It’s easy to give lip service to the fact that we need immigration reform. It’s rare to find anyone who does not say that the system is broken, but there are myriad opinions on how, exactly, it is broken — and still more on how to fix it. The thing people seldom talk about, though, is the actual path to a green card and eventually citizenship.

The thing is, the process itself is harder than you think, even for educated individuals entering the country under legitimate circumstances. There is often a misconception that there are easy ways to get a green card and enter the country legally, but people just have not taken them. That is not the case at all.

Here are a few of the hidden obstacles on the path to a green card and U.S. citizenship:

Physical Barriers

In this case, we are not talking about walls, fences, or the oceans that separate immigrants from U.S. soil. Instead, we are talking about health. To get a green card, an individual must pass the USCIS physical exam. This is much more comprehensive than a yearly physical from your doctor.

The first step is to fill out all the paperwork. The form is called an I-693, and it asks a lot of questions about prior medical history. Since many immigrants don’t yet speak English, there is a provision for an interpreter to fill out some of the information on the form and certify its accuracy.

Second, the potential immigrant must find a doctor who can perform the exam. Not just any doctor can; they must be certified as a USCIS civil surgeon. The doctor also has to undergo training and a certification process, but you can find a qualified one on the USCIS website.

From there is the exam itself. The doctor will not only review medical history and ask several questions but will also examine the candidate for heart problems, lung issues, bone disease, neurological issues, and mental health conditions. Things like comprehension, mood, appropriate behaviors, and more are all examined. Any signs of disease can cause the need for more treatment and examination.

While having an ongoing medical issue may not disqualify someone from entering the U.S., it very well could. Sometimes a medical waiver is appropriate, while treatment for certain conditions must be obtained before the individual can undergo another exam.

Medical history is only the first part of the puzzle, though.

Racial Discrimination

The truth of the situation is that this should not happen, but it does. Applicants can be discriminated against because of how they look, where they are from, even their education level. There are some humanitarian green cards granted, but they are hard to qualify for and offered in extremely limited numbers.

For instance, the recent interest in DACA reform surrounds the fact that “Dreamers,” or undocumented children, can get a two-year reprieve from deportation and be eligible for a work visa. This policy does not offer them a path to citizenship, however, like the proposed Dreamer Act does. The DACA act has technically been suspended, though, and seems likely to be ruled unconstitutional at some point.

Combine this with the recent news about the separation of families at the border, President Trump’s desire to end immigration from various countries, and the refusal of refugees by many cities and states speak to the fact that where someone is from, their religion, and their race all affect their ability to get a green card.

While it is essential that the trauma these immigrant families go through in places like the classroom to the workplace is treated, it is difficult for them even to get far enough in the process to be eligible for this kind of help. The path to a green card and eventual citizenship is narrowed even further by racial bias. It is only through becoming politically active that we can eliminate some of these barriers.

The Few Paths to a Green Card

There are really only a few legitimate ways to get a green card. They are family reunification, employment, and humanitarian protections.

The path of family reunification is itself limited. They are split up in levels of preference and include adult spouses of U.S. citizens, parents, and unmarried children under 21. This means if the immigrant in question is a child under 21 and married or has already reached the age of 21, they would be ineligible under the family reunification statute.

There are exceptions for “less preferred” family members, but the numbers are capped at 226,000 per year, and they take much longer to apply for. Only U.S. citizen brothers or sisters, certain children of green card holders, and occasionally spouses of green card holders are eligible.

The idea behind this is partly humanitarian out of the desire to not split up families, at least in some cases, and in others the idea is that we don’t want to lose productive citizens who will have to go overseas if they have no other choice.

The second is an employment path, but these are capped at 140,000 per year and require high-level professions with provable skills. Also, an employer who wants to sponsor an employee must prove they could not find a U.S. citizen to do the same job.  

Lastly are humanitarian options, but these are also very limited and difficult to get.

• Assylum: An immigrant can seek asylum in their first year in the country but only if they are fleeing persecution in their homeland.
• The T-Visa: Another path for those who are victims of human trafficking. Victims of other serious crimes might be eligible for a U-Visa, but the numbers of all of these are extremely limited.
• Cancellation of Removal: Someone who is facing imminent deportation can also apply for a Cancellation of Removal if they have been in the U.S. for more than 10 years, but they can be turned down for any number of reasons.

It’s not as simple to become a U.S. citizen as you might think. Even once they hold a green card, individuals often wait years for citizenship. It’s easy to say that immigrants should simply follow the rules and come to the country legally, but for a system that is nearly as complex as tax law, the process is neither clear nor easy, and for immigration reform to work, these laws must be revised.