The Trump administration’s immigration policies are negatively impacting health care, as arrests and deportations have disrupted care for some patients, and fears of US Immigration and Customs Enforcement (ICE) officials have caused patients to delay needed care.1-9

In addition, experts are projecting that Trump’s policies will exacerbate existing staff shortages in the health care industry.10,11 In fact, some health care workers have already been deported or denied re-entry into the United States, and others attempting to start work in the US are reporting barriers to entering the country.11-13

Reports have suggested that more than 100,000 immigrants have been deported since President Donald Trump took office in January, and more than 50,000 immigrants are currently detained by ICE.1-3 However, different sources are reporting different figures, and data on the ICE website are not up to date.1-4

Patients Detained and Deported

Reports of cancer patients being detained and deported have sown fear in the immigrant community, particularly because these patients were either US citizens or seeking asylum in the US legally, according to Leighton Ku, PhD, a professor and director of the Center for Health Policy Research at the Milken Institute School of Public Health at George Washington University in Washington, DC.

In May, ICE detained a 6-year-old boy with acute lymphoblastic leukemia (ALL) along with his family.5 The family is seeking asylum in the United States, and they have followed the letter of the law in doing so, according to Elora Mukherjee, the family’s attorney.

Still, the family was detained after a court hearing in which their case was dismissed. The Trump administration has ordered judges to dismiss cases for immigrants who have been in the US for less than 2 years so ICE can deport these individuals, and the family had arrived in the US in October of last year.

While the family was in detention, the child experienced ALL symptoms and missed a medical appointment, Mukherjee said. The family was ultimately released from detention on July 2, after the mother of the family filed a suit demanding their release.

In April, a 4-year-old boy being treated for stage IV cancer was deported to Honduras along with his mother and a sibling, though both children are US citizens and there were legal custodians willing and able to care for the children in the US.6

The children’s mother was undocumented, as she had come to the US as an unaccompanied minor years ago. She was appearing for a routine check-in with immigration officials when she and her family were detained and later deported without due process.

Deporting this family without due process deprived the cancer patient of continued treatment in the US and a chance for the family to create a medical plan with their health care team prior to deportation, noted Katherine Peeler, MD, an assistant professor at Harvard Medical School in Boston, Massachusetts.

A similar situation occurred in February, when a 10-year-old girl with brain cancer — also a US citizen — was deported to Mexico along with her undocumented parents.7 The family had been stopped and detained by immigration authorities in Texas while on their way to an emergency medical checkup for the child.  

Fears Are Delaying Care

Physicians for Human Rights (PHR) recently surveyed clinicians across the US about the clinical implications of current immigration policies and practices, and the responses reflect “a real fear that patients will not present for care due to fear of interactions with immigration enforcement in health care settings,” said Dr Peeler, who is a medical advisor for PHR.8

ICE is now allowed to enforce immigration laws in and near health care facilities because President Trump rescinded a policy that protected health care facilities and other locations (such as schools and churches) from immigration enforcement.9

“Clinicians are telling me that immigrant patients are missing appointments or requesting telehealth visits because they are afraid to leave their homes,” said Stephanie Woolhandler, MD, a distinguished professor of public health at Hunter College of the City University of New York in New York, New York.

Clinicians who responded to the PHR survey reported that patients are afraid of ICE, and those fears have resulted in a reduction in care.8 Patients are canceling health care appointments, skipping appointments without canceling, and failing to respond to outreach more often. Patients are also waiting longer to seek care, arriving sicker when they do present at health care facilities, and seeking treatment for preventable conditions.

“This is particularly problematic for oncology patients, given that so many are on tightly timed chemotherapeutic schedules,” Dr Peeler noted. “I have heard from both adult and pediatric oncology physician colleagues that their patients have expressed fear about coming in for therapy due to concerns that ICE may show up.”

Of course, avoiding health care facilities may not protect patients from ICE, particularly now that the Centers for Medicare & Medicaid Services has given ICE access to personal data for patients receiving Medicaid, including home addresses, in order to find, detain, and deport immigrants.14,15

Health Care Workforce Under Threat

Along with the negative effects on patients and their care, current immigration policies will likely have negative effects on the size and efficiency of the health care workforce, experts project.10,11

Current immigration policies threaten to reduce the existing health care workforce in the US, as roughly 2.3 million naturalized citizen immigrants and about 1 million non-citizens (documented and undocumented) work in health care in this country.10

“Immigrants play a major role in health care staffing, and it is not possible to punish immigrants without punishing Americans who need care,” Dr Woolhandler said. “A major problem for oncology and other fields is that many hospitals already operate below full capacity due to personnel shortages, and further shortages in long-term care may make it difficult to discharge frail patients from hospitals, causing bottlenecks that block new admissions.” 

The Trump administration’s immigration policies also threaten the pool of prospective health care workers attempting to enter the country.11

“To much of the world, the US appears to be less friendly to immigrants, so international clinicians who once wanted to practice in the US are less willing to come,” Dr Ku said. “Those who need visas to enter, study, or work in the US face increased scrutiny, and many immigrants are worried about visiting their home countries because they may not be permitted to re-enter the US.”

There have already been reports of health care workers being deported or denied re-entry into the US.11 In late January, 25 undocumented direct care workers were arrested by ICE in Chicago, and at least 8 of these workers have been deported.

In February, Rasha Alawieh, MD, an assistant professor of medicine at Brown University, was denied re-entry into the US after visiting Lebanon.11 Though there was a court order barring Dr Alawieh’s removal from the US without due process, her H-1B visa was revoked, and she was deported on March 14.

More recently, foreign medical residents who were schedule to start working at health care facilities in the US have reported that they are unable to enter the country as planned due to visa delays and travel restrictions.12,13

In late May, the Trump administration paused interviews for certain visa applications, and this included J-1 visas.12,13 Though this pause was lifted in June, it delayed the immigration process for some medical residents who were set to begin working in the US this month. Other medical residents have been affected by the administration’s travel ban on foreign nationals from 12 countries and partial restrictions for citizens of 7 countries.

The administration’s deportations of existing workers and actions preventing foreign health care workers from entering the US are not the only threats to the health care workforce. Reports suggest that health care workers from the US have moved or are planning to move abroad in response to the Trump administration’s policies.16,17

Disclosures: Dr Woolhandler reported having no disclosures. Dr Ku disclosed that he is an unpaid member of the executive board of the DC Health Benefits Exchange Authority and an advisory board member of the Immigrant Research Initiative. In addition to Dr Peeler’s role as medical advisor to Physicians for Human Rights, she disclosed that she is a consultant for the Massachusetts Institute of Technology on work related to caring for children in custody of the US Department of Human Services’ Office of Refugee Resettlement.

This article originally appeared on Cancer Therapy Advisor