The Deferred Action for Childhood Arrivals program (DACA) has provided more than 900,000 individuals in the US a temporary protected status that they had to renew every two years after its implementation in 2012 (Alulema, 2019). DACA recipients are those who were brought to the US as minors, hail from all corners of the globe, and live throughout the United States. According to Alulema (2019), they represent 158 sending countries. 

The benefits of DACA include the ability to obtain a legal work permit for a limited time, obtaining a Social Security number, and being eligible for a driver’s license. It does not provide federally mandated access to in-state tuition rates or financial aid. Many lack access to health insurance, which can lead to deferred care and thus risk of greater health challenges (Raymond-Flesch et al., 2014). These factors put them at risk of low academic performance and mental health problems (Alif et al., 2020). 

This literature review explores access and barriers to education and health that DACA recipients face. This exclusion from education and health benefits systematically hinders their ability to achieve their full potential and the authors highlight these inequities so that policymakers are presented with, and hopefully inclined to make, the necessary changes so DACA recipients can live fuller lives.

Method

For this study, we used the EBSCO database to search for the terms “Deferred Action for Childhood Arrivals”, “DACA”, “education”, and “healthcare”. The search was limited to articles published during the years 2016−2019, as this would cover publications during the Trump presidential administration. The search of English language peer-reviewed publications yielded close to 100 articles. After reviewing those articles, the authors read through each of the articles using Refworks and included tags for each specific article. The tags that were included consisted of tags such as “undocumented youth”, “health”, “higher education”, and others. After the tags were added in Refworks, the articles were sorted by theme. We were particularly interested in articles that addressed healthcare and education due to their intersectional relationship with one another. Borrowing from Arksey and O’Malley’s (2005) approach to “charting the data”, a literature review matrix was created. The matrix included categories such as the study’s purpose, methods used, findings, and implications. Each article was entered into the matrix. Through the process of summarizing and prioritizing the results (Arksey & O’Malley, 2005), we were able to identify pertinent subthemes that underscore the major areas of investigation for this study. Below we present a summary of the findings.

DACA and Education Access

Higher educational institutions have dealt with the DACA prospective and current student population in varying ways. Much of this is informed by the state in which one resides and how the legislature and the corresponding Board of Regents interprets who can be admitted and what funding mechanisms are at their disposal. In the absence of comprehensive immigration reform, we provide examples to illustrate how states are addressing educational access and inequities within their own jurisdiction. Thus resulting in an inconsistent piecemeal approach that further illustrates where you are determines how well you do.

In 2001, Texas became the first state in the country to provide access to in-state tuition rates for undocumented students (Anderson, 2015). By March 2017, another nineteen had followed, of which six of the nineteen were allowing undocumented students to apply for state financial aid (Patel, 2017; Anderson, 2015). Yet, without the right to apply for federal financial assistance, no state is able to provide full equal access to education funding as their documented peers. Moreover, for those states that do not provide any financial aid, they are even further disenfranchised.

In comparing DACA students to their documented peers, Regan and McDaniel (2019) studied and compared the financial experiences of 317 DACA students with 14,162 U.S. citizens at 65 universities, both two and four-year public and four-year private. DACA students tended to be older, typically were the first in their family to attend college, and were significantly more likely than U.S. citizens to be attending two-year institutions (Regan & McDaniel, 2019). Their findings indicate that DACA students had “similar levels of optimism about their financial futures and the worth of their college investment” as citizens (p. 566). However, they faced greater financial strain and used unconventional means to fund their education. For example, 30% had used a credit card to cover some expenses associated with higher education (Regan & McDaniel, 2019).

In another study, Hsin and Ortega (2018) looked at the effects of DACA on students at eleven four-year schools and seven two-year schools at “one of the largest public university systems in the country” (p. 1492). They found that DACA students were 7.3% more likely to drop out of four-year colleges, a finding they attributed to the fact that temporary work status gives students more options in paying work, and the fact that four-year colleges do not make it easy for students to attend school part-time. By contrast, community college students continued their studies, but were 5.5 percent more likely to be part-time instead of full-time if they received DACA benefits (Hsin & Ortega, 2018).

Hsin and Ortega (2018, p.1503) argued, “DACA incentivizes work over investments in human capital but…the effect of DACA on undocumented students’ decisions to remain in school depends on how easily colleges accommodate working students”. These results show that DACA recipients face a dilemma, as they must choose between work and school. Likewise, they show that community colleges can be beneficial in helping DACA recipients obtain and increase their human capital (Hsin & Ortega, 2018). As Caicedo noted, community colleges are popular among undocumented youth for their low cost and extreme flexibility (Caicedo, 2019), benefits Hsin and Ortega (2018) reference as well.

In yet another similar study incorporating a large number of higher educational institutions, Patel (2017) provided survey data from 50 of the 144 colleges and universities in Massachusetts, Connecticut, and Rhode Island. These three states in the northeastern part of the U.S. are where the majority of New England’s DACA recipients reside. Even though the region has a small portion of the DACA population, about two percent, equating to 13,000 people, 54% of this group live in Massachusetts, which does not offer in-state tuition to any undocumented residents (Patel, 2017). In contrast, Connecticut and Rhode Island do offer in-state tuition to their relatively small number of DACA recipients (Patel, 2017). While the population of DACA recipients in New England is low compared to the total number of recipients, California, by contrast, is home to 25% and provides access to both in-state tuition and state financial aid (Dow and Campaign, 2019).

Similar to the findings of Regan and McDaniel (2019), a qualitative study of undocumented students, of which 30 were participating in DACA, at one University of California campus found that financial stress is common (Golash-Boza & Valdez, 2018). Most of the students participating stated that their parents earned less than $25,000 per year (Golash-Boza & Valdez, 2018). General stress was also a concern found; Golash-Boza and Valdez (2018, p.542) write that:

Both the threat of deportation as well as the uncertainty of their own futures cast a long shadow over [the 35 undocumented participating] students’ lives and reminded them that they remained excluded from incorporating fully into the U.S. economy and society.

At the same time, the particular campus where the study was conducted, University of California-Central is a federally designated Hispanic-serving institution and 51.3% of the students on campus identify as Hispanic. The study found that many of the participants felt comfortable acknowledging their undocumented status on campus because of the support system offered there and because of the high Latino population (Golash-Boza & Valdez, 2018).

The study also described nested contexts of welcoming and receptivity: students considered the local accepting nature in California’s Central Valley, the state as a safe haven, and the harsh national immigration context and credited their sense of safety with their academic success and support from the university (Golash-Boza & Valdez, 2018). Rather than focusing on one university in California, Dow and Campaign (2019)focused on non-financial resources at the campuses of the California State University and University of California systems as well as the state’s community colleges and provided a bleaker view.

They found campus resources such as meeting rooms, printers, and information designated for undocumented students were not always sufficient for the needs of this group (Dow & Campaign for, 2019). They also raised concerns about awareness among faculty and staff of the rights California recognizes for undocumented students, and that misinformation had demonstrable negative effects on students (Dow & Campaign for, 2019). They called attention to the fact that many majors require professional experiences and that those without a work permit cannot fulfil that requirement (Dow & Campaign for, 2019). They called for ally training for faculty and staff and on-campus legal services (Dow & Campaign for, 2019).

Similar to faculty and staff not always understanding the rights of DACA recipients, Sahay et al. (2016), who studied photovoice to examine the experience of five DACA recipients in North Carolina, including high school and college students, found that faculty support and knowledge of DACA was lacking, and students felt faculty did not provide them the support they needed. Indeed, students reported that college recruiters, high school teachers who are in the capacity to serve as mentors, and their peers were often ignorant of DACA’s existence (Sahay et al., 2016). The students stressed the need for faculty to understand that DACA offers them “both limitations and benefits” (Sahay et al., 2016, p. 61).North Carolina does not provide state aid to undocumented students or allow them to access in-state tuition rates (Patel, 2017). Two states that do offer in-state tuition rates, but not funding, are New York and New Jersey.

Caicedo (2019) compared and contrasted the experiences of four DACA recipients at an urban community college in New York City with those of three DACA recipients at a suburban New Jersey community college. Caicedo’s semi-structured interviews revealed that participants at both schools expressed the importance of the need for money to survive, felt that other students should recognize the struggles undocumented students encounter, yet desired to disguise their undocumented identity (Caicedo, 2019). All seven interviewees expressed optimism for the future. However, participants, the study reported, feel that peers “do not fully understand the struggle of ‘living in the shadows’ and all the limitations inherent in not having a Social Security number” (Caicedo, 2019, p. 323). They described a sense that they needed to be perfect since they are undocumented minorities.

DACA recipients’ higher educational endeavours are contingent upon which state they reside in. Some offer better benefits than others, but federal access to aid and benefits is non-existent. While some states recognize that access to higher education is paramount for DACA recipients to continue living their American Dream, access to healthcare is just as important, yet even scarcer.

DACA and Health Care

Raymond-Flesch et al. (2014) studied DACA recipients’ access to healthcare and the challenges they face. They found that among the 61 DACA-eligible young adults in their study, it was common to avoid treatment completely, seek alternatives such as traditional healers, or take family members’ prescriptions instead of seeking mainstream treatment for all but the most severe health concerns. This is also similar to what Getrich et al. (2019) found in that participants only received professional care when they had no other choice. Getrich et al.’s (2019) study involving 31 DACA recipients in Maryland focused on access to health care as well. Participants cited in one of two neighbouring counties, only one of which allows undocumented immigrants to access county-funded health care (Getrich et al., 2019). The authors found punctuated health coverage throughout life to be common among study participants, not least because some had moved between the two focal counties (Getrich et al., 2019). Many study participants noted that they had lacked access to health care as children (Getrich et al., 2019). Many parents of the study participants did not have health care, while younger siblings of the study participants who were born in the United States did, and this highlighted the variability of access to health care families encounter (Getrich et al., 2019).

New York, California, Massachusetts, and the District of Columbia offer Medicaid eligibility for DACA recipients, but no other states do (Gogol, n.d.). DACA recipients receive no subsidies under the Affordable Care Act, although some states allow undocumented residents to purchase insurance on the healthcare exchanges (Gogol, n.d.). However, access to exchanges can have little impact without the money to pay for insurance. Moreover, even with legal employment, benefits of DACA have not typically included health care insurance. Raymond-Flesch et al. (2014) concluded that cost of healthcare was the primary reason DACA recipients do not access it. They also noted the role of “limited health care literacy, difficulty navigating health care logistics, and fear and mistrust of providers” (p. 325).

The most pressing health concerns among their study participants were prompted by undocumented status, as participants “confronted the challenges limiting their ability to attain adult milestones, such as driver’s licenses, college education, and employment” and facing “feelings of hopelessness and thoughts of suicide” and hence an acute need for mental health services (Raymond-Flesch et al., 2014, p. 326). This is in line with what Alif et al. (2020) found by studying different immigration status community college students and how DACA creates psychological distress, including “depression, anxiety, and isolation and alienation” due to “constant fear of deportation, both for themselves and others” (p. 18).

The National UnDACAmented Research Project’s report on its mixed-methods study involving 2,381 DACA recipients pointed out that the threat of deportation of loved ones has significant mental health impacts (Gonzales, 2014). It called for better public messaging on awareness of health care options for DACA recipients and greater sensitivity to their circumstances among health care providers (Raymond-Flesch et al., 2014). One glimmer of hope, however, is that even with psychological distress, temporary status students performed similarly to stable status students (Alif et al., 2020). Alif et al. noted DACA recipients show high self-esteem as well.

Levelling the Playing Field: DACA-mented Individuals’ Resilience

All DACA recipients face barriers in accessing higher education and health care, although some communities provide them more options than others do. The former is a key area in establishing a stable life in the United States, and crucial if communities are to reap the benefits of the K−12 education they provided to DACA recipients. The latter is necessary to life, and depriving significant numbers of people health care runs the risk of endangering the entire population as it incubates infectious disease and vaccine-resistant strains.

The research on education access draws attention to the access and barriers DACA students face when navigating higher education. As there is not a federal mandate on access to aid or in-state tuition for DACA recipients, access varies by the state. Fewer than half of the US states offer in-state tuition and only six of them also offer state aid to DACA recipients. This puts individuals in states that do not offer certain benefits in a debilitating situation. In particular, “ineligibility from educational subsidies and high tuition costs has made it very difficult for many undocumented students to afford a college education” (Macias, 2018, p. 610). Why must they pay out-of-state tuition in a state that they have presumably lived in most of their lives whose parents have contributed to the tax base? DACA recipients work an unhealthy number of hours just to attempt to pay for college. Specifically, “one-quarter of [DACA recipients] juggl[e] both college studies and work. This finding suggests that DACA recipients need to work in order to afford college” (Capps et al., 2017, p. 1). In addition, undocumented individuals are continuously going through the U.S. educational system, and neglecting this fact is wrong. This “problem” is not going away.

Approximately 100,000 undocumented students graduate from U.S. high schools every year (Alulema, 2019; see also Zong & Batalova, 2019). Yet undocumented students face significant barriers to obtaining higher education, which is vital to establish a stable economic life in the United States. More states must offer in-state tuition and aid for these students to ease the burden on their schedules and give them access to upward mobility. Exclusion is callous and only perpetuates the struggle they find themselves in to belong (Frizell & Woodger, 2019).

Access to health care must complement access to higher education. Similar to education benefits, health care benefits are primarily contingent on the state of residence, but coverage is even sparser. With the high cost of health care and the lack of access for DACA recipients, they face challenges in navigating healthy life in America. Private health insurance is expensive, frequently threadbare in its coverage (Gogol, n.d.), and rarely available to undocumented people, including DACA recipients, through employment (Siemons et al., 2017). More states should step up to offer coverage and the Affordable Care Act should be amended to include DACA recipients in its subsidy program. They work and pay taxes, and thus should have access to taxpayer-funded subsidies. 

Ultimately, comprehensive immigration reform and policies for pathways to permanent legal status for DACA recipients are needed. The temporary nature of DACA makes it difficult to map out one’s future and prolongs socio-political stressors (Cadenas et al., 2020). An amended DACA program could place recipients on a permanent path to citizenship, thus eliminating these stressors. Viewing these Americans as members of the body politic and future voters would push elected officials to open education and health to them while they travel such paths. Nevertheless, the changes should not end there. Stress because of fear of deportation of loved ones is a constant reality among DACA recipients. Mass deportation must be abandoned in favour of a sensible immigration policy for the benefit of the country and those who have worked long for its prosperity. 

Conclusion

DACA recipients are resilient in the face of adversity they encounter every day. They juggle many responsibilities such as work and school with the added pressure to perform placed on them by society. The DACA program’s requirements means that they are model (future) citizens who, as Caicedo (2019, p.327) notes, “manage more responsibilities than many adults do”. They do not underscore the benefits they receive from DACA and do not take lightly the program allowing them “to come out of the shadows and engage in many of the day-to-day activities that most permanent residents take for granted including opening bank accounts, graduating from college, and starting long-term careers” (Hardina, 2014, p. 40). However, reformation of DACA to address the barriers that exist in the education and health sectors is vital. With the easing of these barriers, access can be granted to more individuals and life in the only country they know can be more fully lived.