Pandemic Times and Health Care Exclusion: Attitudes toward Health Care Exclusion of Undocumented Immigrants

Abstract

Context: Most of the 11 million undocumented immigrants living in the United States are excluded from government health care programs. Yet, health care inequities pose significant dangers to all members of society during a pandemic. This project explores to what extent undocumented immigrants, in the context of a pandemic, can be seen as deserving of access to government health care programs.

Methods: The project's first survey experiment explores whether work ethic can affect perceptions of undocumented immigrants as deserving of government health care programs. The second survey experiment tests to what extent appeals to fairness and self-interest, during a pandemic, shape health care deservingness attitudes.

Findings: The results show that respondents view undocumented immigrants as less deserving of health care than citizens, even when undocumented immigrants have a solid work history. The second survey experiment, however, shows that appeals to fairness and self-interest trigger substantial increases in support for undocumented immigrants among both Republicans and Democrats.

Conclusions: The results suggest that while undocumented immigrants are seen as less deserving of access, appeals to fairness and self-interest can trigger increased support.

The rapid spread of severe acute respiratory syndrome coronavirus 2, which causes coronavirus disease 2019 (COVID-19), quickly became one of the world's biggest challenges. Four years since its outbreak, the virus has yielded more than 100 million infections in the United States and more than seven million deaths worldwide (KFF n.d.). COVID-19 also exposed the consequences of health care exclusion. In the early months of the pandemic, immigrant and low-income individuals were disproportionately affected by the virus (Ross, Diaz, and Starrels 2020). The unequal spread of the virus reflected the impact of America's health care structure, where health insurance is vital for obtaining medical care. For individuals without access to employer-based health care coverage, such as most undocumented immigrants, government health care programs are a crucial pathway to access medical care (Ornelas, Yamanis, and Ruiz 2019). In this project, I explore to what extent undocumented immigrants, in the context of a pandemic, can be seen as deserving of access to government health care programs.

Deservingness attitudes play a crucial role in public support for determining who ought to have access to social assistance programs. Undocumented persons face compounding penalties in public assessments of their deservingness. Anti-immigrant attitudes have increased public support for strict limits on undocumented immigrants’ access to welfare programs (Fix 2009; Tolbert and Hero 1996). Similarly, prejudice toward ethnic minorities has historically lowered support for welfare programs (Gilens 2000). For instance, racial resentment has been linked with higher support for allowing obstacles that limit individuals’ enrollment in Medicaid, a government program for low-income persons (Haeder and Moynihan 2023). Lastly, the public places a high value on employment as an indicator of contributions to government programs (Haeder, Sylvester, and Callaghan 2021; Magni 2024). Even if undocumented immigrants are employed, however, working without legal authorization may cause them to be seen as noncontributors (Williamson, Skocpol, and Coggin 2011).

Critically, the pandemic has highlighted the significant consequences of health care exclusion. First, health care exclusion poses clear and significant dangers to all members of society during a pandemic. Anyone, irrespective of immigration status, can spread and contract a disease. During the COVID-19 pandemic, fears of immigration enforcement and lack of health care access discouraged immigrants—even those suffering significant symptoms—from seeking testing (Bai et al. 2020). This situation left immigrants susceptible to unintentionally spreading COVID-19 in their communities (Page et al. 2020). Therefore, individuals seeking to protect their well-being might be motivated to support policies that increase health care access. The literature, however, has produced mixed results about the conditions under which self-interest influences behavior (Sears et al. 1980). Additionally, immigrants have been historically scapegoated during crises (Markel and Stern 2003). Thus, the pandemic may follow the pattern seen in previous disease outbreaks, such as SARS or H1N1, where views of immigrants as carriers of disease triggered heightened prejudice and negative attitudes (Person et al. 2004; PRC 2009).

Second, the public views ill individuals as deserving of help and unequal health care access as morally unjust (Illingworth and Parmet 2017; Lynch and Gollust 2010; Rawls 1999). Independent of anti-immigrant prejudice, normative and psychological factors predispose people to view illness as a random event that merits help (Petersen et al. 2010; Petersen 2012). In turn, the COVID-19 pandemic has forced the public to reckon with the consequences of health care exclusion, as immigrant communities were disproportionately affected (Clark et al. 2020). However, there is also evidence that ideological factors influenced the extent to which the public perceived the unequal impacts of the pandemic on different population groups (Gollust and Haselswerdt 2023). Therefore, while the reality of the significant consequences of excluding individuals may trigger increased willingness to extend health care access to vulnerable groups, ideological attachments may suppress support.

In this article, I begin by exploring how work history affects perceptions of health care deservingness. Past scholarship has highlighted the critical effect of employment and prejudice on deservingness attitudes (Gilens 2000; Magni 2024; van Oorschot and Roosma 2017; Williamson, Skocpol, and Coggin 2011). These factors have been vital in pushing exclusionary policies targeting immigrants. For instance, President Trump highlighted a desire to make immigrants “self-sufficient” when his administration issued a “public charge rule” in 2019 that sought to limit immigrants’ access to government programs (Bustamante et al. 2022; White House 2019). Thus, in the first experiment, I explore whether hard work triggers increased support for viewing undocumented immigrants as deserving of government health care programs. The results show that, even in a pandemic, Democrats and Republicans view undocumented immigrants as less deserving of access to government health care programs than nonundocumented individuals. Although hard work has a positive effect on attitudes toward nonimmigrants, it does little to influence attitudes when the recipients of care are undocumented.

Second, I investigate to what extent fairness or self-interest appeals shape attitudes toward access to government health care programs. Independent of whether respondents view a group as deserving, the reality of COVID-19’s impact may push individuals to consider the consequences of exclusion. Put differently, an individual may view certain groups as undeserving of access to government programs but may nonetheless support providing them with access because the consequences of their exclusion are perceived to be worse. Thus, in experiment 2, I explore to what extent appeals triggering respondents to think of their own well-being (self-interest) or the ethical concerns (fairness) of leaving undocumented immigrants excluded influence attitudes. The results suggest that self-interest and fairness appeals trigger increased support for allowing undocumented immigrants equal access to government health care programs. Critically, the results were not driven by newfound knowledge of the spread of COVID-19 across the country and remain present independent of partisan attachments.

Deservingness Attitudes and Health Care

Attitudes toward access to social programs are driven, in large part, by perceptions of recipients’ deservingness. Three factors are critical here. First, contributions to the system matter. The public pays close attention to recipients’ employment history. Unemployed individuals, for instance, are viewed as less deserving of government assistance (van Oorschot and Roosma 2017; Williamson, Skocpol, and Coggin 2011). This notion focuses on a simple idea: individuals not paying into the system do not deserve to receive access to its benefits. The relationship between work history and deservingness of social assistance is not unique to the United States. For instance, using evidence from a survey conjoint experiment, Magni (2024) finds that work history matters for perceptions of immigrants’ welfare deservingness in France, Italy, the United Kingdom, and the United States. Stereotypes and assumptions, however, leave undocumented immigrants residing in the United States in a difficult position. Independent of their work ethic, lacking work authorization has fueled perceptions of undocumented immigrants as noncontributing members of society (Tolbert and Hero 1996; Williamson, Skocpol, and Coggin 2011).

Second, prejudice is a critical factor in deservingness attitudes. Americans have historically viewed immigrants as less deserving of welfare access than citizens (Garand, Xu, and Davis 2015). Undocumented immigrants, however, are especially vulnerable. Many undocumented immigrants face not only prejudice because of their race but also living in the country without authorization, which further lowers support (Tolbert and Hero 1996). Therefore, compared to authorized immigrants, undocumented immigrants are seen as less deserving of access to social assistance programs. These two factors have shaped eligibility policies. Past scholarship has shown that prejudice was crucial in suppressing views of immigrants and ethnic minorities as equally deserving of access while lowering support for expansionary welfare policies (Gilens 2000). For instance, the passage of California's Proposition 187, which banned undocumented immigrants from accessing essential welfare services, was fueled by anti-immigrant attitudes (Calavita 1996).

Third, the kind of social welfare program under discussion also shapes public attitudes about granting immigrants access to the program. Past scholarship has shown that support for welfare policies is shaped by perceptions of likely recipients as “undeserving” (Gilens 2000). These factors, however, may play a lesser role in attitudes toward government health care programs. Specifically, the “deservingness heuristic” predisposes humans to view ill individuals as deserving of help (Jensen and Petersen 2017; Petersen et al. 2010). Unlike attitudes toward unemployment benefits, individuals view illness as a random event worthy of aid, independent of other political considerations (Jensen and Petersen 2017). This psychological predisposition has evolutionary roots and is present across cultures but is not boundless (Petersen 2012). Perceptions of recipients as unlucky or lazy can moderate its effects (Aarøe and Petersen 2014). If so, hardworking undocumented immigrants may be seen as especially deserving of access to medical care when needed.

In sum, it remains unclear to what extent hard work can affect the extent to which undocumented immigrants are perceived as deserving of access to government programs. Presenting immigrants as hard workers striving for a better life may increase support from natives (Alesina and Stantcheva 2020; Kootstra 2016; Magni 2024). Doing so, however, may also backfire. The public may view undocumented immigrants as “lawbreakers” who are taking jobs from Americans and authorized immigrants (Tolbert and Hero 1996). In the context of the pandemic, the salience of a rapidly spreading virus may tilt the balance in favor of undocumented immigrants. After all, the spread of COVID-19 may trigger the deservingness heuristic to counteract prejudice and competition attitudes. Therefore, hypothesis 1 follows:

• H1: Immigrants presented as hardworking will receive greater support for welfare access over individuals with a poor work history.

Health, Deservingness Attitudes, and Immigrants

Independent of perceptions of deservingness, the reality of health care exclusion may incentivize individuals to support providing undocumented immigrants with access. That is, an individual can view certain groups as undeserving but still believe they ought to have access. Two potential mechanisms underpin this behavior. First, individuals may look inward and view the protection of others as critical in reducing their own risk of contracting infectious diseases. Therefore, individuals seeking to protect their own well-being may be incentivized to support those around them. Second, individuals can look out toward the kind of society they want. Even as some groups are seen as undeserving of assistance, leaving them excluded may pose ethical challenges. Thus, individuals who believe society should not exclude those who need medical care will support expanded access.

It remains an open question whether citizens will support health care for undocumented immigrants, even when doing so will reduce their own risk of falling ill. Multiple studies have found that self-interest has minimal effects on a myriad of policy issues, including jobs (Lau and Sears 1981; Sears et al. 1980), education funding (Soares 2003), taxation (Fong 2001; Tolbert, Witko, and Wolbers 2019), and trade preferences (Rho and Tomz 2017). At times, citizens even choose policies that manifestly contradict their self-interests, for example, lower-income citizens choosing tax policies benefitting high-income citizens (Hennighausen and Heinemann 2015). This pattern also extends to immigration policies. Natives consistently favor highly skilled and educated immigrants, irrespective of whether doing so will also increase competition for their jobs (Hainmueller and Hiscox 2007, 2010; Hainmueller and Hopkins 2014, 2015; Hainmueller, Hiscox, and Margalit 2015).

Policies affecting health, however, appear to be an exception. Green and Gerken (1989) find that self-interest shapes attitudes toward strict antitobacco policies. Nonsmokers support higher taxes on cigarettes and strict antismoking policies; active smokers do not. Health self-interest can also moderate partisan cues. Henderson and Hillygus (2011) conclude that Republicans’ opposition to the Affordable Care Act is lower among those concerned about medical expenses.

The COVID-19 pandemic offers an opportunity to test the relationship between self-interest and deservingness attitudes. Its rapid spread quickly turned the COVID-19 pandemic into the biggest public health crisis since the Spanish flu of the 20th century (CNBC 2021). Four years after its outbreak, the pandemic has produced more than 100 million infections among Americans (KFF n.d.). There are three reasons to expect the pandemic to magnify the impact of self-interest. First, individuals are more likely to act on the basis of their self-interest when policies have clear implications (Chong, Citrin, and Conley 2001). The greater the risk of contagion, the more evident the need for health care. Second, self-interest matters when the stakes are high (Sears and Citrin 1982). Older people face the most significant risk of dying from COVID-19, but everyone is at risk (Green 2020). Third, contrary to policies susceptible to top-of-mind considerations, COVID-19, as the most devastating pandemic in a century, is the subject of nearly universal public awareness. Therefore, attitudes toward COVID-19 are unlikely to depend on respondents’ political sophistication. The second hypothesis follows:

• H2: Self-interest appeals will show increased support for allowing undocumented immigrants to have equal access to government health care programs.

Despite broad opposition to providing immigrants access to social programs, US public policy has long embodied an ethos guaranteeing medical care to those who need it. The passage of the Emergency Medical Treatment and Labor Act in 1986 reflects this moral imperative. The law prevents hospitals from denying care for emergency services to individuals on the basis of immigration status or ability to pay (Illingworth and Parmet 2017). Therefore, even if the public views undocumented immigrants as undeserving of aid, the ethical implications of leaving them excluded may affect attitudes.

There are three reasons why ethical appeals could influence attitudes. First, the public views unequal access to health care as morally unjust (Lynch and Gollust 2010). Notably, this is not limited to those directly excluded (Levine et al. 2007). Preventing expecting mothers from receiving prenatal care because of their immigration status, for example, produces unjust consequences for future members of society (Lu et al. 2000; Sommers 2013). Second, the public is more empathetic to victims of unforeseen events (Nielsen et al. 2020; Petersen et al. 2010). Without good health, it is impossible for a person to thrive, participate in the community, and engage in economic or political activities (Daniels 2001; Illingworth and Parmet 2017; Rawls 1999). Third, humans are predisposed to view ill individuals favorably and deserving of aid (Jensen and Petersen 2017).

These three factors may be especially influential during the COVID-19 pandemic. After all, contracting the COVID-19 virus was an unforeseen event that could produce severe consequences for those infected (Nalbandian et al. 2021). Additionally, the pandemic highlighted long-lasting health care inequities affecting undocumented immigrants and low-income individuals. These injustices contrast with the “essential worker” tag given to employees serving on the front lines during the pandemic. Past scholarship has concluded that nearly three quarters of undocumented immigrants in the United States served as essential workers during the pandemic (Allen, Pacas, and Martens 2023). Critically, exposure to these inequities affected public support for expanded health care access. For instance, a 2020 poll found that nearly two thirds of respondents believed the federal government had a responsibility to pay for medical care for undocumented immigrants infected with COVID-19 (PRC 2020). The pandemic thus illustrated the negative consequences of excluding undocumented immigrants from access to government health care programs. Accordingly, the third hypothesis follows:

• H3: Appeals to fairness will yield increased support for allowing undocumented immigrants to have equal access to government health care programs.

Politics, Health, and Immigrants

Political dynamics quickly engulfed responses to the COVID-19 pandemic. President Trump initially downplayed COVID-19 (CBS News 2020). Once the infection rates began rising, the Trump administration's initial efforts to contain the spread focused primarily on restricting the number of people traveling to the United States from China (Parker and Stern 2022). Other policies, such as the implementation of social distancing and delivery of protective and medical equipment, were also influenced by political factors (Adolph et al. 2021; Gadarian, Goodman, and Pepinsky 2022). Politics even seeped into attitudes toward the efficacy of therapeutics and protective equipment, with President Trump influencing his supporters to prefer hydroxychloroquine over mask-wearing (Gonzalez et al. 2021; Madanay, McDevitt, and Ubel 2022). Within a few months of the pandemic's outbreak, partisan attachments heavily influenced attitudes toward the COVID-19 pandemic (Gadarian, Goodman, and Pepinsky 2023; Mehlhaff et al. 2024).

The politicization of the COVID-19 pandemic can shape treatment effects in two ways. First, partisanship may be correlated with lowered COVID-19 concerns and may dilute the impact of self-interest appeals. Republicans, for instance, showed much less concern about the COVID-19 pandemic than Democrats did (Allcott et al. 2020; Grossman et al. 2020). These attitudes also translated into a greater willingness to remove pandemic protections such as social distancing and mask mandates (Adolph et al. 2022). Similarly, this ideological divergence influenced willingness to get the COVID-19 vaccine, with conservatives showing greater skepticism (Callaghan et al. 2020). Therefore, if Republicans are less worried about the virus, then it would follow that self-interest would play less of a role in their attitudes compared to those of Democrats.

Second, the pandemic may also trigger stronger anti-immigrant attitudes. Rather than viewing the protection of immigrants as necessary for reducing the spread of COVID-19, some individuals may view immigrants as disease vectors worsening the pandemic. During the early months of the COVID-19 pandemic, the Trump administration portrayed immigrants as a public health threat (Hernández and Miroff 2020). This was not a new dynamic. Immigrants have historically been scapegoated during disease outbreaks. In the 1890s, perceptions of immigrants as responsible for spreading diseases triggered immigration authorities to perform strict checks on their health before allowing them into the country (Markel and Stern 2002). Views of immigrants as vectors of disease did not stop upon their admission, as the public blamed recurrent epidemics on foreigners. For instance, in the late 19th and early 20th centuries, countless Chinese immigrants had their homes and businesses decimated by local authorities who argued that doing so would reduce the spread of tuberculosis and the bubonic plague (Trauner 1978). In the early 2000s, Asian immigrants became the target of fears of the SARS virus (Person et al. 2004). Similarly, in 2009, the outbreak of the H1N1 virus produced significant stigma toward Latinos (PRC 2009). The COVID-19 pandemic was no exception. Anti-immigrant prejudice toward Asian Americans rose significantly during the pandemic (Le et al. 2020). Additionally, President Trump leveraged the pandemic to push a “Stay in Mexico” directive under Title 42 to sharply reduce the number of immigrants and refugees admitted into the country (Long 2023). Therefore, viewing immigrants as partially responsible for the COVID-19 pandemic may lead to anti-immigrant attitudes that suppress any treatment effects.

Perceptions of Deservingness

A total of 2,000 respondents were surveyed in September 2020 using the Lucid Theorem platform.¹ In the first survey experiment, I investigated whether work ethic can affect perceptions of undocumented immigrants as deserving of government health care programs. To do so, I introduced respondents to a fictitious group with two traits randomly assigned. First, the group was composed of either “undocumented immigrants” or “individuals” (suggesting that the “individuals” were neither immigrant nor undocumented). Second, the group had either a “strong record of working hard” or a “spotty history of work.” I asked respondents to what extent they believed that “under the ongoing dangers of COVID-19” these people “deserve access to government health care programs” using a 4-item Likert scale ranging from strongly disagree (0) to strongly agree (1). This design yields four possible trait combinations: (a) individual + solid work history, (b) individual + spotty work history, (c) undocumented + solid work history, and (d) undocumented + spotty work history.²

Figure 1 outlines the main effects, with 95% confidence intervals. Contrary to expectations (H1), a solid work history does not matter for perceptions of health care deservingness. Nevertheless, this does not mean that respondents viewed undocumented immigrants as equally deserving of government health care programs. Rather, undocumented immigrants faced a penalty of nearly 15 percentage points. Notably, positive descriptions of immigrants’ work history cannot overcome this penalty. Compared to individuals with spotty work history, undocumented immigrants with a solid work history are rated as being nearly 11 percentage points less deserving of government health care programs (p < 0.05). Partisanship does not make a big difference. Republicans and Democrats consistently perceive undocumented immigrants as less deserving of government health care programs.

Effectiveness of Appeals to Self-Interest and Fairness

Independent of whether some groups are seen as less deserving than others, certain events, such as a pandemic, can expose the consequences of health care inequities. Therefore, deservingness attitudes may clash directly with the reality on the ground. That is, undocumented immigrants may be seen as undeserving of access, but if their exclusion poses a significant threat to their lives or the well-being of their communities, the public may support expanding access. The COVID-19 pandemic presents a unique opportunity to explore whether, in the presence of a deadly virus, the consequences of exclusion influence support for providing access to undocumented immigrants.

To investigate the effect of appeals to fairness and self-interest on health care attitudes, I randomly assigned respondents to one of four groups: control, soft control, self-interest, or fairness.³ Except for those in the control group, all respondents viewed a map showing the total COVID-19 cases and deaths across the United States. The map provides respondents with baseline knowledge of the spread of COVID-19 at the time of the survey. Critically, the map also served as a placebo to test to what extent any treatment effects are driven by knowledge about the spread of COVID-19 across the country.⁴

To measure attitudes, I asked respondents to what extent they agreed or disagreed with one of three statements about providing undocumented immigrants equal access to government health care programs. Those in the control and soft control group received the baseline statement: “Undocumented immigrants living in the US should have the same access to government health care programs as citizens.” Those in the self-interest group read the baseline statement and a small prime highlighting the individual and collective consequences of health care exclusion: “. . . because by failing to provide them with adequate health care, many more Americans will die from COVID-19.” Finally, those in the fairness group read the baseline statement along with a prime noting the normative and moral ideals of helping those who need medical help: “. . . because everyone should be able to get help when they are sick.”⁵ All responses were measured using a 4-item Likert scale ranging from strongly disagree (0) to strongly agree (1).

Figure 2 shows the main effects and 95% confidence intervals for each experimental group.⁶ There are three key results. First, seeing a map of COVID-19 deaths, with a milestone of 200,000 deaths, did not influence attitudes toward providing undocumented immigrants with access to government health care. Mean support for undocumented immigrants in the control group was nearly indistinguishable from that of the soft control group (p > 0.05). Second, following theoretical expectations (H2), respondents primed to think of their self-interest showed a substantial increase in support toward undocumented immigrants. Compared to the control group, a self-interest appeal increased support by around 15 percentage points (p < 0.05). Including a soft control helps distinguish the impact of the self-interest appeal from the impact of seeing a map showing the national spread of COVID-19. If the soft control group shows attitudes comparable to those in the self-interest (or fairness) treatment groups, then it would be difficult to separate the effect of the COVID-19 map from the effect of the prime. But while the soft control group did not change attitudes, the self-interest appeal triggered increased support.

The results also provide support for H3. A fairness appeal increased mean support for undocumented immigrants by about 14 percentage points compared to the control group (p < 0.05). The effect was also substantially larger than when respondents only viewed a COVID-19 map. These results suggest that even during times of crisis—where every individual focuses on their survival—respondents can still be persuaded by normative ideals of justice and fairness. Most importantly, the effect of the appeal to fairness is almost equal in magnitude to the effect of the appeal to self-interest.

As expected, partisan attachments moderated attitudes. Republicans were significantly less supportive of undocumented immigrants than Democrats. The treatment effects, however, were consistent across partisans. Compared to the control group, appeals to self-interest and fairness ideals increased support for equal access between 12 and 14 percentage points among Democrats and Republicans. The only difference was among the responses to the COVID-19 map. After accounting for demographic variables, the soft control group yielded an increase of 8 percentage points among Republicans but only 2 percentage points among Democrats.⁷ The difference may be attributed to the deep politicization of the pandemic, as Republicans discounted the severity of COVID-19 (Allcott et al. 2020).

Conclusion

Persuading the public to support expansionary health care policies—especially those benefiting undocumented immigrants—has been difficult. The results here showed that respondents consistently viewed undocumented immigrants as less deserving of government health care programs than other individuals. Notably, hard work cannot overturn this difference. Respondents viewed undocumented immigrants with a solid history of work as less deserving of health care than individuals with a spotty work history. These results support previous scholarship that concludes immigrants and ethnic minorities are held to higher standards than natives (DeSante 2013; van Oorschot and Roosma 2017). However, the reality of health care exclusion, especially during a pandemic, may incentivize individuals to support providing “undeserving” individuals with access to government health care programs. This study provides empirical evidence that appeals to self-interest or fairness can increase support for providing undocumented immigrants equal access to government health care programs. Specifically, asking individuals to consider the consequences of exclusion or the potential risk to individual and collective well-being produced greater support for providing undocumented immigrants access to government health care programs. Critically, the treatment effects remained present independent of respondents’ partisan attachments. Therefore, the results are consistent with scholarship noting that despite rhetoric showing significant ideological divisions, partisans can be persuaded in parallel (Coppock 2023).

This article contributes to four distinct literatures. First, past scholarship has found that individuals rarely consider their self-interest when making policy decisions (Chong, Citrin, and Conley 2001; Green and Gerken 1989; Sears and Citrin 1982). The results here suggest that individuals may favor their self-interest when the policy directly affects their well-being. Second, the results also contribute to scholarship on health care ethics by showing that appeals to fairness can affect attitudes toward access for undocumented immigrants (Levine et al. 2007; Lynch and Gollust 2010). Third, this project extends a growing literature on public attitudes toward immigrants (Adida, Dionne, and Platas 2018; Adida, Lo, and Platas 2018; Adida et al. 2022; Hainmueller and Hopkins 2014; Williamson, Skocpol, and Coggin 2011). Fourth, the results contribute to the literature on the impact of politics in addressing health inequities during a pandemic (Gollust, Nagler, and Fowler 2020; Gollust and Haselswerdt 2023; Pollack 2020; Rosenbaum et al. 2021). The results in this article underscore that individuals, independent of partisan attachments, can be triggered to become more supportive of expanding access to undocumented immigrants.

Despite the strength of these results, they have four main limitations. First, the project cannot speak to the longevity of the treatment effects. Past scholarship has shown significant variance in the duration of treatment effects from survey experiments (Coppock 2023). Although the pandemic has evolved since its initial outbreak, future studies can use a panel to explore the duration of similar treatments. Second, the design cannot determine to what extent deservingness attitudes vary across differing immigration statuses. Thus, I cannot assess the marginal effect of only being an immigrant (without an undocumented label) or arriving as a refugee. Third, the data were collected during the early months of the worst pandemic in a century. Thus, the results should be considered in the context of the pandemic. These results also cannot outline whether the treatment effects depend on COVID-19’s presence, transmissibility, or risk. This limitation can be addressed by future studies that explore public attitudes long after the advent of COVID. Fourth, the experiments do not test to what extent the pandemic triggered anti-immigrant animus. Rather, the experiments focus on the effects in one direction: increasing support for access to government health care programs. Future studies should test to what extent disease outbreaks increase negative attitudes toward immigrants and support for anti-immigrant policies.

Notwithstanding this study's limitations, the results hold important implications. Providing undocumented immigrants with access, however, will inevitably be a point of discord. Despite partisan polarization, this study suggests that appeals to self-interest and fairness can motivate individuals to support expansionary health care policies that benefit undocumented immigrants.

Acknowledgments

I would like to express gratitude for support from Paul Sniderman, Adam Bonica, Jens Hainmueller, Tomas Jimenez, Efren Perez, Hans Lueders, Valentin Figueroa, Freddy Valencia, Soyoung Lee, Rachel Lienesch, Hakeem Jefferson, Feyaad Allie, Gabriele Magni, Will Marble, Alice Wang, Aliz Toth, Sarah Thompson, and Zuhad Hai. I also thank the generous funding from Stanford's Center on Philanthropy and Civil Society and Center on Poverty and Inequality. All remaining errors are my own.

Notes

References