The changes in federal immigration policies in this country over the past four years have been substantive. For example, the plight and ramifications of children separated from their families at the southern borders when parents are determined to be undocumented immigrants in the United States has been shared in studies and commentaries in our journal since the start of executive orders leading to such separations. Less dramatic but just as worrisome are the concerns that undocumented Latinx parents will be afraid to bring their children for health maintenance or even sick visits out of fear they will be identified and forced to leave the country, perhaps separated from their children. How valid are these concerns?
Cholera et al (10.1542/peds.2020-0272) share with us a study looking at the effects of executive actions on outpatient cancellation and no-show rates between October 2016 and March 2017 (immediately before and after the implementation of immigration policies affecting Latinx families) in four health care systems in North Carolina, a state with a growing Latinx population. To look for changes in outpatient cancellations or no-shows, the authors used a controlled interrupted time series, comparing it to appointment cancellations and no-shows for Latinx children for the same time period a year earlier and to non-Latinx children at the same time. Interestingly, for all Latinx children the authors found no significant changes in cancellation or no-show rates compared to Latinx children in the prior year or to non-Latinx children in the same year. However, Latinx children who were uninsured (an indirect way to focus on the undocumented population of Latinx families) had a sustained increase in cancellations of 2.4% per week, peaking in the last week of the study in 2017 with cancellation rates being higher (33.33%) than predicted (17.79%), or a relative increase of 87%.
Why are cancellations increased but not no-shows? The authors offer some interesting thoughts in the discussion section of their article that are well worth considering although cannot be proven from the data as presented. To better frame the importance of these findings and take an even broader look at how immigration policies that further exclude Latinx immigrant families in this country, we invited Dr. Raul Gutierrez from UCSF and San Francisco General Hospital (10.1542/peds.2020-045880) to provide an accompanying commentary. Dr. Gutierrez shares how the “chilling effect” of restrictive immigration policies can lead to immigrant families opting not to participate in public benefits available to them and their children out of fear or threat of being deported. He raises how the Public Charge Rule of 2019 only worsens this effect and how in doing so, this type of legislation and prior 2016 executive actions only enhance how systemic racism underlies such policies that categorize well-meaning families seeking refuge in our country as “illegal” and dehumanizing them on the basis of their race, ethnicity, and national origin.
With the new administration starting in 2021, we will hopefully see these orders rescinded and a more inclusive set of policies reinstituted at the federal level—but recognize that even at state levels, there are ways to counteract existing federal immigration policies that are exclusionary, such as developing sanctuary policies or enabling immigrant families to access to the Women, Infants, and Children program for supplementary nutrition. To ensure that immigration policies become more inclusive, this study and commentary will encourage you to advocate for those in your community who may not be documented citizens but like all of us, want the best for their children who will be the next generation who will continue to address systemic racism and foster equity, diversity, and inclusion for all. Link to this study and commentary so you can make sure we move forward and not backward in creating such a future.