care services.²

In March 2010, the Affordable Care Act (ACA) was signed into law, significantly expanding access to care for vulnerable populations, including lawful permanent residents, by allowing them to obtain insurance coverage and purchase private plans. The ACA’s expansion of Medicaid prevented thousands of premature deaths, with an estimated 39 to 64 percent reduction in annual mortality rates among older adults.⁷

Since my uncle’s death, several policies have been implemented to address these inequities. In California, Medi-Cal, the state’s Medicaid program, provides free or low-cost coverage to low-income individuals across all age groups. Notably, in January 2024, California became the first state to extend full Medi-Cal benefits to all income-eligible residents regardless of immigration status.³ This expansion represented a major step toward reducing disparities in access to care and improving health outcomes for underserved communities.

However, recent policy changes may undermine this progress. Due to ongoing budget constraints and shifts in funding priorities, California is introducing new restrictions on Medi-Cal eligibility. Beginning in January 2026, adults without satisfactory immigration status (SIS) will no longer be eligible for full-scope Medi-Cal coverage. While undocumented individuals who are already enrolled may maintain their coverage if they complete annual renewals on time. This could create additional barriers for those seeking care for the first time and are unaware of these new policies.^4,8

At the federal level, policies such as the Emergency Medical Treatment and Labor Act (EMTALA) ensure that hospitals cannot deny emergency treatment based on a patient’s insurance status or ability to pay.5 While I believe EMTALA serves as a safety net, it primarily addresses health conditions only after they have become severe. This reliance on emergency care highlights the need for stronger investment in primary and secondary prevention strategies that can reduce disease burden earlier and more effectively.

A useful comparison can be drawn from Canada’s healthcare system. Canada’s publicly funded model provides universal coverage for hospital and physician services at no cost at the point of care.⁹ Although implementing a fully similar system in the United States may present political and structural challenges, certain elements could be adapted to strengthen existing programs like Medi-Cal.

In addition to public coverage, Canada supports uninsured populations through community-based services. The Health Network for Uninsured Clients (HNUC) offers primary care, gender-affirming services, pregnancy care, and tuberculosis prevention programs for individuals without insurance.¹⁰ Similarly, Community Health Centres (CHCs) provide team-based care, health promotion, and disease prevention services, particularly for populations facing barriers such as low-income residents and recent immigrants.¹¹ These centers play a critical role in expanding access to essential services, an approach that could help address gaps that still exist in California.

Expanding similar community-based models in the United States could help reduce gaps in access for immigrant populations, particularly those who remain uninsured. Additionally, expanding Medicare or Medicaid to cover essential services while maintaining private insurance options would better align with the United States market-based system while improving access to care.

Ultimately, immigrant health disparities are not inevitable. They are the result of policy decisions that shape who has the right to access care and who is excluded. Strengthening inclusive policies and investing in preventive services can improve health outcomes and reduce inequities across populations throughout the United States and help prevent premature deaths from avoidable chronic illnesses like those experienced by my uncle.