When she was working as a family medicine doctor in Fresno, California, earlier this year, Anjani Kolahi brought an ultrasound machine to the fields where some of her patients worked.
She and her colleagues knew that many undocumented farm workers in the area weren’t visiting their health center, even though they qualified for affordable care. Kolahi wanted to bring that care to them.
She found two women in their third trimester of pregnancy, one over 40 and one a teenager. Neither had received any prenatal care. “That moment was actually joyous,” said Kolahi, a fellow with Physicians for Reproductive Health. “They could see their baby; they could hear the baby’s heartbeat.”
But going without prenatal care can be risky for mother and baby. Unfortunately, lack of insurance and fear of deportation mean undocumented immigrants often don’t receive necessary reproductive health care.
Deferred Action for Childhood Arrivals (DACA) helped some recipients get access to health care. But now that President Trump has rescinded the program, leaving Congress to come up with a replacement, DACA recipients’ future is in doubt — and that includes their ability to get the care they need to stay healthy and plan their families.
Rescinding DACA puts some recipients’ health insurance at risk
Immigrants face some obstacles to health care even if they are legal residents — as the National Women’s Law Center notes, they are barred from Medicaid and the Children’s Health Insurance Program (CHIP) for the first five years of their legal status. DACA recipients are also barred from Medicaid and CHIP, and from buying insurance on the Obamacare exchanges.
DACA, which granted recipients a work permit, helped some people get insurance through work, said Luis Serrano, who works on communications and digital media strategy for the California Immigrant Youth Justice Alliance and is a DACA recipient. In a survey by the Center for American Progress, 57 percent of DACA recipients said they’d gotten a job with health insurance after their DACA application was approved. “I think DACA did bring a lot of stability for folks’ health, physically and mentally,” Serrano said.
Some of that stability is reflected in public health research. A study recently published in Science found that children of mothers who were eligible for DACA had lower rates of anxiety and adjustment disorders than children whose mothers were ineligible.
But due to the president’s decision to rescind DACA, recipients are now in a kind of limbo. As Vox’s Dara Lind explains, the president has promised to “revisit” the issue if Congress doesn’t come up with a plan within six months to grant DACA recipients permanent protections. Even if Congress does come up with such a plan, it’s not at all clear what would happen to recipients whose protections — and work permits, and ability to access health care — expired in the meantime. And the deadline for applicants to renew, October 5, is fast approaching.
Another barrier to care is the fear of deportation
Undocumented immigrants sometimes avoid visiting hospitals or clinics because they’re afraid of being deported, said Matthew Lopas, a health policy attorney at the National Immigration Law Center. Kolahi’s patients typically didn’t come to the health center until they were very sick, she said. One reason: They were afraid of “being in a computer somewhere and giving their information.”
The Health Insurance Portability and Accountability Act (HIPAA) prevents some of patients’ information from being shared, said Lopas. And the Department of Homeland Security, under President Obama, issued guidance recommending that immigration authorities not enter hospitals or clinics. In the past, authorities have generally followed the guidance, Lopas said. But in May, a Border Patrol agent came to the Texas hospital where Oscar and Irma Sanchez, who are undocumented, had taken their sick infant son, reports John Burnett at NPR. Agents followed the couple to another hospital where the baby was to have an operation, and then arrested them. Their lawyer will seek permission for them to stay in the country with their son, now largely recovered, and three other children.
Even if Border Patrol or Immigration and Customs Enforcement (ICE) agents don’t enter a medical facility, their presence can be intimidating. Kolahi assured her patients in Fresno that the health center staff would protect their identities, she said. But that didn’t carry much weight when her patients saw an ICE van a few blocks away.
In some border areas, getting to a hospital or clinic can mean driving through a Border Patrol checkpoint, noted Kelli Garcia, the director of reproductive justice initiatives at the National Women’s Law Center. That poses an added risk for undocumented immigrants seeking care. “When people are afraid to go outside, when they are afraid to get in their cars and drive, when they could get deported for dropping their kids off at school,” said Garcia, “that fear is going to keep people from being able to get both health care for themselves and health care for their children.”
DACA granted recipients protection from deportation, but now the future of that protection is uncertain. Some DACA recipients, including a mother of young children, have already been detained or deported (the ACLU, meanwhile, has filed a complaint against ICE for its treatment of pregnant women in immigration detention). Earlier this year, Attorney General Jeff Sessions said that DACA recipients would not be targeted for deportation, but did not offer any assurance that they would not be deported, according to the Chicago Tribune.
Serrano said that inability to afford care was a bigger issue for many DACA recipients than fear of deportation. But, he said, “the removal of DACA is causing a lot of anxiety.”
And increases in deportations and raids under President Trump, as well as some of his executive actions, have created a new sense of uncertainty among immigrants, Lopas said. “The lack of solid information that people have to make decisions on right now is really leading folks to be as cautious as they can be.”
Lack of care can lead to unintended pregnancy, illness, and other problems
Immigrant women in general are at disproportionate risk of a variety of reproductive health problems, in part because of lack of access to care, according to the National Women’s Law Center. They are less likely to be screened for cervical cancer than women born in the United States, and so Asian and Pacific Islander and Latina immigrant women are more likely to get cervical cancer than US-born women, and more likely to die from it. Immigrant women are also less likely to get contraceptive care and more likely to have an unintended pregnancy.
Lack of prenatal care can mean undocumented immigrant women don’t receive screening for conditions like gestational diabetes or infections that could be transmitted to the fetus, said Kolahi. They also miss out on the information and reassurance that a doctor can provide, especially for first-time parents.
When undocumented immigrant women seek abortions, they face all the obstacles women born in the United States face, including restrictive laws and a dearth of providers, along with problems unique to their immigration status, Garcia said. Add in the need to pass through a checkpoint to get to a clinic, and undocumented immigrant women may be unable to get an abortion at all, or may have to push the procedure until later in pregnancy when it is more expensive.
Uncertainty about the future of DACA and other immigration policies can also affect immigrants’ family planning decisions. Fears of being deported or of losing a scholarship or other opportunities because of immigration status can keep people from having the children they want to have, Garcia said. “All of those things can get in the way of being able to make the decision that really is the right one for you.”
One of Kolahi’s former patients, a naturalized citizen in her 20s, is in a relationship with a young man who is a DACA recipient, Kolahi said. When Trump rescinded DACA, they decided to get married. “It’s just so awful that this external US policy is now pressuring them to get married,” Kolahi said. “It’s a very personal decision that you have to be ready for.”
DACA recipients need more access to health care, not less
To make sure undocumented immigrants get the reproductive health care they need, preserving the Affordable Care Act is an important first step, Garcia said. Then DACA recipients and undocumented immigrants need to be allowed to get Medicaid and CHIP coverage and buy insurance on the exchanges. Beyond that, she said, “we really need to make sure that providers have policies in place that make it possible for people to access care and know that their information is not going to be used to call immigration.”
Many reproductive health providers, including Planned Parenthood, have stepped up to offer care regardless of immigration status, said Lopas. Providers have certain legal rights they can assert to prevent patient information being taken by the government (the National Immigration Law Center has a list of these rights). For undocumented patients, Lopas said, “one of the biggest protections is really just the providers themselves.”
Changes in immigration policy — namely, an end to detention and deportation — are also necessary to truly safeguard all immigrants’ access to health care, Serrano said. He also advocates for a single-payer system that includes coverage for immigrants. “Even as we hear conversations about single-payer, we don’t hear if immigrants are going to be included,” he said.
Ultimately, keeping undocumented immigrants from getting necessary health care is bad for everyone, Garcia said. Health care is more expensive when people can’t get it until they’re very sick. And lack of health care increases the risk of chronic illness, which can make people unable to work or be active in their communities. When it comes to immigrants and health care, Garcia said, Americans need to take a broad view: “What kind of society do we want to live in?”