Why Public Health sees a community threat in proposal about immigration

The new proposal to amend the U.S. Department of Homeland Security’s “public charge” test is a threat to the public’s health.

“This is inhumane, and it would undermine efforts to improve the overall health of King County—and impact generations to come,” said Patty Hayes, director of Public Health—Seattle & King County, in a news release and at a news conference on Sept. 25 in Seattle.

Public Health Director Patty Hayes with other community leaders at a news conference held at International Community Health Services in Seattle on Sept. 25, 2018
Public Health Director Patty Hayes with other community leaders at a news conference held at International Community Health Services in Seattle on Sept. 25, 2018

Already, fear and confusion about this proposal are causing people in our community to go without essentials such as food and medical care, because of fear that it would prevent them from attaining permanent status in the United States.

If you missed the details, current immigration policy includes a test to determine if an immigrant is likely become primarily dependent on taxpayer-funded services, specifically cash welfare and long-term nursing home care. If so, they can be denied entry or a green card. The new proposal would change the definition to include anyone who uses any amount of a long list of services – focusing on healthcare (Medicaid), food (food stamps) and housing (e.g. Section 8 vouchers).

In our own Public Health clinics, and in food banks, community clinics and other locations, staff have seen these fears first-hand. In recent weeks, staff have shared stories of new mothers who declined baby formula that they needed, pregnant women who declined nutrition services, and parents who removed children from health insurance.

That’s horrible for those families, and it’s a public health threat.

Immigrants make up a small percentage of the people using services – but King County is large, and the numbers are sobering in terms of potential human impact.

  • We have more than 20,000 households in King County where at least one adult or child is an immigrant receiving health care through Medicaid
  • And we have more than 30,000 households where at least one immigrant receives food stamps (Supplemental Nutrition Assistance Program, or SNAP).

What would it mean if these families drop out of these programs? From a health perspective, we know that:

  • creating adverse or traumatic experiences for a child correlates directly with life-long physical and behavioral health problems.
  • as fewer pregnant women access prenatal care, we can expect increases in premature births and poor birth outcomes
  • hospital and emergency department costs will go up, as more families avoid routine medical care until conditions are critical and life-threatening
  • we can expect long-term increases in diabetes, heart disease, cancers and other conditions, as fewer children and adults receive routine preventive care

Assuming that immigrants who already live and work here are likely to remain here, all of these impacts – from hospital use to social services – will drive up overall health care costs for everyone.

Any action that discourages use of health and nutrition programs by immigrants and their families will deepen already significant health disparities based on race and place. This policy would exacerbate these types of inequities and undermine the goal of ensuring that all residents have a fair opportunity to achieve good health.

By making these essential services affordable to all, we actually enable people to strengthen their self-sufficiency – and we promote a healthier, more resilient society.

For clients of Public Health services:

At clinics operated by Public Health—Seattle & King County, we remind all clients and potential clients that we welcome all, regardless of their race, ethnicity or immigration status. We protect the privacy of all clients, we do not collect information about immigration status, and our Public Health clinics are “designated private areas.” That means they are sensitive locations, and we do not allow immigration agents inside our clinics without a judicial warrant.

For concerned families, there is no reason at this point for people to stop benefits that they or their families currently receive legally. Current law has not changed. The proposed new rule has not been not finalized and must go through a lengthy public process before being finalized. And, the proposal says any changes would apply only to benefits received after a new rule is finalized.

Originally published: 9/25/2018

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I'm part of the communications team at Public Health - Seattle & King County and work closely with all of the programs in the Community Health Services Division.