New immigration laws hit migrant workers
Rumors of clinic raids, snitch’ laws
Recently enacted changes in immigration and welfare laws threaten to restrict access to tuberculosis care for the nation’s estimated 4 million agricultural workers, advocates say.
Even though health care for communicable diseases is exempt from newly imposed restrictions, the new laws have fueled fear and misunderstanding among the community of migrant workers, experts say.
"The problem is that if basic health care is restricted, that closes one of the main gateways to care for illnesses like TB," says Josh Bernstein, JD, policy analyst for the National Immigration Law Center. "Typically, you don’t go to a TB clinic first; you go to a primary health care provider and get referred. Without that access, it’s harder to get treated for communicable disease."
Others agree. "I expect we will see an increase in communicable diseases like TB because there will be an increase in general avoidance of health care providers," says Kate Kellenberg, senior health policy adviser to the Washington, DC-based National Association of Community Health Centers.
To try to gauge the long-term impact of the new laws, the Austin, Texas-based Migrant Clinicians’ Network (MCN) is conducting a survey of clinics that serve agricultural workers. "We want to develop a set of baseline data to be able to compare where people are now with where they may be in a year," says Jillian Hopewell, MA, MPA, director of education and professional development for MCN.
Because they move with the seasons and the harvests, migrant workers already find it especially difficult to complete a course of treatment for TB, says Deliana Garcia, MA, director of the Binational and Demonstration Initiatives for MCN. The new legislation will make it harder still, she says. "I think we’re going to be damned by association," she says. "Because of the environment these laws have created, there are many more people who will not seek services."
In many immigrant families, some members are legal, and some are not, says Kellenberg. "Undocumented people generally know they are not eligible for much in the way of services," she says. "But legal immigrants who’ve been eligible in the past are now also scared to use services. They’re afraid it may impact a citizenship application, flag them for a public charge denial, or may adversely affect another [illegal] member of their family."
Confusion and misunderstanding
The fact that the new laws afford such wide latitude to states in how to enforce the legislation makes for more confusion and misunderstanding, says Garcia. For example, some states have passed resolutions that, in effect, explicitly condone "snitching" by state employees who want to report illegal immigrants to the Immigration and Naturalization Service (INS), Garcia says. "These states have enacted policies internally indicating that you cannot demand that someone in the health department not call the INS," Garcia says. "In effect, such policies are saying: We’re not going to let bleeding-heart do-gooders coerce employees into not turning anyone away or not questioning them [about their immigration status]."
Indeed, the new federal immigration law already includes a provision that expressly forbids policies that restrict communication of immigration status to law enforcement officials, says Bernstein.
In the past month, several clinics on the East Coast that serve farm workers are rumored to have been raided by officers from the INS, who come looking for illegals, says Hopewell. "As you can imagine, it’s been extremely disruptive," she says. "It completely destroys the trust that’s been built up between patients and providers."
Bernstein, too, confirms having heard such reports. As TB Monitor went to press, it was not possible to confirm whether such raids indeed had taken place.
On some fronts and in some states, there is more heartening news, says Hopewell. Washington State has adopted a resolution not to deny health care services to immigrants, and Oregon has passed a mixed bag some supportive, some not of such resolutions, she says. On the downside, Georgia recently issued directives aimed at preventing illegals from getting pre-natal care.
Survey aims to track the changes
Response to the MCN migrant-worker survey has been so enthusiastic that the survey deadline has been extended to mid-April, says Hopewell. The survey consists of only a few questions and is designed to be administered quickly. "Our organization emphasizes practice-based research,’ which means there are time constraints and other limitations to the survey," she says. "It’s perhaps not as statistically rigorous as something out of a university."
On the other hand, survey results will be shared and should prove useful and applicable in concrete ways that university-based research sometimes is not, she says.
A second advantage to practice-based research is that it provides a source of satisfaction for clinicians who work on the front lines, she adds. "It’s intellectually stimulating and good for people’s careers," says Hopewell. "We hope that it might encourage some people to stay in the field and keep providing health care to low-income people."
Whether health care providers can be penalized for providing services to illegal immigrants is one of the hottest issues associated with the new laws, says Hopewell and again, an issue that may be answered on a state-by-state basis. "No one wants to ask about immigrant status," she says. "That’s one thing clinicians are really fighting against."
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