DHSS's primary mission remains assisting all Delaware residents.
From one end of Delaware to the other, immigrants to our state – whether they are citizens, have documents or are undocumented – are growing increasingly fearful about seeking social services or medical care in the face of ramped-up immigration enforcement activities.
Clients of our Women, Infants and Children supplemental nutrition program are asking if it is safe for them to come to meet with staff. In the community, pregnant women are missing medical appointments and pre-natal care. Individuals with chronic conditions are not showing up for appointments, forcing clinic staff members to do critical follow-ups by phone. And others are asking Department of Health and Social Services employees to cancel their families’ benefits. At one health clinic that I visited recently, there has been a 30 percent decline in visits due to fear of arrests and deportation, and a 15 percent decline in visits to our social services buildings.
Across our state and country we are seeing the intended and unintended consequences of President Donald Trump’s immigration enforcement policy. Some people may not see the impact that these arrests and deportations have on those who live, work and study here and contribute to our state’s economy. Although not always in the news, U.S. Immigration and Customs Enforcement officials are creating fear in a community of individuals and families who contribute to our state’s agricultural, hospitality, construction and health economies. That fear is steering some Delawareans to avoid health care and social services, even when they need it most. One worried WIC client told a program employee, “I’m not getting kicked out of the country for milk.”
As a family physician who has treated underserved populations, I have seen the impact that avoiding necessary care and social services can have. It raises the stress levels in individuals and families, leaves children and adults feeling hungry, isolated or unsupported, increases the number of preventable emergency room and hospital stays and, ultimately, contributes to a higher cost of health care for everyone. And that doesn’t even account for the decreased quality of life for the individuals and their families.
I worry that if people are afraid to seek care for a suspected infectious disease like tuberculosis or the Zika virus, the disease could spread, causing a wider public health emergency. That’s why the prospect of all Delawareans not seeking and obtaining health care when they need it, not getting preventive care and not having a primary care doctor should concern us all. We should want that not only as a way to ensure that everyone is able to work and contribute to the well-being of their families, but also to help us build healthier communities. Instead, we see families afraid to seek food benefits, go to doctor’s visits or embrace counseling services until a crisis arises.
As a state, we have made so much progress under the Affordable Care Act in reducing our uninsured rate. In 2008 – two years before the ACA was signed by President Barack Obama – Delaware’s uninsured rate was 11.2 percent, or about 101,000 individuals. That rate ranked Delaware 33rd among the states.
By 2015 our uninsured rate was down to 5.9 percent, with an estimated 54,000 Delawareans without coverage. Our state now has the ninth-lowest uninsured rate in the country. Among those uninsured today are people who choose not to pay for health insurance, those who are exempt from having to buy it and thousands of undocumented immigrants who are not eligible for coverage. If our nation’s immigration policy forces us to go backward, the long-term costs for our state actually could see a sharp increase. Uncompensated care likely would rise, with those costs passed along to those of us who pay for health insurance premiums.
We need to recognize another fact. Immigrants, whether citizens or not, contribute far more in income, payroll and other taxes to support public programs like Medicare and Social Security than they receive in government benefits. According to a study published in the journal Health Affairs in 2013, between 2002 and 2009, immigrants contributed $115 billion more to Medicare than they received from the program.
Undocumented immigrants and citizens who are worried that they might be targeted by immigration officials need to know this: Our program offices, service centers and clinics will not share information about anyone’s immigration status, benefits they receive, their address or other contact information, except in rare circumstances in which we have received a court order. Otherwise, whether you are a citizen or not, health records are protected by the Health Insurance Portability and Accountability Act and benefit records are protected by state and federal law. As a state government agency, we will respect your right to privacy and that of your family.
With our partners across the state, we need to focus on promoting a safe and healthy community for all Delawareans, documented or not. It is smart fiscally, better for public health and well-being, and just the right thing to do.
Dr. Kara Odom Walker, MD, MPH, MSHS, is the Cabinet Secretary for the Delaware Department of Health and Social Services and a board-certified family physician.