ARTICLE: Chilling Effect? Post-Election Health Care Use by Undocumented and Mixed-Status Families

AUTHORS: Kathleen R. Page and Sarah Polk

JOURNAL: N Engl J Med. 2017 Mar 23;376(12):e20. doi: 10.1056/NEJMp1700829. Epub 2017 Mar 8.

A pregnant woman from Central America was diagnosed with syphilis at the Baltimore City Health Department in 2007. The outreach team contacted her to discuss the need for, and availability of, treatment. She agreed to return to the clinic, but did not. When reached by phone, she reported that on arriving at the clinic she saw an armed security guard, and “because I have no papers, I left.”

Highly publicized raids by the U.S. Immigration and Customs Enforcement (ICE) unit in Baltimore during 2007 instilled fear in the immigrant community.1 Charges of human rights violations and racial profiling were filed against ICE, but Latinos continued to feel targeted. The city subsequently adopted a more welcoming approach to immigrants as part of a strategy to reverse population decline and promote economic growth. In 2012, Baltimore’s mayor, Stephanie Rawlings-Blake, signed an executive order prohibiting all city employees, including police, from asking residents about their immigration status. In 2014, Governor Martin O’Malley ordered a halt to the “Secure Communities” immigration-enforcement program, stating that Maryland would not automatically honor federal government requests to hold immigrants for deportation.

Although welcomed as important statements of intent, these executive orders did little to address common barriers to health care for Baltimore’s immigrant community. Navigating the health care system is particularly difficult for people with limited English proficiency and health literacy or without health insurance or a Social Security number. Many undocumented immigrants and their families therefore go without needed care, to their detriment and sometimes that of others, as in the case of a woman with syphilis who is pregnant with a future U.S. citizen.

For a link to the full article, click here: http://www.nejm.org/doi/full/10.1056/NEJMp1700829

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