Report on the Impact of Federal Policy Changes on Noncitizen Healthcare Access in Vermont

Introduction: Legislative Impacts on Healthcare and Sustainable Development Goals

Forthcoming federal policy changes, specifically elements of the “Big Beautiful Bill Act,” are projected to significantly restrict access to health insurance for noncitizen populations in Vermont during 2025 and 2026. This development presents a direct challenge to the principles of the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities). The resulting confusion and administrative complexity are expected to create substantial barriers to care, undermining the goal of universal health coverage and exacerbating social and economic disparities.

Projected Reductions in Health Coverage and Contradiction of SDG 3

Official State Estimates of Coverage Loss

Testimony from the Vermont Agency of Human Services indicates a significant number of individuals will lose healthcare support. The projected impacts are as follows:

• Effective January 1, an estimated 100 legal noncitizens who have been in the country for fewer than five years are slated to lose health insurance premium assistance.
• An additional 400-500 refugees, asylum seekers, and nonlegal residents are expected to lose the same assistance at the start of the year.
• By October 2026, between 500 and 600 Medicaid enrollees who are asylum seekers or refugees are expected to lose their eligibility.

Implications for SDG 3: Good Health and Well-being

These cuts directly contravene SDG Target 3.8, which calls for achieving universal health coverage, including financial risk protection and access to quality essential health-care services for all. By removing coverage, the policy increases the risk of preventable health crises and forces individuals toward more costly emergency department visits, representing an inefficient allocation of health resources and a failure to ensure well-being for vulnerable communities.

Systemic Barriers and the Deepening of Inequality (SDG 10)

Administrative Hurdles and Disproportionate Impact

Advocates report that the policy’s impact extends beyond direct coverage loss, creating systemic barriers that disproportionately affect noncitizens and challenge the aims of SDG 10 (Reduced Inequalities).

• The inherent complexity of the health insurance system is a significant barrier for all, but it is magnified for those with language barriers or limited internet access.
• Many immigrant workers in sectors with variable income, such as agriculture and construction, find it difficult to accurately estimate earnings, a critical step for securing subsidized insurance.
• The reduction or elimination of subsidies will disproportionately harm those with fluctuating incomes, with reports indicating that some eligible workers already forgo insurance due to fear of owing unexpected payments.

Fear of Enforcement as a Barrier to Care

Increased federal immigration enforcement has cultivated a climate of fear, discouraging individuals from interacting with public institutions, including healthcare facilities. This chilling effect leads to delayed care for treatable conditions, which can result in more severe health outcomes and higher costs. This trend undermines SDG 10.7, which aims to facilitate safe and responsible migration, and SDG 16 (Peace, Justice and Strong Institutions), as it erodes trust in the very institutions designed to provide public services.

Socioeconomic Consequences and Interlinked SDG Impacts

Observed and Anticipated Repercussions

Healthcare providers are already observing behavioral changes that signal broader socioeconomic consequences.

• Clinics serving uninsured and under-insured residents report seeing fewer new patients, suggesting a reluctance to seek preventative care.
• Delayed care is anticipated to increase the burden on emergency services.
• There are anecdotal reports of individuals choosing to return to their countries of origin due to these mounting pressures.

Analysis of Interlinked Sustainable Development Goals

The impact of the healthcare cuts is not isolated and directly affects progress on several interconnected SDGs:

1. SDG 1 (No Poverty): Lack of health insurance is a primary pathway to poverty. A single significant medical event can lead to catastrophic debt for uninsured families, negating efforts to achieve economic security.
2. SDG 8 (Decent Work and Economic Growth): The noncitizen population is an integral part of Vermont’s workforce, contributing to key industries. Denying this workforce access to healthcare jeopardizes their health, productivity, and the stability of the local economy they support.
3. SDG 16 (Peace, Justice and Strong Institutions): The creation of complex, intimidating, and inequitable systems for accessing a fundamental service like healthcare weakens the integrity and inclusivity of public institutions.

Conclusion: A Regression from Sustainable Development Principles

The legislative changes detailed in the “Big Beautiful Bill Act” represent a significant setback for the State of Vermont’s alignment with the 2030 Agenda for Sustainable Development. The policy is poised to worsen health outcomes, increase inequality, and create negative socioeconomic ripple effects. The full scope of the impact remains uncertain, but initial analysis indicates a clear regression from the goals of ensuring universal health coverage, reducing inequality, and building inclusive and effective institutions for all members of society.

Analysis of Sustainable Development Goals (SDGs) in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being: The article’s central theme is the restriction of access to health insurance and healthcare services for noncitizens in Vermont, directly impacting their health and well-being.
• SDG 10: Reduced Inequalities: The article focuses on the disproportionate impact of policy changes on a specific vulnerable group—immigrants, refugees, and asylum seekers—based on their origin and immigration status, highlighting a clear issue of inequality in access to essential services.
• SDG 1: No Poverty: The loss of health insurance subsidies and the financial burden of healthcare costs are discussed, which can push vulnerable individuals and families with variable incomes into poverty. The article notes that changes will “disproportionately affect immigrants and those with variable incomes.”
• SDG 8: Decent Work and Economic Growth: The article identifies the affected individuals as vital contributors to the local economy (“putting on our roofs and helping milk our cows”). Lack of access to healthcare can impact their ability to work and their overall economic security, particularly for those in precarious employment like agriculture and construction.
• SDG 16: Peace, Justice and Strong Institutions: The article points to institutional failures, such as “bureaucratic complexity” and a lack of clarity in policy implementation (“There’s a lot of unknowns”). It also highlights how fear of immigration enforcement, an issue of justice and safety, prevents people from accessing care.

2. What specific targets under those SDGs can be identified based on the article’s content?

• SDG 3: Good Health and Well-being
  • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. The article directly discusses the loss of “health insurance premium assistance” and Medicaid eligibility for noncitizens, which undermines financial risk protection and access to healthcare.
• SDG 10: Reduced Inequalities
  • Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of…origin…or other status. The article details how noncitizens, refugees, and asylum seekers are being excluded from health coverage due to their immigration status.
  • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices. The “Big Beautiful Bill Act” is presented as a policy that creates unequal health outcomes for immigrants compared to other residents.
  • Target 10.7: Facilitate orderly, safe, regular and responsible migration and mobility of people. The article describes how fear of “federal immigration enforcement is causing people to fear going to the doctor,” indicating that the environment for migrants is not safe and their well-being is not being protected.
• SDG 1: No Poverty
  • Target 1.3: Implement nationally appropriate social protection systems and measures for all…and by 2030 achieve substantial coverage of the poor and the vulnerable. The article discusses federal cuts to “health insurance premium assistance” and Medicaid, which are key social protection systems for vulnerable populations.
• SDG 8: Decent Work and Economic Growth
  • Target 8.8: Protect labour rights and promote safe and secure working environments for all workers, including migrant workers…and those in precarious employment. The article highlights the vulnerability of migrant workers in industries with “variable incomes” like agriculture and construction. Access to healthcare is a fundamental part of a secure working environment, which is being threatened.
• SDG 16: Peace, Justice and Strong Institutions
  • Target 16.6: Develop effective, accountable and transparent institutions at all levels. The article points to a lack of institutional effectiveness and transparency, citing “bureaucratic complexity,” “confusion,” and the fact that “the full scope of new federal policies is still coming into focus.”
  • Target 16.9: By 2030, provide legal identity for all. The article underscores the importance of legal status, as different “immigration statuses” determine eligibility for essential services like healthcare.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• For Target 3.8 (Universal health coverage):
  • Quantitative Indicator: The number of individuals losing health insurance. The article provides specific estimates: “100 legal noncitizens…are slated to lose health insurance premium assistance,” “400-500 refugees, asylum seekers and nonlegal residents to lose the same assistance,” and “Between 500 and 600 Medicaid enrollees who are asylum seekers or refugees are expected to lose eligibility.”
  • Qualitative Indicator: The number of people avoiding or delaying medical care. The article states, “People are delaying care that can in turn result in them being at a really costly emergency department visit.” It also notes that a free clinic “is seeing fewer new patients.”
• For Target 10.3 (Reduce inequalities of outcome):
  • Quantitative Indicator: The number of people losing health coverage, disaggregated by immigration status (legal noncitizens, refugees, asylum seekers, nonlegal residents). The article provides these specific numbers, which can be compared to the general population to measure inequality.
• For Target 1.3 (Social protection systems):
  • Quantitative Indicator: The number of vulnerable people losing access to social protection programs. The article specifies the number of noncitizens, refugees, and asylum seekers losing “health insurance premium assistance” and “Medicaid” eligibility.
• For Target 16.6 (Effective institutions):
  • Qualitative Indicator: The level of public confusion and fear regarding policies. The article repeatedly mentions “confusion,” “bureaucratic complexity,” and “fear” among the immigrant community as direct results of the policy changes and enforcement actions.

4. Summary Table of SDGs, Targets, and Indicators

Source: vtdigger.org