Asian Immigrant Experiences with Racism, Immigration-Related Fears, and the COVID-19 Pandemic

Asian immigrants have faced multiple challenges in the past year. There has been a rise in anti-Asian hate crimes, driven, in part, by inflammatory rhetoric related to the coronavirus pandemic, which has spurred the federal government to make a recent statement condemning and denouncing acts of racism, xenophobia, and intolerance against Asian American communities and to enact the COVID-19 Hate Crimes Act. At the same time, immigrants living in the U.S. have experienced a range of increased health and financial risks associated with COVID-19. These risks and barriers may have been compounded by immigration policy changes made by the Trump administration that increased fears among immigrant families and made some more reluctant to access programs and services, including health coverage and health care. Although the Biden administration has since reversed many of these policies, they may continue to have lingering effects among families.

Limited data are available to understand how immigrants have been affected by the pandemic, and there are particularly little data available to understand the experiences of Asian immigrants even though they are one of the fastest growing immigrant groups in the U.S. and are projected to become the nation’s largest immigrant group over the next 35 years. To help fill these gaps in information, this analysis provides insight into recent experiences with racism and discrimination, immigration-related fears, and impacts of the COVID-19 pandemic among Asian immigrant patients at four community health centers.

The findings are based on a KFF survey with a convenience sample of 1,086 Asian American patients at four community health centers. Respondents were largely low-income and 80% were born outside the United States. The survey was conducted between February 15 and April 12, 2021. Key findings include:

• One in three (33%) respondents report that they have personally felt more discrimination based on their racial/ethnic background since the COVID-19 pandemic began in the U.S. Asian health center respondents report facing a range of negative experiences due to their racial or ethnic background over the past 12 months, including 14% who say they experienced a personal verbal or physical attack due to their race/ethnicity.
• Many respondents have immigration-related fears, and most say they don’t have enough information about how recent immigration policy changes affect their family. Over four in ten (44%) Asian health center respondents say they worry a lot or some that they or a family member could be detained or deported. One quarter (25%) say they or a member of their household did not apply for or stopped participating in a government program to help pay for health care, food, or housing in the past year due to immigration-related fears. Over half (54%) say they do not have enough information about how recent changes to U.S. immigration policy might impact them or their family.
• Asian health center respondents report negative health and financial impacts from the COVID-19 pandemic. Nearly half (48%) of respondents say the COVID-19 pandemic negatively affected their ability to pay for basic needs like housing, utilities, and food, and over half (54%) say someone in their household experienced job or income loss due to the pandemic. Over four in ten (43%) report negative effects on their mental health.
• Nearly six in ten (58%) respondents say they have worried at some point that they have been exposed to coronavirus. Most (60%) of those who worried about being exposed say they have been tested for the virus. Among those who worried about exposure but say they have not been tested, the most frequently cited reasons for not getting tested were thinking they could isolate at home (31%) or not knowing where to get tested (26%). Some also say concerns about costs (13%), effects on ability to work (12%), and fears of negative impacts on their or a family member’s immigration status (10%) are reasons for not getting tested. The large majority of Asian health center patients who responded say they are willing to get a COVID-19 vaccine, with nearly two in three (64%) wanting to get it as soon as possible at the time the survey was fielded.

Approach

The findings in this report are based on responses from a convenience sample of Asian patients at four community health centers. KFF worked with the Association of Asian Pacific Community Health Organizations (AAPCHO) and community health center staff to develop and field the survey. Because the survey is based on a convenience sample, the findings are not generalizable to a broader population and cannot be benchmarked against other population-based surveys. Respondents are limited to four locations and may be lower income than Asian immigrants overall as they are patients of federally qualified health centers serving a predominantly low-income population. Further, as patients of a community health center, respondents are connected to a source of health care. Despite these limitations, the findings increase the knowledge base for understanding Asian immigrant experiences, which remains very limited. (See Methods for more details.)

The health centers that fielded the survey serve a predominantly Asian, low-income population that likely includes many immigrants. Four health centers fielded the survey: Asian Health Services in Alameda County, CA; North East Medical Services, in San Francisco, CA; HOPE Clinic in Houston, TX; and International Community Health Services (ICHS) in King County, WA. Overall, 79% of patients at these health centers identify as Asian; over 87% have income below 200% of the federal poverty level, including 54% who have income below poverty; and 12% are uninsured.¹ Health centers do not collect information on patient immigration status, but nearly seven in ten patients at these health centers are best served in a language other than English.²

Mirroring the patient populations served by the health centers, respondents include Asian American patients who are largely low-income and born outside the United States. Overall, a total of 1,086 survey respondents self-identify as Asian patients of one of the health centers. Among Asian patient respondents, over six in ten (62%) identify as Chinese and roughly one in five (18%) identify as Vietnamese, with the remaining respondents representing a broad range of ethnic backgrounds. Eight in ten (80%) report that they were born outside the U.S. The remaining share report they were U.S.-born; however, these respondents may have an immigrant family member living in their household as many express immigration-related concerns in their survey responses. Over seven in ten (72%) respondents report total annual family income below $40,000, and 15% report they were uninsured.

Respondents include a larger share of patients age 65 or older compared to the total patient population served by the health centers. Nearly four in ten respondents (39%) are age 65 or older compared to 20% among the total patient population of the health centers. The higher share of respondents age 65 or older reflects that the health centers fielded the survey during the time they began COVID-19 vaccination efforts, which were initially focused on people in this age group.

Over half of respondents (57%) are patients at either of the two California-based health centers, while about a third (32%) are patients with ICHS in Washington state, and 11% are patients at HOPE clinic in Texas. California health center respondents are more likely than other health center respondents to be under age 65 (69% vs. 51%) and less likely to have lower household income (<$40,000 per year) (65% vs. 80%). They also are more likely to be Chinese (71% vs. 49%) and less likely to be Vietnamese (13% vs. 24%).

Given that the respondents are older than the overall patient population for these health centers, we examine findings by age to identify key differences in experiences of adults ages 18-64 and those ages 65 and older. In addition to comparing findings by age group, we also examine differences between California health center respondents vs. other health center respondents. The data allowed for comparisons between California health center respondents and other health center respondents, but the ability to make comparisons for Washington and Texas, specifically, was limited due to sample size restrictions. In addition, we highlight differences by gender and parental status (i.e., whether respondents are parents or guardians of children under age 18 living in their household). We also identify differences between Chinese and Vietnamese respondents; comparisons for other ethnicities were not possible due to sample size restrictions. All differences mentioned in the brief are significant at the .05 level.