People Are Scared to Use Health Safety Nets Because of ICE

Known as a "chilling effect​," this public health principle can lead to a drop in everything from vaccinations and routine doctor visits to prenatal and HIV care.
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Federal safety net programs such as food stamps are able to reduce the number of children in poverty and help adults lead healthier lives. However, many people are too terrified to sign up for them because they fear the US Immigration and Customs Enforcement Agency (ICE) may use their personal information to track down and deport their loved ones.

“Historically, going all the way back to the Great Depression, this kind of information was shared by relief workers with immigration authorities, who then used the information to coordinate their enforcement/deportation operations,” says Francisco Padraza, a political science professor at the University of California, Riverside. Padraza recently published a paper with colleagues on mistrust of government health information in places where immigration policies are the most severe.


Known as a "chilling effect," this public health principle—that people will not hand over sensitive information to a government that seems intent on fucking up their lives just because they promise they won’t this time—is hardly new. A drop in everything from vaccinations and routine doctor visits to prenatal and HIV care was seen in the wake of Arizona’s SB 1070 “show me your papers” law. Visits to county clinics for communicable diseases (you know, the kind you should at least selfishly want everyone treated for) dropped by nearly a third after Alabama’s HB 56. Last year, Padraza and his colleagues found that Hispanic citizens “are less likely to make an appointment to see a healthcare provider when the issue of immigration is mentioned.”

All of this data points to one conclusion: If you can't gut federal safety net programs and healthcare the old fashioned legal way, as the Trump administration failed to do repeatedly last year, you can make people scared to use them. While researchers are still collecting hard data, reports from health and police departments across the country make clear this form of safety net sabotage is working devastatingly well in the Trump administration. San Antonio, for example, reports Hispanic women are not accessing WIC, the federal food program for poor pregnant women, new mothers, and their children. Houston and LA both report a decrease in sexual assault reporting.


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Now, a new paper shows that between 2008 and 2013 Hispanic citizens avoided signing up for food stamps and Obamacare in areas where ICE most aggressively detained people as part of Secure Communities, an immigration program piloted in the Bush administration, expanded by Obama until 2014, and restarted by Trump as soon as he possibly could.

Importantly, these were not people who had reason to fear deportation themselves; the chilling effect was the greatest in areas with mixed-immigration status families. That suggests people believe the programs are not worth the risk of listing the names and social security numbers of household members without documentation, even if a 2013 ICE memo swears their policy is not to use ACA information “as the basis for pursuing a civil immigration enforcement action.”

“This is a spillover effect as opposed to a direct effect, because people who are authorized are not eligible [for] forceable removal," says Marcella Alsan, an associate professor at Stanford Medical School and a co-author on the paper with Crystal Yang from Harvard Law School. But if you care about people who might be, you might be worried about offering information to authorities."

In their paper, Alsan and Yang analyzed more than two million detainers—that is, 24- to 48-hour immigration holds. Then they compared the data with sign-ups for the Supplemental Nutrition Assistance Program (SNAP), commonly referred to as food stamps, and the Affordable Care Act (aka Obamacare). Alsan and Yang found a decrease in safety net sign-ups for every 10 percent increase in ICE detainers. But they also found a vanishing of the chilling effect in sanctuary cities, or places that don’t always enforce those detainers.


“But even US citizens who would otherwise be eligible for social service programs and who do not personally live with undocumented persons or non-citizens may be deterred from accessing the services,” Padraza says. “That is because in the US stereotypes of citizenship and race are so strongly related.” After all, as a Stanford Center on Poverty and Inequality report points out, while 75 percent of undocumented persons are from Latin American countries, they are 97 percent of the people deported.

To understand just how cruel it is to make people choose between signing up for food stamps and Obamacare and feeling safe from being separated from their families, we need to look at the impact these programs when fully implemented have made in the lives of Hispanic Americans. Food stamps, for example, help nearly 2.5 million Hispanic Americans, half of them children, according to the Center on Budget and Policy Priorities, and Obamacare has dramatically reduced the uninsured rate by over 40 percent.

“For decades, Latinos have been disproportionately uninsured, but in the first three years of the ACA, the uninsured rates among Latinos declined significantly,” says Michelle Doty, vice president of survey research and evaluation for the Commonwealth Fund. “They had the largest decline in the uninsured rate of any ethnic group.”

While Alsan has a serious scholar’s hesitance to apply her data loosely to what is happening today (“I would definitely leave it to future researchers to look at what’s happening,” she says), the Trump administration seems to be following the results of her and Yang’s paper in all of the wrong ways. While more lower-level arrests were found to result in a decline in food stamp and healthcare use, ICE is increasingly arresting people with no criminal charges. In Dallas alone, non-criminal arrests, according to Pew, rose 156 percent in 2017. It’s almost like a chilling effect is the point.

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