Trump's immigration crackdown has serious public health implications

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When you hear about President Trump’s crackdown on immigrants and plans to build a wall to keep them out, the first thing you think about probably isn’t health care — but maybe it should be.

Trump’s Immigration and Customs Enforcement raids, and the administration’s promise to do everything it can to kick “bad hombres” out of the country, are shaping up to have far-reaching effects on the health of migrants and their families.

While fear among migrants seems to be spreading faster than Trump’s actual policy changes, doctors and researchers who study the link between immigration and health say that’s enough to wreak serious damage. The Trump administration's aggressive new anti-immigrant stance, they say, already seems to be impacting the health and health-care-seeking behaviors of undocumented residents and mixed-status families.

One concerned researcher, the University of Wisconsin’s Edward Vargas, grew up in South Texas, along the Mexico border, where he often saw his immigrant neighbors being deported.

A few years ago, Vargas was volunteering in his community with a mixed-status family (some members were US citizens and others were in the US illegally). He suggested they apply for SNAP, the government program to help families pay for food, for their children. The mother told him she wouldn't out of worry that any information she provided would be used to deport her or her family members who were in the US illegally.

"I told her, 'Your kid is a US citizen and your kid by law is eligible to receive services,'" Vargas said. But she was too afraid to enroll for the food vouchers.

Vargas decided to explore whether there's a link between that fear and the use of health and social services. In one paper, published in 2015, he zeroed in on Medicaid and learned that mixed-status families living in communities where the risk of deportation was higher were less likely to use Medicaid across the US.

Other researchers have come to similar conclusions. A 2014 policy brief from the Urban Institute looked at barriers to accessing health and human services among eligible migrants. They found that fear and mistrust (which had mushroomed in response to the growth in immigration enforcement programs) was a key reason for lower application rates for health services among migrants — along with the complexity of the application process, language, literacy, and transportation challenges.

Around that time, the Obama administration found fewer than expected eligible Latinos were signing up for Obamacare — again, in part because of this climate of mistrust and fear.

Deportation fear can also have immediate health consequences. In a new Lancet paper, researchers looked at the mental health impact of the 2012 Deferred Action for Childhood Arrivals (DACA) program, which offered renewable work permits and freedom from deportation for undocumented immigrants. DACA eligibility was associated with "large and clinically meaningful reductions in symptoms of psychological distress." In other words, people were less likely to feel anxious and depressed when deportation wasn’t a looming risk. This paper adds to the growing body of evidence about the link between deportation worries and mental health.

It's still too early to tell exactly how Trump's anti-immigration policies are affecting the health of immigrants. But Vargas told me, "It’ll be a lot different now.” And anecdotal reports suggest the perception of a crackdown may already be having a negative influence.

Lanre Falusi, a DC-area pediatrician focused on migrant health, said she’s hearing reports from colleagues across the country about a drop in the use of health care services among migrant children following Trump's swearing in. Mixed-status families are not showing up for their health care appointments, or they're asking to be unenrolled from services that children were eligible for, like WIC (the Special Supplemental Nutrition Program for Women, Infants and Children), she said. And she's worried that the "prolonged exposure to serious stress will harm the developing brain and affect the health" of these kids.

Recently, several media reports have suggested more families are going hungry post-Trump because they are avoiding SNAP. As the Washington Post recently reported, "In the two months since President Trump’s inauguration, food banks and hunger advocates around the country have noted a decline in the number of eligible immigrants applying for SNAP — and an uptick in immigrants seeking to withdraw from the program."

It’ll take time to get a sense of the bigger picture and to muster evidence on what impact Trump’s rhetoric and changes in immigration policy have. For now, as the debates about health care creep along, this is a trend to watch.

Chart of the Day

The UCLA Center for Health Policy Research

Immigrants don't get the same health care as other Americans. According to the UCLA Center for Health Policy Research, "Despite the far-reaching expansion of health care coverage for the large number of uninsured individuals in the US, the ACA explicitly excludes undocumented immigrants from purchasing health insurance coverage through the health exchanges. In addition, undocumented immigrants continue to be ineligible for most public forms of health insurance coverage and would not benefit from any Medicaid expansions carried out by the states."

Kliff's Notes

With research help from Caitlin Davis

• "GOP centrists push back on ObamaCare repeal": “Centrist Republicans are throwing cold water on prospects that the House is getting closer to a deal on ObamaCare repeal. The centrists object to demands from conservatives that states be given waivers that would allow them to repeal certain ObamaCare requirements. The conservatives say the state waivers would reduce premiums, but centrists worry the move would also put insurance out of reach for people with pre-existing conditions.” —Peter Sullivan and Scott Wong, the Hill
• "For Republicans, there is no safe position on Trumpcare": “While this is just a tiny sampling of opinions, national polling shows the House bill was hugely unpopular. Democrats were always going to hate it, and the coverage losses under the bill were always a liability with independents. But it also suggests messaging from the right is getting through to Republican voters, meaning moderates are feeling extreme heat from all sides.” —Caitlin Owens, Axios
• "Republican House leader avoids selling GOP health-care plan at home": “Rep. Greg Walden is one of the Republican House leaders who crafted the measure to overhaul the health-care system that dramatically imploded before lawmakers went home for a two-week recess. But when faced with a large crowd of angry constituents in his district this week, the Oregon Republican seemed reluctant to claim the legislation as his own. Instead, Walden stressed the parts of President Obama’s Affordable Care Act that he wants to keep.” —Paige Winfield Cunningham, Washington Post

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