Why health providers are emerging as immigration advocates
By Heather Skrabak
There is a group of Americans that is currently under threat — waiting on Congress to put aside differences and to take immediate action to ensure they can continue to contribute to making our country great. These Americans are young undocumented immigrants who arrived as children and are seeking a path to citizenship, known as Dreamers.
This week, Dreamers and other advocates are gathering in Washington, D.C. to support including the DREAM Act into federal funding legislation. Many health care provider groups around the country, including the Association of Asian Pacific Community Health Organizations (AAPCHO), will be joining them.
In the midst of national health conversations, many national health groups have begun to step out as immigration advocates. Provider groups have numerous reasons for supporting Dreamers and the immigrant community overall, including:
Immigration is a social determinant of health.
Social determinants of health are economic and social conditions that impact patients’ access to care, understanding of health conditions and ability to participate in health interventions. “Immigration status is a leading social determinant of health,” said Jeffrey Caballero, executive director of AAPCHO. “We can see the impact of immigration status issues in patients access to insurance, safety in accessing care, and ability to address chronic issues. AAPCHO and our member health centers believe that addressing these determinants, which disproportionately impact the communities we serve, can have great implications on patients’ health and our country’s public health overall.”
Immigrants are a key part of the communities health care providers serve, and immigration is complex.
For many, the immigration process takes years, especially for those stuck in the family visa backlog. Thus, many family units contain people with multiple immigration statuses. Preventing access to care for any family members can contribute to the rest of the family either limiting care or avoiding seeking services entirely. The effect is especially cruel when it results in gaps in care for immigrant and citizen children. As American Academy of Pediatrics’ President Fernando Stein, MD, FAAP, puts it, “Immigrant children and families are an integral part of our communities and our nation, and they deserve to be cared for, treated with compassion, and celebrated. Most of all, they deserve to be healthy and safe. All children in this country should have access to health care and nutritious foods. The fact that some immigrant children and parents are avoiding seeking services for which they are eligible like health care, federal nutrition programs, and early education, due to fear of deportation, threatens their health. Without these resources, immigrants and citizens that live in our communities and neighborhoods may develop more complex medical challenges, increasing costs to the healthcare system. Pediatricians stand with the immigrant families we care for and will continue to advocate that their needs are met and prioritized.”
Immigrants are health providers.
According to a recent Migration Policy Institute study, about 14,000 Deferred Action for Childhood Arrivals (DACA) recipients are in the health care and support field. Given the well-documented need for primary care providers and allied health workers facing the country and the anticipated primary care shortage, the loss of “DACAmented” providers would be detrimental to the U.S. public health infrastructure. “The loss of DACA would hurt our health care system, removing an estimated 5,400 future clinicians from the medical pipeline. We would lose health care providers with language skills and cultural competencies, who are uniquely positioned to care for our diverse patient populations,” said Michael Byun, CEO of Asian Services in Action, Inc. in Ohio. “As those in the trenches of direct service and care, we believe in the right to health for those that we serve and that includes Dreamers and their families.”
Ensuring the health of new Americans has local benefits.
Across the country, advocates are gathering at statehouses and meeting with local legislators to urge support for Dreamers, including health providers. Among the advocates are physicians, who know that providing essential preventive care, vaccination, and chronic disease support, benefits the health of all local communities. “Addressing the health needs of immigrant communities is good for public health,” says Jim Duffett, executive director of Doctors for America, “We believe in the community impact of the services that we provide, and the safety and security of our patients and fellow physicians is essential to a healthy America.
Immigrants give back to the U.S. tax base and deserve access to care.
One of the common misconceptions about undocumented immigrants is that they do not give back to the U.S. tax base. Rather, undocumented immigrants clearly must pay sales tax, and DACA recipients do file income and, if applicable, property taxes using Individual Taxpayer Identification Numbers (ITIN). ITINs are used by the IRS for persons without social security numbers and according to the Internal Revenue Service, ITIN filers in 2015 paid $23.6 billion in total federal taxes, including over $5.5 billion in payroll and Medicare taxes. According to a Center for American Progress study, ending DACA would cause the loss of over $460 billion in the national GDP over the next decade. “Immigrants are aspiring Americans who support the American economy with billions in sales, income and property taxes,” says Marielena Hincapié, executive director of the National Immigration Law Center. “They deserve equitable access to health care like all Americans.”
As the fight continues, providers have a unique and strong voice as immigration advocates. As organizations committed to serving patients and communities, we stand together to support the needs of undocumented and all immigrants and the families and communities that support them. We encourage other advocacy groups to join the fight, whether you work on health issues or not. Together we will ensure a health system that provides for all.
Heather Skrabak is the Associate Director of Policy and Advocacy at the Association of Asian Pacific Community Health Organizations (AAPCHO), a national association of community health organizations dedicated to promoting advocacy, collaboration and leadership that improves the health status and access of Asian Americans, Native Hawaiians and Pacific Islanders in the United States.