Thousands of families face an unsure future as the deadline recently passed for Deferred Action for Childhood Arrivals (DACA) recipients -- also known as "Dreamers" -- to renew their permits to live and work in the United States for another two years.
Approximately 150,000 of the roughly 800,000 DACA recipients brought to the United States with their parents as children are affected, and they now wait to see if their permits are renewed or if DACA is ultimately rescinded.
If DACA disappears, these young people will lose their ability to work, study and live freely in the only country they have known as home. They will be considered "illegal aliens" subject to deportation. They will also lose access to health care services that they now receive through their schools and employers -- and the military.
The American Medical Association warned that termination of DACA will reverberate throughout the health care system in the United States, decreasing the health care workforce and decreasing access to health care for patients. A large number of DACA recipients -- approximately one-fifth -- work in high-demand, low-paying and difficult-to-fill positions such as home health aides and medical assistants. Without DACA, access to health care services will decrease and young people who obtained insurance under the program may avoid seeking health care even when it is available.
Furthermore, a recent article from the New England Journal of Medicine points to what may amount to a public health crisis in rising mental health diagnoses should DACA be eliminated.
The extreme stress of losing documented status and returning to undocumented status has the potential to exacerbate numerous chronic conditions. It can cause an increase in psychological diagnoses, such as anxiety, depression, adjustment disorders and substance abuse. Studies have shown that measures of psychological stability increased substantially after DACA was implemented in 2012.
While statistics and facts should speak for themselves, the stark reality facing DACA recipients is more powerful through the stories of the young people who are affected.
Dalia* is one of these Dreamers. I have known her and her family for the past four years, as I provide primary health care to them as a family nurse practitioner in a community health center in Chicago.
Dalia arrived with her mother 15 years ago, when she was 4 years old, after leaving a small town in Guatemala because of violence and political unrest. They traveled through Mexico, and crossed the desert into the United States to join her father and two brothers.
Both parents work and her older brothers -- who did not apply for DACA – have found jobs in construction.
A high-achieving student in a selective high school in Chicago, Dalia was offered a full scholarship to a college on the west coast two years ago. She plans on becoming a medical researcher. As hard as it was to let their daughter move so far away, her parents told me with pride about how she was adjusting and about how well she was doing in school.
When I last saw Dalia in August, to talk to her about control of her mild asthma before she headed back to campus after her summer break, I was struck by a change in her demeanor.
Usually talkative and engaged, she was subdued and anxious, fidgeting on the exam table. She said that her college had offered to provide support in navigating the bureaucratic maze to submit her application for renewal of DACA status. The dean of students called her personally to say that the college would do everything possible to protect her if her application was rejected or if DACA is eventually rescinded.
But she was not convinced.
Her list of "what ifs" was long:
What if US Immigration and Customs Enforcement (ICE) raids the campus?
What if they found information that put her family in jeopardy?
What if she were separated from her family?
What would happen if she were unable to get her asthma inhaler through the student health service at her college?
What if she were forced to return to Guatemala, a country she can barely remember since leaving when she was 4-years-old?
Dalia's story brings the statistics and legal wrangling surrounding immigration into sharp relief. Yet there are many who reject the facts and rely instead on false assumptions about DACA recipients.
DACA and the Economy
Concerns voiced by immigration opponents that DACA recipients are "robbing" native-born US citizens of employment or are draining resources are unsubstantiated.
Leading economists note that the facts do not support the opinion that DACA is a drain on the economy. Not only are DACA recipients generally well-educated, in school pursuing advanced degrees or working, but they mirror the highly-skilled H1B visa holders. Eliminating this highly-skilled workforce will not increase job growth. What it will do is have an adverse effect on economic growth in the US, according to a poll of leading economists published by the University of Chicago earlier this year.
Ironically, the decision by President Trump to rescind DACA if Congress does not present an alternative by March of 2018 will have a substantial and negative effect on health care in this country.
Dalia, and other Dreamers like her, face an uncertain future. But the chilling effects of the political machinations surrounding DACA affect not only their health, but the health and future of all who call this country home.
*Dalia chose not to disclose her real name because she fears that this would jeopardize her family and her ability to continue her education.