Families are choosing between their health and staying together

When it was time for Ximena to go to her prenatal appointment, she decided to stay home.

“I have to miss my appointments,” she told us, “because it scares me to leave, because of the fear that one day they’re going to arrest me. And what would happen to my kids?”

Ximena, whose name we agreed to change to protect her confidentiality, was pregnant at the time and is originally from Guatemala. She left there a decade ago because of constant violence in her town. Since then, she has lived in the U.S. without legal permission.

Immigrants living in the U.S. without legal permission are not eligible for most public benefits. However, if their children are born in the U.S., the children are eligible for benefits like Medicaid and food assistance programs that could help them stay healthy.

We are part of a team of researchers and health practitioners studying the impact of rapidly changing immigration policies on immigrant families in Detroit and nearby Washtenaw County, Michigan. Ximena is one of a dozen immigrants we have interviewed since March 2018 who are members of families in which at least one person is living in the U.S. without legal permission or is otherwise not a citizen.

We also interviewed 28 health and social service agency employees, including doctors, nurses, insurance enrollment specialists and patient advocates. All names we will use are pseudonyms to protect the confidentiality of our research participants.

We found that some immigrant families in Michigan are choosing to miss clinic appointments and opt out of public benefits that would help keep children healthy and prevent disease. They are doing this because they are afraid it will affect their chances of staying in this country together with their families.

Chilling effect

After Ximena delivered her baby boy in a hospital in Detroit this past summer, she worried about whether she should enroll her son in programs like Medicaid and WIC that provide health care coverage and nutritious foods. As a U.S. citizen, her son is eligible for these public assistance programs.

However, a rule newly proposed by the Trump administration, often referred to as the “public charge rule,” is affecting her decision-making.

The rule would make it harder for immigrants to enter the U.S. or become a citizen if they become a “public charge,” dependent on government assistance.

It’s unclear whether the Department of Homeland Security will pass and enforce the rule, or when. Nonetheless, we found that many immigrants – including those with legal status – fear that using public assistance could make them ineligible to receive a visa or citizenship in the U.S.

Grocery bags loaded with food from the Special Supplemental Nutrition Program for Women, Infants and Children, better known as WIC. AP Photo/Rogelio V. Solis
In our interviews with people who work with immigrants, they reported that their clients were more fearful of deportation since the 2016 election. Isabel, a staff member at the Detroit clinic attended by Ximena, described it this way: “They are so much more fearful now than they were two, three, four, five, 10 years ago … huge huge impact, huge difference.”

Others echoed that report. Martha, a receptionist at a clinic in Washtenaw County recalled a patient who had called her to cancel an appointment.