Blog: Terminating the DACA Program Would Harm Health and the States

Stymied by years of Congressional gridlock concerning immigration reform, in 2014 President Obama used executive action to create the Deferred Action for Childhood Arrivals (DACA) program to provide temporary legal status to children and young adults who came to the U.S. as undocumented children, also known as “DREAMers.” In September 2017, President Trump announced he would terminate DACA, effective March 2018, and challenged Congress to develop legislation to address this and other immigration issues. Congress and the President have been debating DACA and immigration reform legislation, but as of mid-February the outcome remains uncertain.President Trump’s action has been challenged in court. I provided a declaration as a public health expert in one of these lawsuits. The New York State Attorney General’s office, acting as lead in a suit brought by 17 state attorneys general (including the attorney general for the District of Columbia), requested my input, focusing on the health harm, including harm to states, that could occur if DACA is rescinded. The suit claims that the repeal of DACA was arbitrary and capricious, largely motivated by a racial animus against Latinos, as demonstrated by statements of the President. After considering the evidence, Judge Nicholas Garaufis of the Federal District Court in Brooklyn imposed an injunction, keeping the DACA program open for now. This injunction is consistent with an earlier injunction directed by a federal court in San Francisco for another lawsuit. In both cases, the judges issued injunctions protecting the DREAMers and ordering that the DACA program continue, pending further review.My declaration focused on four points:DACA status protects young immigrants against deportation. They can receive work authorization for legal employment, can continue their education, get drivers’ licenses, and so on. Most DACA recipients work and a majority obtain health insurance through their jobs. The termination of DACA would imperil their jobs, harming both their livelihoods and their employment-based health insurance. They have few alternatives for coverage: DACA recipients are still considered undocumented and are not eligible for federal health insurance assistance, such as Medicaid, health insurance exchanges or premium tax credits to make exchange coverage more affordable. Generally, the only federal health aid available to them is Medicaid coverage for emergency medical care.Research shows that DACA recipients have improved mental health because it reduces stress related to fears of deportation or loss of work and lets them live normal, gainful lives.DACA status not only improves the mental health for DACA recipients themselves, it improves mental health for their US-born children, who are citizens. Loss of DACA would increase stress and mental health problems for hundreds of thousands.The termination of DACA will create financial harm for states and health care providers. If hundreds of thousands of DACA recipients become uninsured, emergency Medicaid and uncompensated clinic care costs will increase. Using a variety of data, I estimated that this could create an additional $113 million in emergency Medicaid costs and $230 million more in uncompensated care costs per year.Termination will also disrupt the healthcare workforce and patient care. Over 5,000 doctors, nurses and other medical professionals are DACA recipients, as are almost 9,000 health support staff, such as home health workers .Loss of DACA status would not only harm their professional lives, it would make it harder for hundreds of thousands of patients to continue to receive care. Many DACA recipients are training to become health professionals and loss of DACA status could also end those dreams.In this, as in other work, GW health policy faculty and researchers are trying to use health research and analysis to inform ongoing public policy debates, including debates occurring in the nation’s courtrooms.Leighton Ku, PhD, MPH, is a Professor and Director of the Center for Health Policy Research at the George Washington University’s Milken Institute School of Public Health.