Posted on 04/16/2025 4:26:16 PM PDT by nickcarraway
Here's how health systems should respond
For nearly 2 weeks, the nation's eyes were fixated on a case in Sackets Harbor, New Yorkopens in a new tab or window, where Immigration and Customs Enforcement (ICE) officers arrested a mother and her three children and detained them in Texas. After an uncertain 11 days, the advocacy from their community won their release.
The story reflects the fears of millions of immigrant families across the country who face impossible choices daily: whether to go to work, send kids to school, or keep medical appointments, and risk being separated from their family. Threatening rhetoric from federal officials, alongside the rescission of ICE's long standing "sensitive locations" policyopens in a new tab or window, supercharged fears among health systems that ICE would begin immigration enforcement actions at their facilities.
Health systems have an ethical imperative to serve all people, a responsibility that is undermined when they become targets for immigration enforcement.
The Consequences of Anti-Immigrant Policies
Multiple studiesopens in a new tab or window demonstrate that patients skipped appointmentsopens in a new tab or window or stopped seeking careopens in a new tab or window altogether after increased anti-immigrant rhetoric and immigration policy changes in 2017. Missed appointments can contribute to poor health statusopens in a new tab or window, and even represent a risk-factor for all-cause mortalityopens in a new tab or window. Meanwhile, threats to end Temporary Protective Status, DACA, and other visas may worsenopens in a new tab or window the unprecedented healthcare workforce shortage, since 18% of U.S. healthcare workersopens in a new tab or window are immigrants.
There are economic consequences too: missed appointments cost the U.S. health system $150 billion annuallyopens in a new tab or window, with an average missed appointment costing approximately $200.
The Health System Response
How should our health systems respond to this moment? We highlight below vital lessons learned through our organizing efforts, which are also reflected in excellent guidanceopens in a new tab or window issued by the Massachusetts Attorney General.
Establish written policies and educate staff before ICE arrives.
Healthcare institutions should adopt policiesopens in a new tab or window and educate all staff about what to do if immigration agents come to their facilities. Best practices include clearly designating private spaces within medical facilities that would require a judicial warrant to enter; confirming that two or three individuals are trained to speak with immigration agents and assess the validity of warrantsopens in a new tab or window; and ensuring staff know who to call and how to reach them. It is also crucial to ensure that patient information cannot be seen or overheard by third parties, as mandated by HIPAA.
Establish an immigrant health task force.
Coordinating and implementing effective institutional responses requires a wide range of expertise and perspectives. Task forces should include legal counsel, frontline healthcare workers, financial services staff, marketing/communications staff, social workers and case managers, local immigrant advocates, and, importantly, senior leadership. The Protecting Immigrant Familiesopens in a new tab or window coalition is a crucial resource.
Post welcoming messages and share "know your rights" (KYR) materials.
Signs in multiple languages should welcome the community to seek services and reflect images of the community served. These messages should be shared in waiting areas, bathrooms, and on TV monitors. KYR materials can be placed with other informational pamphlets in waiting areas, patient care rooms, and other public spaces. Posters with QR codes linking to the National Immigrant Law Centeropens in a new tab or window or the American Civil Liberties Union Know Your Rightsopens in a new tab or window websites are also helpful. Hosting a KYR training for immigrants in your health system can also signal a supportive environment to patients and staff.
Don't document immigration status in patients' medical records.
Asking patients about immigration status can cause fear and undermine the trust needed for effective care. Status can also change, and some patients may misunderstand or misreport their own status. Providers should document matters relevant to diagnosis and treatment, such as whether patients have lived and received care abroad, and/or whether they have a history of trauma. It is also important to document who accompanies patients on visits without asking about immigration status.
If it becomes relevant for a future immigration case, the patient will be able to request the data to share with their lawyer. If a patient asks for a medical support letter for their immigration case, get a signed release to speak with the patient's immigration attorney to see what information would be most helpful. Lastly, it is better to avoid requiring a photo ID to confirm patients' identities because not all immigrants have one, and this may dissuade some from seeking care.
Encourage patients to apply for and keep their public benefits.
Between 2017 and 2021, many immigrants dropped their public benefits due to a proposed federal rule change that would have deemed some green card applicants a "public charge" for enrolling. The chilling effect harmed millions of people who were not even covered by the rule.
Since the November election, we've been hearing from patients and providers that immigrants are withdrawing from care and coverage. If policies like the public charge ruleopens in a new tab or window change again, there should be ample time to decide what to do, but for now, patients should keep and use their benefits. Furthermore, state and federal laws require that information shared in applications for healthcare benefits can be used only to determine eligibility, and not for immigration enforcement or any other purpose.
Train staff to help immigrant families plan in the event of detention or deportation of a family member.
The detention and/or deportation of a family member is not only traumatic, it can also leave patients without a caregiver or source of financial support. It is crucial for any family with members who are at risk to create a preparedness planopens in a new tab or window. These documents help families collect vital information and make provisions such as choosing a caregiver, completing an affidavit if needed, and creating a family reunification plan. The plan should not be part of the medical record, but providers, social workers, or community health workers can help immigrants learn how to create one.
Build networks to support and advocate for immigrant families.
In 2017, we formed the Health and Law Immigrant Solidarity Networkopens in a new tab or window, a network of healthcare providers, legal professionals, and community organizations, including Health Law Advocatesopens in a new tab or window, to analyze policy and advocate for solutions in real time. Meeting the current moment will require innovative and interdisciplinary collaborations, organizing, and advocacy to pressure institutions and lawmakers to ensure that all patients can access the care they deserve. We also encourage providers to seek training to help them perform evaluations in support of asylum-seekers and to invest in medical-legal partnershipsopens in a new tab or window to help immigrant patients address their legal, financial, and social needs.
Inclusive policiesopens in a new tab or window make our cities and states safer. Our country is great, not in spite of, but because of immigrants. Immigrants often contribute more to the Medicare trust fundopens in a new tab or window and in private insurance premiumsopens in a new tab or window than they receive in benefits. Should our immigrant community members be forced out through repressive and harsh policies, our health systems will suffer. Healthcare institutions must stand by our immigrant patients, communities, and our own colleagues. We are stronger together.
Lara Jirmanus, MD, MPH,opens in a new tab or window is a primary care physician practicing in Revere, Massachusetts, a clinical instructor at Harvard Medical School, and faculty affiliate at the FXB Center for Health and Human Rights at Harvard. She has been a leading advocate for immigrant rights in Massachusetts, and is co-founder of the Health and Law Immigrant Solidarity Network.
Andrew P. Cohen, JD, MA,opens in a new tab or window is director and lead attorney for the Access to Care and Coverage Practice at Health Law Advocates, a non-profit law firm dedicated to healthcare access for Massachusetts residents with low incomes.
“Health systems have an ethical imperative to serve all people, a responsibility that is undermined when they become targets for immigration enforcement. “
Bulls***! They are attempting to protect CRIMINALS!
They forget one vital word always.
LEGAL, immigrants. LEGAL.
Immigrant families who are following the laws and rules have little to worry about. They entered legally and and perhaps will one day apply to become citizens.
Illegal alien entrants however are subject to deportation. They have no standing to remain.
It is telling others how break or at the very least break laws.
The sooner the better!
In the meantime, if he had been here illegally, he could have gotten citizenship many, many times, going back to at least the 1986 amnesty. And my friend will never be on welfare or commit a crime.
So, what are we saying to immigrants? We are saying: If you come here legally, we will punish you, but if you come here illegally, you will be rewarded.
It’s normal to be separated from your family when you break the law.
When faced with impossible choices, aim for the possible, Option D: GTF HOME.
“face impossible choices daily: whether to go to work, send kids to school, or keep medical appointments, and risk being separated from their family”
What a dilemma. Notice the one option that is absent from this list?
Pack up your family and go back where you came from.
The big lie!
Not one single immigrant has been, or will be, affected by ICE employees upholding the laws of the United States...
This Nation welcomes immigrants...
However, sneaky invading bastard scum migrants that cross our borders illegally and suck our economy dry need to be stopped, punished, and deported...
In addition, the country of origin for each migrant invader needs to suffer physical or financial retribution until they put a stop to their role in this onging invasion...
Probably mohammedan.
And just think that they could live without that constant fear in their home countries.
Just maybe they could leave???? They and their spawn b are illegal criminal alien invaders. Tough luck.
Illegals are known for using the Emergency Room for primary care, taking resources away from actual emergencies.
Their whole argument is based on assuming we need a permanent underclass to work the service economy.
My give a dman is busted. I want them all gone and the sadder the story the more I want them gone.
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