The Trump administration’s hard-line positions on immigration recently helped shut down the government. It’s also provoked a public health crisis among undocumented immigrants, who live under the constant fear of deportation and who forgo routine medical treatment to avoid being discovered. And now, according to advocates, the Trumpian rhetoric around “illegal immigrants” is also affecting legal immigrants, who’ve begun avoiding public health services and subsidized insurance plans for fear their information could be used against undocumented relatives.
The Associated Press reports a “chilling effect” among Hispanic people who participated in healthcare programs, particularly in the Affordable Care Act’s open enrollment season, which ended in December. The ACA provides low-cost, subsidized insurance, though the problem of getting Hispanics to sign up for insurance predates the Trump administration, the AP notes.
A 2015 Pew Research Center study found that Hispanics are more three times as likely to go without health insurance compared to their white counterparts. And while whites were about 63 percent of those who signed up for Affordable Care Act plans last year, Hispanics were only about 15 percent, according to the Centers for Medicare and Medicaid Services. Fear of deportation has long been one reason that more Hispanics avoid signing up.
And the current heated rhetoric around immigration hasn’t helped the problem. Daniel Bouton is a director at Community Council, a Dallas nonprofit that specializes in enrolling low-income families in health insurance. He told the AP that, since Trump’s election, "every single day families canceled" their Medicaid plans, and "people really didn't access any of our programs.”
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Over the next year, Bouton said participation stabilized a bit. But there are still people going without insurance because they’re afraid of what might happen to their families. For example, a 52-year-old housekeeper from Mexico, herself a legal resident, had signed up for federally subsidized insurance for two years through Bouton’s organization. But in the current climate she chose to go without insurance, worried that federal authorities might use her information to track down her husband, who is in country illegally. She is considering not re-enrolling her two teenagers in the Children’s Health Insurance Program (CHIP) even though they were born in the US.
"We're afraid of maybe getting sick or getting into an accident, but the fear of my husband being deported is bigger," the woman told the AP, speaking through a translator. Both she and her husband chose to remain anonymous so as to avoid his potential deportation.
It’s difficult to give hard numbers on just how many people are making similar choices. My Health LA works in Los Angeles County to provide primary care services to low-income residents and anyone who lacks the necessary documentation to enroll in public healthcare programs, including Medicaid. Its annual report showed 189,410 participants enrolled during Fiscal Year 2017. Later, though, 44,252 people (or about 23 percent) dropped out. But the report doesn’t describe the ethnicity of those who left the program, or why they chose to do so.
Advocates say people are even passing up vital care because of deportation fears. “One social worker said she had a client who was forgoing chemotherapy because she had a child that was not here legally,” Oscar Gomez, CEO of Health Outreach Partner, told the AP.
Doctors are already seeing undocumented people waiting until they're very sick to seek care for acute illnesses and chronic conditions, which strains public health resources, and now it seems legal immigrants could be doing the same thing.
Far from being unpredictable side-effects of our current immigration debate, these are entirely expected outcomes. It fits perfectly with the Republican embrace—spoken or not—of a policy of “self-deportation” designed to make life so difficult for undocumented immigrants to remain in the United States that they return to their home countries. Now we’re seeing that the stance has effects well beyond the undocumented people. It’s also become the mainstream GOP position—something to remember as the party has, in exchange for funding the government, pledged to continue immigration talks.