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Changes to immigration, health policies will create economic havoc, increase ‘human cost’
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President Donald J. Trump’s campaign was anti-immigrant from the day it was announced.
The Trump campaign website detailed anti-immigrant policies, and picks for his transition team and administration appear to indicate that fulfilling campaign promises to deport millions of noncitizens, exclude many immigrants from the workforce and reduce the eligibility of noncitizen immigrants for federal benefits will be a priority.
What will these policies mean for the health of immigrants?
Repeal of the Affordable Care Act (ACA) will disrupt the delivery of health care to millions and, indeed, promises to destabilize the entire health care economy. But, for immigrant families, change may be particularly stark.
Threats to immigrant health under the Trump administration may arise from reduced capacity of safety-net health providers, fear of interacting with the health care system, and reduced federal spending on health. Legal immigrants are more likely to use Medicaid than individuals born in the United States, as one example of access which would be compromised with reduced federal health care spending.
Further, the downstream effects of reduced access to care — familiar in the United States from the past era of high rates of uninsurance — may result in reduced ability to track infectious diseases, higher rates of diseases of stress — such as obesity and mental illness — and reduced life expectancy.
Undocumented immigrants continue to rely on community health centers and emergency rooms for health care. Repeal of the ACA — with its $11 billion Community Health Center Fund — would weaken this safety network.
The sanctuary cities movement — which began in response to the arrival of Central American refugees in the 1980s — now encompasses nonparticipation in the deportation of immigrants, which can break up families and place children at risk. Sanctuary cities also often provide local benefits and rights to immigrants. During the campaign, Trump vowed to withhold federal funding from these cities, placing this source of health care in jeopardy, as well.
Overall use of health services is lower for undocumented immigrants, including for children.
Nadereh Pourat, PhD, first author of a study conducted in California that examined use of health care services by undocumented immigrants, appeared in an interview on PBS NewsHour in which she described the barriers undocumented workers face when seeking emergency care.
“One likely issue is the fear or worry that you walk into the door of the emergency room, and you might have to provide some documentation,” Pourat said. “Emergency room staff tries to figure out whether or not you have insurance, and they try to see if you qualify for any of the public forms of coverage out there. Eventually you might have to say something about your documentation status.
“We did focus groups with young populations, and they say you learn early on to avoid going to the doctor,” Pourat added. “Your first instinct is to avoid [doctors] as long as possible. While the lower level [of] utilization might seem like a good thing, if undocumented immigrants undergo any major health problems, they’re often not discovered until [those problems are] more severe and more costly, and the patient could have a worse prognosis.”
A Hastings Center report from 2012 highlights the health consequences to children who are U.S. citizens, often eligible for coverage through Medicaid or the ACA, but whose parents are undocumented and avoid contact with the health care system to avoid detection.
Secure Communities, an immigration law enforcement policy from 2008, aimed to streamline detention by linking data from arrested immigrants with U.S. Immigration and Customs Enforcement. Not only did this program heighten fearfulness with respect to the health care system, some immigrant families stopped sending their children to school. Fear of detection can only be projected to increase if the risk for detention and deportation rises under a new administration.
The projected high price tag for keeping the Trump campaign promises to build a wall along the U.S.–Mexico border is $25 billion and to arrest, detain and deport up to 3 million noncitizen immigrants — we currently spend $2 billion per year to detain approximately 30,000 immigrants — as well as the cost of the economic havoc that would result from rapidly removing millions of workers from the hospitality, agricultural and other industries heavily reliant on immigrant labor, may divert government and private sector spending from health care.
Following a time of great crisis in world history, on Dec. 10, 1948, the United States was one of the original signatories of the Universal Declaration of Human Rights, Article 25 of which specifies access to medical care as a fundamental human right.
Those of us in health care have seen firsthand the human cost of uninsurance and denial of that right. It seems likely that immigrants will see increased barriers to receiving health care in the next 4 years, and the human cost will not be far behind.
References:
Aboii SM. Undocumented immigrants and the inclusive health policies of sanctuary cities. Harvard Public Health Review. Available at: harvardpublichealthreview.org/undocumented-immigrants-and-the-inclusive-health-policies-of-sanctuary-cities. Accessed on Jan. 12, 2017.
Gusmano MK. Undocumented immigrants in the United States: Use of health care. The Hastings Center. Available at: undocumentedpatients.org/issuebrief/health-care-use. Accessed on Jan. 12, 2017.
Tam R. What’s holding undocumented immigrants back from seeking health care? PBS NewsHour. Available at: www.pbs.org/newshour/updates/whats-holding-undocumented-immigrants-back. Accessed on Jan. 12, 2017.
Pourat N, et al. Health Aff (Milwood). 2014; doi:10.1377/hlthaff.2013.0615.
Wallace SP, et al. Policy Brief UCLA Cent Health Policy Res. 2016;(PB2016-7):1-8.
For more information:
Barbara Burtness, MD, is professor of medicine at Yale University School of Medicine. She also is a HemOnc Today Editorial Board member. She can be reached at barbara.burtness@yale.edu.
Disclosure: Burtness reports no relevant financial disclosures.