Healthy Harbors

Addressing Health Consequences of Immigration Policies

CAFP is working on updating resources, but given the urgency many of our members are feeling, we wanted to make the below information available immediately. This information reflects the legal landscape as of 2019. It has not been updated to reflect current law, including the President's January 2025 Executive Orders.

In his first two days in office, President Trump issued Executive Orders (EOs) that potentially affect access to health care for immigrants and their families. Most notable was the rescission of the Department of Homeland Security’s “Sensitive Locations” Policy potentially allowing immigration enforcement in clinics and other health care locations.

CAFP's Healthy Harbors provides information and guidance on public charge, family separation and ICE raids. Please note that this resource has not been updated to consider the new Executive Orders. CAFP policy supports health care access as a basic human right regardless of immigration status. AAFP policy also recognizes health care as a basic human right for every person. These policies will guide our actions and advocacy in the coming weeks.

Published in 2019, these resources were developed in collaboration with the Alameda Contra Costa Medical Association, San Francisco Marin Medical Society, American Academy of Pediatrics-California, Osteopathic Physicians and Surgeons of California, Sonoma County Medical Society, and the CAFP Foundation. Our thanks to the California Health Care Foundation for its support of this important project.

Resources

The Change in Public Charge

In September 2018, the Trump Administration issued a proposed regulation that changes long-standing rules governing how and whether immigrants can be determined to be a “public charge;” widens the scope of programs considered by the government in making such a determination; and dramatically lowers the bar for refusing admission or denying individuals green cards or US visas on this basis. The concept underpinning this proposed rule may be replicated in other future proposed rules.

Immigration Rights and Responsibilities

The potential for increased enforcement of federal immigration regulations has raised concerns among health care providers and their patients about individual rights and responsibilities. It is essential that all physicians, but especially family physicians and other primary care physicians, know their rights and responsibilities before responding to enforcement actions by immigration officials and interactions with law enforcement that could result in immigration consequences.

Family Separation

Children in families in which a parent has been detained and deported exhibit significant changes in behavior that can include “changes in eating and sleeping, frequent crying, increased fear and anxiety, and/or withdrawal or anger.” Some children experience “speech and developmental difficulties, including regression and reversal of developmental milestones.”

Health Consequences

Family separation and detention can complicate and exacerbate existing trauma among vulnerable populations. As noted by the American Academy of Pediatrics, separating children from their parents exposes them to “toxic stress” that can disrupt healthy development and lead to lifelong negative impacts on their mental and physical wellbeing.

ICE Raids

The primary effect of the threat of an ICE raid on a health care facility is a reticence among patients to seek medical care. Three steps should be taken by family and primary care physicians:
1. Prepare your team, practice and/or facility to respond to a raid/ICE intervention
2. Inform your patients about their rights
3. Gather information about an ICE raid that has already occurred