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September 2025 (Volume 103)
Quarterly Article
Gabriela Plasencia
Kamaria Kaalund
Olurotimi Kukoyi
Viviana Martinez-Bianchi
Andrea Thoumi
Sep 23, 2026
Jun 29, 2026
Jun 12, 2026
Back to The Milbank Quarterly
Policy Points:
Populations that identify as Latino/a/e/x or Hispanic (herein referred to as Latine) in the United States continue to face disproportion-ate health and socioeconomic challenges that were exacerbated during the COVID-19 pandemic and persist in the current political climate.1–3 Long-standing systemic inequities, including precarious employment, fears caused by immigration policy (e.g., variations in the definition of public charge, a term in immigration law that describes individuals who are predominantly dependent on government assistance, influencing their eligibility for visas or residency status), and high uninsurance rates, among other factors, contribute to these disparities.4–7 Recently, in NorthCarolina, two legislative measures—House Bill 10 (implemented in December 2024) and Senate Bill 153 (passed in March 2025)—have directly targeted immigrant communities by mandating that sheriffs and state agencies collaborate with US Immigration and Customs Enforcement (ICE) without ensuring due process. Furthermore, the escalation of public deportations and the looming threat of cuts to Medicaid fund-ing reflect and reinforce long-standing concerns among Latine and other immigrant populations regarding enrollment in insurance and other public benefits.In this article, we assert that the persistent gaps in insurance coverage among eligible Latine individuals in North Carolina are largely exacerbated by structural barriers and data deficiencies that minimize the appearance of inequities. We first examine the transition from the COVID-19 Public Health Emergency (PHE) to the recentMedicaid expansion in North Carolina to reveal how procedural challenges and systemic distrust have contributed to significant coverage lapses. We then detail the unique obstacles Latine communities face during enrollment, which underscore the need for more precise data collection and culturally informed outreach. Finally, we propose community-informed policy solutions designed to address these challenges.
Vargas ED, Sanchez GR. COVID-19 is having a devastating impact on the economic well-being of Latino families. J Econ Race Policy. 2020; 3(4): 262–269. https://doi.org/10.1007/s41996-020-00071-0
De Ramos IP, Lazo M, Schnake-Mahl A, et al. COVID-19 outcomes among the Hispanic population of 27 large US cities, 2020–2021. Am J Public Health. 2022; 112(7): 1034–1044. https://doi.org/10.2105/AJPH.2022.306809
Tai DBG, Shah A, Doubeni CA, Sia IG, Wieland ML. The disproportionate impact of COVID-19 on racial and ethnic minorities in the United States. Clin Infect Dis. 2021; 72(4): 703–706. https://doi.org/10.1093/cid/ciaa815
Gould E, Perez D, Wilson V. Latinx workers—particularly women—face devastating job losses in the COVID-19 recession. Economic Policy Institute. August 20, 2020. Accessed April 4, 2025. https://www.epi.org/publication/latinx-workers-covid/
Pillai D, Artiga S. Changes to the public charge inadmissibility rule and the implications for health care. Kaiser Family Foundation. May 5, 2022. Accessed April 4, 2025. https://www.kff.org/racial-equity-and-health-policy/issue-brief/2022-changes-to-the-public-charge-inadmissibility-rule-and-the-implications-for-health-care/
Hill L, Ndugga N, Artiga S, Damico A. Health coverage by race and ethnicity, 2010–2022. Kaiser Family Foundation. February 13, 2025. Accessed April 4, 2025. https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-by-race-and-ethnicity/
Bustamante AV, Félix-Beltrán L, Nwadiuko J, Ortega AN. Avoiding Medicaid enrollment after the reversal of the changes in the public charge rule among Latino and Asian immigrants. Health Serv Res. 2022; 57(Suppl 2): 195–203. https://doi.org/10.1111/1475-6773.14020