Amongst the legislation proposed before this year’s quickly approaching sunset, the bipartisan DREAM Act urgently demands our attention. As a physician and public health practitioner, I worry the health of both our country and the DREAMers is at risk without its swift passage.
The DREAM Act (Development, Relief, and Education for Alien Minors Act) offers a legal path for residency for those undocumented immigrants — some 800,000 — who came to the U.S. as children. This legislation is critical since the recent repeal of DACA, an Obama-era legacy that offered temporary relief from deportation and work authorization for DREAMers, those who immigrated to America at an average age of 6 and have a high school diploma.
Since DACA was rescinded in September, it is estimated that over 10,000 immigrants have lost their protective status. According to the Center for American Progress, every day a vote on the Dream Act does not go to the Senate floor, an additional 122 DREAMers — people who identify as American and know no other home than America — are eligible for deportation.
In addition to the litany of economic and moral reasons to pass the DREAM Act, there are profound and perhaps unsuspected health reasons as well. As a physician practicing at one of the largest public health systems in Florida, home to roughly 800,000 undocumented immigrants, I see this first hand on a daily basis.
First and foremost, not taking action on DREAMers portends harmful psychological consequences on immigrant communities — those that are already marginalized and face a high disease burden. A recent study from Harvard Medical School used national survey data to demonstrate that rates of psychological distress fell 40% amongst those eligible for DACA after it’s passage compared to those ineligible for DACA. What’s more, this effect appears to impact subsequent generations. Another study showed that amongst children of DACA eligible mothers, rates of anxiety and adjustment disorder fell by nearly half after its passage. While programs like DACA and the DREAM Act are not explicitly meant to be public health programs, their impact on mental health are on par with our best available population health interventions.
The health impact of not passing the DREAM Act is not just limited to immigrant communities, though. It also has significant implications for the general population and, in particular, our elderly. Surveys suggest that nearly one-fifth of DREAMers work in health care and education, filling critically needed direct care roles such as home health aides as well as even highly trained roles as doctors and nurses. This is critically important because there are already significant health workforce shortages, particularly in home care, which cannot meet current demand. The population of seniors, currently 48 million, is projected to nearly double by 2050. And the Bureau of Labor Statistics already projects an additional 1.1 million direct care workers will be needed by 2024. Deportations of DREAMers will put at least tens of thousands of these jobs at further risk.
While a majority of DREAMers were previously able to obtain health insurance through employer-sponsored plans, the DACA repeal puts health insurance at risk. Inaction on DREAMers leads to a double jeopardy for health, as it not only adds to mental health burden but puts healthcare farther from reach, too. There is also a real concern that many DREAMers will forego seeking needed medical services for fear of deportation. My heart cracked reading about Rosa Maria Hernandez, a 10-year-old girl with Cerebral Palsy who was detained at a border facility following an emergency gallbladder surgery in October, and of Oscar and Irma Sanchez, undocumented parents who were apprehended, fingerprinted and booked in the process of taking their 2-month-old for an emergency surgery. Both reduced access to and avoidance of care drives this population further into the shadows, oftentimes leading to a spiral of unnecessary and preventable morbidity.
In a time of political brinkmanship, DREAMers have been used as a bargaining chip to pass or stall other legislative items such as spending bills and tax reform. All the while, we debate about whether they belong — immigrants who arrived as children and have grown up to be our teachers, doctors, nurses and caregivers. Immigrants who call no other place home. The question in my mind is not about who they are, but rather who we are. This is not a political question, but simply a human one and whether we have the courage to recognize what America really means when we look ourselves in the mirror.