Health advocates around the country worry that President Donald Trump’s restrictive immigration policies could deter people from seeking health services as communities work to contain the spread of the new coronavirus that has killed at least 30 people in the United States.
Many people who lack legal immigration status tend to largely avoid hospitals “out of fear that their information might be released to ICE even though emergency rooms here are known for being welcoming,” Ismael Castro, a project manager at Building Healthy Communities in the Boyle Heights neighborhood of Los Angeles, said referring to Immigration and Customs Enforcement.
Nearly 11 million undocumented immigrants are estimated to live in the U.S., a majority of them in just six states: California (with the largest population at 2.2 million), Texas, Florida, New York, New Jersey and Illinois.
“It’s important for undocumented people to feel like they deserve access to these services, especially if it comes to an outbreak,” Castro said.
Dr. Don García, the medical director at Clínica Romero, which runs two clinics providing health services for underserved communities in the Los Angeles area, told NBC News he’s mostly concerned with the unforeseen impacts of the Trump administration's “public charge” rule. That measure could deny immigrants some visa renewals or green card applications if they've used certain federally funded programs such as Medicaid or food assistance over a certain period of time — or if the government considers they're likely to become dependent on a program in the future.
Around the country, groups have already reported people taking their families out of health or nutrition programs, even if they qualify, for fear it would reduce their chances of getting a green card.
“We should stop implementing the public charge rule in a time of emergency,” García said, adding that the coronavirus is the first case to test the country's ability to protect those lacking citizenship from becoming a "public charge during a biological war."
"We don't evaluate their immigration status"
Paul Vélez, CEO of Miami's Borinquen Medical Centers, said he worries there may be a percentage of people who may not seek medical attention due to their immigration status. However, he’s confident those familiar with the clinic, which has received funding from the Department Health and Human Services under the federal public health service designation and is well-known among the city’s undocumented population, will seek their service if they’re in need.
“We have been providing health care to over one million people during the past 47 years. Many of our patients are undocumented,” Vélez said. “They know that when they come to Borinquen, we don’t evaluate their immigration status. It’s based on their ability or inability to pay.”
Chris Keeley, assistant vice president of ambulatory care operations at the New York City Health and Hospitals Corporation, said they “don’t share information with immigration authorities and don’t keep records on people’s immigration status.”
Bitta Mostofi, commissioner of Mayor Bill de Blasio’s Office of Immigrant Affairs in New York City, said they've been “sounding the alarm on reckless federal policies spreading a dangerous sense of fear and stigma” in immigrant communities.
“We don’t care about your immigration status. We care about everyone having access to health care,” Mostofi said, adding that New York City has 1 million households with undocumented people.
There's medical help available
The Coalition for Humane Immigrant Rights in California, also known as CHIRLA, is urging immigrants to seek medical care if they suspect they’re experiencing symptoms of coronavirus.
"The health of our community comes first, and medical care is a human right," said CHIRLA's Executive Director Angelica Salas said in a statement. "Immigration status should not prevent us from protecting our health and that of our families."
People who are worried about their legal status or who don't have health insurance should be able to go to a public health center, a free clinic or the emergency room, said García.
“Make sure to call the clinic or the hospital ahead of time so they can isolate you to avoid spreading the disease,” he added.
In the meantime, taking precautionary measures such as not touching one's eyes, nose or mouth without washing hands for at least 20 seconds — as well as periodically disinfecting surfaces — is key to avoid getting sick, said García.
Keeley also urged New Yorkers who lack legal status to “seek care if they feel any of the COVID-19 symptoms.” He said to call 311 to get oriented on the resources available or to reach out to the New York City Health and Hospitals Corporation to receive treatment.
The Florida Department of Health said in a statement it “encourages all populations, regardless of citizenship or immigration status, to seek medical attention and diagnosis if they suspect they have contracted COVID-19 or come into contact with someone who has COVID-19.”
They stressed they are "not responsible for immigration enforcement" and as such they don't ask about a person's documentation status.
For some immigrants who are worried about the public charge rule, “emergency medical assistance” doesn’t qualify as a “public charge,” according to the Department of Homeland Security. The same applies to state-funded Medicaid services.
Though federal Medicaid programs have very restrictive eligibility for immigrants and exclude undocumented immigrants, states such as California and New York provide eligibility to some undocumented immigrants, as well as others who don’t have green cards, for state-funded health insurance.
The House passed a roughly $8 billion package to fund efforts to respond to the coronavirus that includes vaccine development, support for state and local governments and assistance for affected small businesses. The Senate voted in favor of the bill on Thursday afternoon and Trump signed it on Friday.
More than a year could go by before a vaccine is available to the public. The process of developing a vaccine normally takes between five to 20 years.
Rep. Jesús “Chuy” García, D-Ill., said in a statement that once a COVID-19 vaccine becomes available, he “will work with my colleagues and Illinois health officials to ensure it remains affordable and accessible for all, including undocumented immigrants throughout Chicago.”
Nicole Acevedo reported from New York and Carmen Sesín from Miami.