Bridges to Care, Not Walls

The current President ran his campaign on the platform and the promise to build a superior border wall to stop illegal immigration. His administration has reinforced and implemented many of his anti-immigrant views and policies igniting antipathy towards immigrants and asylum seekers. These policies and views have affected immigrant families and challenged communities known to be sanctuaries for newly arriving immigrants and refugees.

As the rhetoric heightens, immigrant families often forego needed care due to the fear of deportation and separation from their loved ones. These policies impact overall wellbeing, making immigration status a social determinant of health. Lessons learned from Arizona’s most stringent anti-immigrant policy, Arizona Senate Bill 1070 (SB1070), are critical as policy proposals furthering restricting services are proposed and the next presidential campaign unfolds.

Many immigrant households are made up of family members with different immigration status. Immigrant households are therefore not only fragmented by their immigration status but by their ability to access services. Contrary to what many are led to believe, undocumented immigrants as well as DACAmented individuals, are already excluded from federal public benefits except for emergency care. Their health care is limited to federally qualified health centers or free clinics that provide limited health care services. Mental health care is absent from these services. Whenever possible, local governments and institutions fill in the gap to provide services to residents regardless of immigration status and ability to pay.

My colleagues and I conducted a study examining the healthcare experiences of mixed-status households after Arizona’s SB1070 was passed. We were particularly interested in how households access health care when members have varied immigration status. We interviewed members of 43 households in Tucson, Arizona. Eighty one percent of participating households had at least one undocumented member. Our interviews revealed the harm of enacting restrictive policies and chilling effects that include a culture of fear and alienation.

Immigrant households are therefore not only fragmented by their immigration status but by their ability to access services.

Barriers to care that families reported included complexity of public assistance applications, language barriers, cost of care, and fear and trepidation in seeking needed care. Factors that improved access to care included assistance in navigating the complexity of public assistance applications, discount care programs, and discretionary practices exercised by front-line staff (for example, accepting other forms of documentation when customary income verification is unavailable etc.).

Our study observations indicated that the long-term impacts of restrictive policies persist years after the enactment of such policies, harming the community’s wellbeing and consequently prohibiting health equity. Local policies such as Arizona’s created an environment of fear that stopped immigrant household members from seeking services.

To address and expand access to health care for mixed-status households, we recommend expanding safety net programs and training healthcare professionals and other frontline staff to address the unique needs of mixed-status households. We also recommend increased outreach to immigrant households to provide health literacy programming and “know your rights” workshops to facilitate use and navigation of programs.

As the Trump administration continues to propose further restrictions on public services for immigrant families, local jurisdictions can use their discretionary powers to expand services to all regardless of status to address health equity. California Governor, Gavin Newsom, has recently announced proposals to expand Medi-Cal (Medicaid) eligibility to all eligible undocumented young adults between the ages of 19 and 25. His health care proposals expand access to health care and tackle affordability not only for young undocumented adults but for all eligible residents. To promote health equity, we argue for a strong local response to restrictive legislation.

Photo by Raivis Razgals on Unsplash