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ACP Joins Allied Physician Organizations in Opposition to Immigration-Related Health Policies

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The College is speaking out against the public-charge rule and government plans to end protective policy for minors in immigration custody

Sept. 20, 2019 (ACP) – The American College of Physicians is taking a strong stand in favor of vital public health protections and against federal policies that threaten to prevent immigrants from seeking and getting medical care.

ACP also is speaking out against plans to end a nationwide policy for the detention and treatment of minors in immigration custody, which could indefinitely expose immigrant families and children to demonstrated health hazards in detention.

“ACP believes immigration policy should not interfere with the patient-physician relationship and that health policy should not foster discrimination against any patient, regardless of immigration status,” said Dr. Robert McLean, ACP's president. “The welfare of patients in need must be a primary concern.”

Under the current public-charge rule, immigrants can be declared inadmissible to the United States if they are considered likely to be “primarily dependent” on the government. The changes being made to the policy greatly expand the list of programs that would be considered, including things like Medicaid and the Supplemental Nutrition Assistance Program. Also under the policy, nonimmigrant aliens who have received certain public benefits above a specific threshold can be deemed ineligible for an extension of stay and status change.

“These immigrants are frequently our patients,” McLean said. “We all should have concerns that our patients, rather than face threats of detention or deportation, almost certainly will avoid needed care from their trusted physicians, jeopardizing their own health and that of their communities.”

In a joint Aug. 13 letter, ACP and other allied organizations wrote, “the regulation upends decades of settled policy with regard to public charge and makes it much more likely that lawfully present immigrants may not seek health care, whether preventive services or treatment, when faced with illness, since doing so could be used to deny green cards or U.S. visas, or even lead to deportations.”

The letter was signed by ACP and the American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American Osteopathic Association, and American Psychiatric Association.

“The order puts a governmental barrier between physicians and patients and stands in contrast to the mission of ACP: ensuring meaningful access to health care for patients in need,” McLean said. “This deferred care leads to more complex medical and public health challenges; it will also significantly increase costs to the health care system and U.S. taxpayers.”

Last year, ACP joined with 15 other allied organizations – including major physician and insurer groups – to write a joint letter to the U.S. Department of Homeland Security warning of the “chilling effect” that the policy will have on immigrants who need health care.

ACP additionally weighed in this week on changes being made that would discontinue deferred action requests for individuals with serious medical conditions.

In a letter from ACP to the U.S. Citizenship and Immigration Services (USCIS) acting director, McLean expressed concern for those “seeking asylum or to immigrate to the U.S. in order to receive life-saving medical treatment.” The letter requested that USCIS resume consideration of deferred action requests for medical reasons, stating “Access to care for critically ill individuals must be prioritized over their immigration status.”

ACP is also concerned about the Trump administration's final decision to roll back long-standing policy established under the Flores Settlement Agreement that set a 20-day limit for holding children in immigration custody. Under the new regulations, immigrant families could be held together indefinitely.

In an Aug. 28 letter, ACP joined with the American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and American Psychiatric Association to oppose the change. They wrote: “Conditions in federal detention facilities too often fail to ensure access to health care that meets guideline-based standards, treatment that mitigates harm or traumatization, and services that support immigrants' health and well-being. Even short periods of detention can have long-lasting consequences for vulnerable populations such as pregnant women, children, and those with chronic or complex health conditions or mental illness.”

The coalition urges that the policy be rescinded by the federal government and rejected by the courts. “ACP urges the Department of Homeland Security to work with us to ensure broader access, improved quality, and more affordable care for our patients,” McLean said.

More Information

The statement opposing the changes to the public-charge policy is available on the ACP website.

ACP's letter to USCIS is available on the ACP website.

The statement opposing the rollback of protections in the Flores Settlement Agreement is available on the ACP website.

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