COMMENTARY

Immigrants Afraid to Seek Medical Care in Trump Era

F. Perry Wilson, MD, MSCE

Disclosures

October 30, 2019

Welcome to Impact Factor, your weekly dose of commentary on a new medical study. I'm Dr F. Perry Wilson.

This week, the power of words:

"They're bringing drugs. They're bringing crime. They're rapists. And some, I assume, are good people."

That was President Trump on the day he announced his candidacy for President. The campaign and his subsequent presidency have brought the issue of illegal immigration to the center of the national conversation.

For some, the harsh rhetoric is a welcome respite from politics as normal. Supporters praise the "no-nonsense," "politically incorrect" tone. Others roll their eyes at what they call bloviation or grandstanding. But to some, those words may cause genuine fear, as suggested by this paper appearing in PLOS One,[1] which examines the sentiments of Latinos, legal residents, citizens, and the undocumented when they seek healthcare in the Trump era.

A bit of background. The Emergency Medical Treatment and Labor Act (EMTALA) requires that all emergency departments (EDs) stabilize and treat any patient regardless of their insurance status, ability to pay, or citizenship. Because undocumented immigrants are not eligible for most forms of health insurance, this makes the ED an important source of medical care. This has not gone unnoticed:

"You and the hardworking taxpayers of our country will be asked to pick up the entire tab. And that's what's happening. Medical and, in many cases, they've got some big medical problems before they get here."

Researchers from UCSF and UCLA interviewed 1337 individuals at the EDs of Zuckerberg San Francisco General, Olive View-UCLA Medical Center, and Highland Hospital. Thirty-four percent of them were undocumented Latino immigrants, 36% were Latino legal residents or citizens, and 30% were non-Latino legal residents or citizens.


 

They asked them a variety of questions about the specific impact of President Trump's rhetoric on their medical care—not the current political climate—literally the President's statements. The results were rather dramatic.

Seventy-five percent of the undocumented immigrants reported that Trump's statements made them feel worried or unsafe living in the United States; 50% of Latino legal residents and citizens reported feeling that way, and just 34% of the non-Latino respondents.


 

Concerning from a medical perspective, 24% of the undocumented immigrants reported that they were afraid to come to the ED, compared with just 4% of the legal residents. A quarter of the Latino respondents reported having a friend or family member not come to the ED out of fear of deportation. The fear is understandable:

"People come into our country illegally, we're taking them out legally. It's very simple."

And, of course, the authors note that these are the individuals who actually overcame their fear and came to the ED, suggesting that there may be many undocumented immigrants avoiding care that we just can't measure.

Now, this is a politically charged issue. It's undeniable that we are in a more hostile environment for immigrants—particularly undocumented immigrants—than we've seen in recent history. But individuals watching this video will differ as to whether it's a bad thing that these individuals are avoiding care in our nation's emergency rooms. My utilitarian argument here is that avoiding care may result in more expensive care down the line. My moral argument? Well, if we can reduce human suffering, then we should reduce human suffering. And despite the rhetoric, we're all still human.

F. Perry Wilson, MD, MSCE, is an associate professor of medicine and director of Yale's Program of Applied Translational Research. His science communication work can be found in the Huffington Post, on NPR, and here on Medscape. He tweets @methodsmanmd and hosts a repository of his communication work at www.methodsman.com.

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