Wednesday, September 6, 2017

Doctors Defending Dreamers

Why should physicians care about President Trump’s decision to end the Deferred Action for Childhood Arrivals (DACA) program?

Because it brings “great harm” to health care, to medical education, and to the country, said the American College of Physicians in a statement issued moments after Attorney General Jeff Sessions announced the President’s decision.

Directly affected by the decision are Dreamers enrolled in U.S. medical schools.  “According to the Association of American Medical Colleges, in 2016, 108 students with DACA status applied to medical school, and 34 matriculants with DACA status entered medical school, bringing total medical school enrollment to approximately 70 students,” ACP noted in its statement. “Without the protections afforded to them by DACA, these students would be forced to discontinue their studies and may be deported. As these students train to become physicians, they will have the experience and background necessary to treat an increasingly racially and ethnically diverse patient population to fulfill the cultural, informational, and linguistic needs of their patients…”  Also affected are Dreamers “studying to be nurses, first-responders, scientists, and researchers, and approximately 1,000 foreign-born recruits who enlisted in the military under the protections offered by DACA could face deportation, according to the Washington Post.”  

Public health will also be adversely affected, according to ACP. “If the nearly 800,000 people who are currently benefiting from DACA have their protections removed, many will avoid seeking health care in order to reduce the risk of detection and deportation, and as noted above, those who seek to serve in the health care professions will be denied that opportunity.  Many will be forced to return to violent, war-torn and dangerous countries with poor health care services.”

That the President will delay full enforcement of his decision to end DACA “in no way mitigates the harm that will be done to the 800,000 law-abiding persons who have achieved permits under DACA to work or study in the United States without fear of deportation” said ACP. “They are now at risk of losing their jobs, being forced to drop out of school, and being deported in just a matter of months.” 

ACP called on President Trump to reverse his decision and continue protections for those with DACA-status—even though there is virtually no chance that he will.  More likely, Congress will need to act, by enacting legislation to block the deportation of Dreamers and to create a pathway for citizenship, as proposed by S. 128, the Bar Removal of Individuals who Dream and Grow our Economy (BRIDGE) Act, and S. 1615, the DREAM Act of 2017.

ACP’s decision to stand up for Dreamers reflects our long-standing commitment to creating a national immigration policy that recognizes the enormous contributions that immigrants make to the United States, and to health care in particular.  In 2011, ACP issued a policy paper that called “for a national immigration policy on health care that balances legitimate needs and concerns to control our borders and to equitably differentiate in publicly supported services for those who fully comply with immigration laws and those who do not, while recognizing that society has a public health interest in ensuring that all resident persons have access to health care.”  Further, ACP asserted in this paper that “Any policy intended to force the millions of persons who now reside unlawfully in the U.S. to return to their countries of origin through arrest, detention, and mass deportation could result in severe health care consequences for affected persons and their family members (including those who are lawful residents but who reside in a household with unlawful residents— such as U.S.-born children whose parents are not legal residents), creates a public health emergency, results in enormous costs to the health care system of treating such persons (including the costs associated with correctional health care during periods of detention), and is likely to lead to racial and ethnic profiling and discrimination.”

On January 30 of this year, ACP’s Board of Regents released a comprehensive statement on immigration policy, expanding on the 2011 paper, which “strongly opposes discrimination based on religion, race, gender or gender identity, or sexual orientation in decisions on who shall be legally admitted to the United States as a gross violation of human rights.”  Based on this policy, ACP has opposed President Trump’s executive orders to bar persons from several majority Muslim countries from entering the United States. 

ACP also said that “Priority should be given to supporting families in all policies relating to immigration and lawful admission to the United States to live, study, or work.”  Accordingly, “ACP opposes deportation of undocumented medical students, residents, fellows, practicing physicians, and others who came to the United States as children due to the actions of their parents (‘Dreamers’) and have or are eligible for Deferred Action for Childhood Arrivals (DACA) status. We urge the administration to preserve the DACA action taken by the previous administration until such time that Congress approves a permanent fix. The College also urges Congress to promptly enact legislation to establish a path to legal immigration status for these individuals to ensure that ‘Dreamers’ are permanently protected from deportation.”

For ACP, concern about immigration policy and its impact on health care clearly is nothing new.  What is new, regrettably, is that the current administration has chosen to embrace immigration policies that are discriminatory against persons based on their religion and country of origin, threaten to split up families that have members here both lawfully and unlawfully,  make it less likely that immigrants who lack legal residency will access needed health care services, and now, threaten with the deportation of Dreamers, who for all practical purposes, are as American as the rest of us, having lived almost their entire lives in the United States, and who stand to contribute so much to our country if the country has the wisdom to welcome them.   
This is why it is more important than ever that doctors defend Dreamers, and others who would be harmed by the current administration’s ill-advised immigration policies.

Today’s question: what do you think of ACP’s response to President Trump’s decision to discontinue DACA?