Health-care practitioners and public-health analysts across the country are urging the Trump administration against a proposed immigration policy change that would discourage immigrant families from using public services. As flu season approaches, experts remind that public-health care helps combat viruses that endanger Americans of all citizenship statuses.
Last week, the administration published its proposed changes to the public charge rule, barring immigrants who use a broader array of public services—including health-care programs like non-emergency Medicaid or the Medicare Part D, which helps enrollees pay for prescription drugs. The change also penalizes the use of food and housing assistance.
During the ongoing 60-day public comment period, health-care providers and analysts across the country are underlining the potential dangers of a plan to penalize access to health-care programs. The California Academy of Family Physicians, a group of over 10,000 practitioners, has issued a press release opposing the draft rule that warns that "disease and illness do not discriminate based on immigration status." The statement marked the beginning of a campaign to spread awareness of the potential effects of the proposal on public health.
"California will be especially hard-hit by any efforts to limit immigrants' access to health care," doctor and CAFP president Lisa Ward tells Pacific Standard in an email. She explains how restrictive immigration policies leave immigrants hesitant to utilize social services:
It's a basic tenet of public health that preventive care—like getting a flu shot—works best among a general population when more people are vaccinated, so fewer people get sick and spread the flu. Yet now, at the beginning of flu season, we're seeing fewer immigrant adults and their children in clinics. That's mostly likely because people are afraid to get health-care services, even for their U.S.-born children who are citizens, because of the proposed new rule.
The CAFP is flanked in its efforts by a wide array of medical experts. Late last month, a broad umbrella of health-care practitioners—the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, the American Psychiatric Association, and the American College of Obstetricians and Gynecologists—put out a statement opposing the change. And this week, Texas' community health clinic network, Legacy Community Health, is sending representatives to Washington to lobby against the rule, the Houston Chronicle reports. Legacy Community Health did not respond to Pacific Standard's request for further comment on the issue.
Others agreed with Ward that, although the effects of the proposal would be indefinite, it is most illogical to discourage the use of medical care ahead of flu season. The Centers for Disease Control and Prevention (CDC) defines the flu season as beginning in October, peaking in December through February, and lasting as late as May.
"Denying important support for immigrant families affects everyone" says Lourdes Baezconde-Garbanati, a professor in preventive medicine at the University of Southern California. "Providing care to families will help prevent the spread of the flu and other contagious diseases throughout the general population. Infectious diseases do not discriminate on whom they infect."
The proposed change to the public charge rule also stands to burden already overwrought emergency rooms. "If people can't get basic health care or preventive care, they may wait until health problems become more difficult to treat and they turn to the hospital emergency department. This is an expensive alternative to more cost effective primary care, which will be difficult to access under the public charge rules being proposed," says Michael Cousineau, also a professor of preventative medicines at USC.
"It is in the best interest of public health to ensure that everyone gets the care they need," he adds.
Leading academics on public health across the country agree that, while the administration's rule apparently aims to penalize non-citizen American residents for using public-health facilities, all Americans stand to suffer.
"The change in the public charge policy for immigrants has potential to further discourage immigrants from accessing important health-care and public-health services, which puts all of society as a disadvantage, especially when it comes to infectious diseases or conditions that are easily managed in primary care but can end up resulting in costly emergency room visits," says Lisa Goldman Rosas, a health policy professor at Stanford University.
The Trump administration seems to acknowledge the potential effects of the decision on the general publics health. Lorna Thorpe, an epidemiology professor at the New York University School of Medicine, notes that, in the proposal itself, the Department of Homeland Security "acknowledges that it may have 'follow-on effects,' such as increased prevalence of communicable diseases." Thorpe predicts that free vaccinations and treatments that are not subject to the public charge rule might also see a dip.
The proposal lists, among the potential effects of its changes, an "increased prevalence of communicable diseases, including among members of the U.S. citizen population who are not vaccinated."
The CDC recently revealed that there were a total 183 pediatric deaths during the 2017–18 flu season, the highest number in recent memory, and 80 percent of the children who died from flu-related causes were unvaccinated. The effects of the Trump administration's pending change to the United States' immigration policy remain to be seen.