Health Care Access for Undocumented Immigrants
Dr. Jenkins
PS101
28 April 2022
Arguably the most dangerous problem facing refugees and undocumented immigrants is the lack of health care services available to them and the fear of deportation that discourages the use of what little is offered. This fear has existed in undocumented communities for a long time, at least since Immigration and Customs Enforcement (ICE) was moved from the Department of Justice to the Department of Homeland Security (DHS) after 9/11. But when the Trump administration implemented new deportation guidelines in early 2017, there was a noticeable spike in anxiety in communities nationwide.
Under President Obama, ICE was instructed to prioritize those with criminal convictions for deportation, under Trump, they began targeting all “removable persons” across the country. Under these new guidelines, there was a dramatic increase in workplace raids, especially in states that do not have a foreign border, and many began to worry that public facilities that have traditionally been considered “sensitive locations” (medical facilities, schools, places of worship) by DHS would be next. According to Alex Armstrong, CEO of Alliance Medical Center, a community health facility outside Santa Rosa, CA, AMC’s appointment cancellation numbers were double the weekly average the week the new guidelines were implemented. Many patients who were asked why they were canceling said either they or the person who has supposed to drive them to the appointment were afraid of ICE officials (PBS Newshour). One spokesperson for King’s County Hospital in Brooklynn, New York who spoke to PBS said their facility experienced a similar phenomenon that same week. Someone had spread false rumors in the nearby LatinX community that ICE officers were prowling the halls of the hospital and patients canceled appointments en masse because of the fear of deportation.
It’s not just the fear that ICE officers might be in the hospitals themselves, but also that they might somehow get their hands on documents containing sensitive personal information, like Medicaid and CHIP enrollment records, and the lists that hospitals sell to debt collection agencies, which typically contain patients' personal and/or work phone numbers, and home addresses. This became a real danger during the worst days of the COVID pandemic. One anonymous Bostonian did not seek medical attention until it was almost too late. She spoke to GBH (Boston’s NPR affiliate), under the name Esmeralda: “There have been many times when I have been scared to get medical care,” said Esmeralda through a translator. “I’m afraid I won’t be able to pay for the medical care and this will lead me to being flagged for not being able to pay bills. I’m always afraid I will get put on a list many times when it comes to medical care” (GBH News). In the United States, refugees and asylees are granted health insurance for the first eight months after their arrival through the Refugees Medical Assistance (RMA) program run by the Department of Homeland Security’s Office of Refugee Resettlement, some are then able to apply for and receive Medicaid and Child Health Insurance Program (CHIP) benefits if they are eligible. Undocumented non-asylees however, are ineligible for all of these programs. Thus discouraging undocumented people from seeking medical care until they can no longer avoid it.
At this time, there has not been an official study into the effect of Trump administration policies on the willingness of undocumented individuals to seek medical care, but there is evidence that immigration policy at the local level can lead to an increase in hesitancy. In 2010, Arizona passed a bill giving state and local law enforcement the authority to open investigations into individuals they suspected were in the country illegally. When it was passed, researchers studying childhood obesity noticed that their participants stopped showing up. “Several providers described a drop in health maintenance, such as regular doctor visits, diabetes education, vaccines, prenatal care, HIV education, and procurement of medications, as the result of [the law],” (PBS Newshour).
While comprehensive care will likely remain unobtainable for the foreseeable future, access to basic services has been improving in recent years thanks to medical students. In 2014, nearly two-thirds of all medical schools in the United States had at least one student-run clinic for the uninsured, and many schools in the border states are partnering with non-profits to provide migrants stuck in Tijuana under the “Remain in Mexico” policy with care and medications they had been foregoing as they made the journey north (AAMC). While this is nowhere near enough, especially since the beginning of the pandemic, it is a good start.
Sources:
https://www.pbs.org/newshour/health/immigrants-trump-deportation-doctor
https://ajph.aphapublications.org/doi/10.2105/AJPH.2011.300541