Healthy Harbors

Issues being raised by immigration actions, such as the separation of families, ICE activities, changes to the Public Charge policies for Medicaid, and CHIP, at the Federal level will have repercussions for all Californians, including physicians, their practice teams, and their patients. While the depth of problems that may be created remains unclear today, increasing physician awareness about such issues will better prepare them and other clinicians if and when the actions are implemented.

Working 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, and Sonoma County Medical Society, your CAFP Foundation offers an opening salvo, so to speak, an information and awareness campaign to lay the groundwork for future political, advocacy, and educational efforts aimed at protecting the health of California’s most vulnerable populations, especially children.

The six partners in this project have implemented a multi-pronged information strategy, including identifying champions to speak at live events and to the media; a series of position papers and patient education pieces; webinars on a variety of topics; and a web resource center for California physicians, culminating with a panel presentation at CAFP’s All Member Advocacy Meeting, March 2019.

Our thanks to the California Health Care Foundation for its support of this important project.


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

Connect with your local CAFP chapter

Find fellow family physicians in your neighborhood.
(415) 345-8667
816 21st Street, Sacramento, CA 95811
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