Bridging the Gap: Immigrant Access to Healthcare Policy Information in the Biden-Harris Administration

By Victoria Arias

In the wake of the COVID-19 pandemic and amid deepening polarization around health and immigration, the Biden-Harris Administration sought to rebuild trust in public institutions through expansive healthcare policies, aimed at equity and access. But policy creation is only one side of the equation. How that information reaches immigrant communities, and whether they understand and act on it, remains a critical and underexplored question.

As a student researcher at the University of Denver, I spent the past eight months investigating public awareness of healthcare policies during the Biden-Harris administration, with a particular focus on immigrant communities. My research sought to uncover whether policy awareness shaped civic engagement, especially participation in elections and local advocacy.

This work emerged from my internship with the U.S. Department of Health and Human Services (HHS). In this internship, I translated critical public health documents into Spanish, and worked with the Regional Director for Region VIII, Lily Griego. Through that experience, and with the support from the Center for Immigration Policy & Research (CIPR), I started an independent research project combining interviews, surveys, and policy analysis.

What I found reveals both hope and deep disconnections. Many immigrants care about healthcare and want to participate in democracy, but systemic and communicative barriers too often leave them uninformed or excluded. This project aims to bridge that gap and make immigrant voices central to future policy communication strategies.

Translating and Advocacy

In Spring 2024, I began an internship with the HHS working under Lily Griego. My title was Bilingual Outreach Intern, and in this role, I conducted research on healthcare policies and disparities. One project was focused on Afro-Latinos and African American communities’ health disparities, specifically on cancer and cardiovascular disease. Using databases from the National Library of Medicine, I collected and translated complex data into culturally sensitive and linguistically accessible Spanish documents. These materials were then reviewed and sent to my supervisor for use in outreach. I also wrote and translated an editorial for Colorado newspapers like El Semanario and La Voz Colorado. This piece addressed Asian American and Pacific Islander (AANHPI) Heritage Month, highlighting the troubling data that Asian American Medicare enrollees disproportionately struggle to afford prescription medications. It connected these disparities to the Inflation Reduction Act and broader themes of racial injustice and equity. At every stage, I ensured that the Spanish I used was non-bureaucratic, compassionate, and culturally attuned, because language access is more than translation; it’s about connection.

The CIPR Research Project

With the support of DU’s Center for Immigration Policy and Research, in October 2024, I began to investigate how healthcare policy reaches and is understood by immigrant communities. My guiding question was, “How do immigrants and Spanish-speaking individuals receive healthcare policy information, and does that understanding translate into trust, access, or civic engagement (like voting or advocacy)?”

To answer this, I created a 15-question, anonymous, bilingual survey from individuals currently living all around the United States. Respondents represented diverse national backgrounds, such as Mexico, Guatemala, El Salvador, Venezuela, and more. Some were immigrants but others were born in the United States. Comparing these populations offered insight into shared and distinct challenges. The anonymity of the survey was intentional, as given the climate of fear many immigrant families still face, I wanted to ensure safety and trust.

Instead of direct interviews with immigrants, I turned to professionals who work closely within these communities. I conducted three interviews, two with individuals who hold Ph.D.s, where I received valuable insights into how healthcare policy information is consumed, interpreted, and trusted across different generations and social contexts. These conversations revealed critical gaps in how federal healthcare policies are communicated, especially among older adults, who often struggle with digital access, and among highly educated individuals who nonetheless found official government messaging lacking in clarity or presence. Their perspectives, though not grounded in direct work with immigrants, highlighted the broader structural and informational barriers that likely impact immigrant communities even more acutely. I also interviewed a Registered Nurse who works directly with Spanish-speaking immigrants in community health clinics, and provided a frontline view of communication gaps, systemic neglect, and the moral burden of navigating healthcare with and for underserved populations.

Interview Insights: Frontline Perspectives on Access and Equity

One of the most powerful interviews in this project came from a registered nurse who has worked in a nonprofit hospital and in the healthcare field for over 10 years. Her firsthand account painted a picture of the daily communication barriers immigrant patients face, not only due to language, but because of systemic neglect and understaffing. She explained that while professional interpreters are technically available, they’re often underused. Nurses may avoid finding translators because of time constraints, lack of motivation, or even indifference. This leads to patients receiving only partial information or none about their diagnoses, treatments, or care plans. As she put it “Some nurses don’t want to go out of their way, or they don’t have the time. So, they just don’t do it.”

The consequences are severe. She described caring for Spanish-speaking patients who had already been hospitalized for several days yet had no idea why they were receiving certain medications. As one of the few bilingual staff, she often had to spend extra time filling in major gaps. Patients who were assumed to “understand enough” had gone days without clear explanations. In a troubling development, she shared that two recent patients from Guatemala were reportedly encouraged by medical staff to return to their home country. One due to repeated readmissions and mental health challenges, and another because he was uninsured and now quadriplegic. These stories raise ethical red flags, particularly in a nonprofit setting. 

“I’ve worked in healthcare for over a decade,” she said, “and I’ve never heard of a hospital trying to send someone back to their country just because they can’t pay.” 

She emphasized that when she introduces herself in Spanish, families visibly relax. “They’ll leave the room, because they trust me to care for the patient. Just that language connection makes them feel safe.”

Finally, she offered a clear, actionable policy recommendation: mandate the use of interpreters at least twice per shift, for patients with limited English proficiency. “Even just once per shift, to explain the medications or plan of care, would make a huge difference. Communication is everything.”

Her message underscored the deeper truth behind language access, because it’s not just about translation, but about dignity, trust, and equal treatment in life-or-death situations.

Survey Patterns and Findings

Though limited in scale, the survey responses show how different populations receive and interpret healthcare information. Among English-speaking respondents, social media (80%) and friends or family (67%) were the most common sources of health policy information. By contrast, Spanish-speaking respondents primarily relied on TV news (83%) and close personal networks (83%), such as family members. Notably, both groups cited “complexity” and “lack of time” as the most frequent barriers to fully understanding policy messages.

Awareness of government campaigns also varied. While 63% of English speakers recalled seeing campaigns, mostly on platforms like Instagram or TikTok, only a third of Spanish-speaking respondents remembered any outreach. Even among those who had seen official messaging, the majority rated it as only “somewhat effective.”

Age played a major role in communication preferences as well. Spanish-speaking participants were largely over 40 and suggested TV, mail, or community-based events as more impactful outreach strategies. English-speaking participants, mostly college-aged, preferred digital media, especially short-term video content. Despite generational differences, nearly all respondents expressed a shared desire for more transparent, culturally aware, and plain-language health communication.

These findings confirm what advocates and healthcare workers have said: Immigrant and bilingual communities are not disengaged, they are underserved. Improving communication requires not just more content, but audience-specific strategies that recognize both language and life experience.

Policy and Communication Recommendations

While the Biden-Harris Administration has made substantial investments in health equity, gaps remain in how these policies reach the people they are meant to serve. Based on my research and my experience with the U.S. Department of Health and Human Services, the following areas offer meaningful opportunities for improvement:

1. Mandate Language Access Standards Across All Healthcare Settings – Despite existing civil rights regulations, enforcement of interpreter services is uneven. Federal policy should mandate that hospitals and federally funded clinics offer real-time interpretation services. As one interviewee noted, requiring even one interpreter interaction per shift for limited English proficiency patients, would improve care quality.
2. Rethink Digital Equity and Platform Bias – Digital health campaigns often overlook older adults and those without reliable internet access. Television, radio, and even printed mail still matter, especially in rural or older immigrant communities. Multilingual PSA campaigns should reflect generational diversity in both platform and tone.
3. Continue Targeted Grants and Capacity Building – The administration has taken steps in this direction. The HHS Office of Minority Health, for instance, has simplified grant applications and increased support to small, disadvantaged businesses. Programs supporting doulas and midwives, Medicaid postpartum coverage expansions, and Maternal Mortality Review Committees are all steps in the right direction. These programs must be sustained and scaled up, especially in states with high immigrant populations.
4. Strengthen Enforcement of Non-Discrimination Policies – The HHS Office for Civil Rights’ Language Access Plan marks a strong foundation. Ongoing quality assessments and regular complaint resolution mechanisms should be widely publicized and easily accessible in multiple languages. The goal is not just compliance, but trust-building.
5.  Invest in Civic Literacy Around Health Policy – Very few respondents felt confident in their understanding of how federal health policies are created or how to advocate for changes. Educational programs could be in partnership with local schools and colleges and empower immigrant families with tools to engage in policy advocacy, vote with confidence, and hold systems accountable.

Reflection

This project began as a quarter-long internship for my Spanish minor, but it quickly became something much more profound. As someone who hopes to pursue medicine, this research has transformed the way I view healthcare, not just as a clinical practice, but as a matter of equity, ethics, and communication. I learned that access is not just about being eligible for coverage, but about understanding that coverage in a language, and format that feels human.

Working under Lily Griego at the U.S. Department of Health and Human Services was one of the most formative experiences of my undergraduate career. Her mentorship reminded me that policy change is possible, and that even as students, we can be part of that change. Translating real policy documents, interviewing professionals on the front lines, and hearing directly from immigrant families made this issue deeply personal.

I am grateful to the Center for Immigration Policy & Research for supporting this work and to the many people who trusted me with their stories and insights. This project is not the end, it is a beginning. As I continue my journey toward medicine, I carry with me a commitment to language justice, cultural humility, and health equity. My hope is that this work contributes in some small way to a healthcare system that listens, includes, and empowers all people.

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Victoria received a CIPR student internship grant to be a Bilingual Outreach Intern with the  U.S. Department of Health and Human Services (HHS).