New variations on the orders, which had been blocked by a federal court, were signed yesterday. Despite tweaks related to the number of Muslim-majority countries targeted (six, rather than the initial seven) and removal of language about giving preference to those who practice majority religions, however, the documents aren't radically different from the earlier ones, to which the Colorado Coalition for the Medically Underserved objected, in part because of their potential for harming medical care in America. CCMU believes that's the case not just when it comes to undocumented individuals already in this country, but also for citizens of every description because of reasons that include the large number of foreign-born doctors working in this country and the growing demand for even more, especially in rural areas.
"We've never done anything like this before," says CCMU executive director Joe Sammen about joining an amicus brief in Darweesh v. Trump, a complaint filed in U.S. District Court for eastern New York; read it below. "But we thought we needed to stand up for our values and the mission to make the health-care system work for everybody, including immigrants."
CCMU "brings people together to ensure health care that works for everybody in Colorado," Sammen continues. "We make sure factors like race and zip codes don't get in the way of living a healthy life. So we're concerned about the health of all Coloradans, but in particular about the health of Coloradans who face bigger barriers to accessing health-care services — and immigrants and refugees in particular fall into the category of being underserved. We don't want to marginalize them further by dividing communities and making the barriers that are there even greater. And we feel the executive orders create a situation that makes it harder in our communities to be healthy."
Broadly speaking, President Trump's more restrictive immigration policies lead to "a fear of deportation," Sammen allows, "and that fear definitely leads to a mistrust of our institutions. That leads to people fearing that they can't seek the services they need, so they may push off preventative-care needs. They also put stress on immigrant communities that lead to many issues. They make a bad situation worse and have the potential of pulling these communities apart."
But it's not just immigrants and refugees in need of health care who may suffer, argues the Darweesh v. Trump brief. Here's how the ACLU, which supports the plaintiffs in the matter, describes the main suit:
This case challenges President Trump’s Muslim ban. The lead plaintiffs have been detained by the U.S. government and threatened with deportation even though they have valid visas to enter the United States. One plaintiff, Hameed Darweesh, an Iraqi husband and father of three, worked for the U.S. military, and his life was in danger in Iraq due to that relationship. The other plaintiff’s wife and son were threatened because of their perceived ties to the United States. U.S. Customs and Border Protection detained both men in JFK Airport in New York as they entered the country."Some of the data in the brief is very striking," Sammen says, "including the information about the amount of physicians and nurses in this country who are foreign-born — immigrants who are making important contributions to our health-care system."
Their continued detention based solely on the executive order violates their Fifth Amendment procedural and substantive due process rights as well as U.S. immigration statutes. Their detention is part of a widespread pattern applied to many refugees and other foreign-born visitors and immigrants arriving in the United States since the executive order was issued on January 27, 2017.
The brief calls foreign-born health-care providers a "critical pillar of the American health-care infrastructure." In attempting to back up this claim, the document notes that an estimated 28 percent of physicians in the U.S. are immigrants, as are 15 percent of registered nurses and nearly 21 percent of direct-care workers, who include home health aides and personal-care assistants.
These numbers are growing. From 2001 to 2009, direct-care workers in the U.S. nearly doubled, going from 375,820 to 676,200. And an April 2016 study by the Association of American Medical Colleges estimates a current shortfall in the number of physicians in America of between 29,000 and 46,000, with those digits rising to between 61,700 and 94,700 by the year 2025. The scenario is similar for nurses and direct-care workers and could worsen considerably if foreign-born medical professionals face more difficulty coming to and working in this country.
The brief also demonstrates that "immigrant doctors and health-care workers are especially concentrated in medically underserved areas such as poor and rural communities" — meaning that a good many people in parts of the country that heavily supported President Trump may find themselves without many, or perhaps any, good medical options nearby. Likewise, the brief's authors feel that the executive orders will have a chilling effect on the recruitment of foreign medical personnel, since they already face what's characterized as "rigorous scrutiny before entering the United States."
Prior to President Trump's first prime-time speech before members of Congress on Tuesday, February 28, members of his administration floated hints that he would be open to comprehensive immigration reform. And during the address itself, the president touted a "merit-based" concept that would give preference to those "able to support themselves financially" — a group that would presumably include physicians, if not all foreign-born medical personnel. But because such prospects remain in the idea stage, they don't fundamentally change the current status quo.
Joining the brief isn't the only example of public advocacy related to immigration to be taken up of late by CCMU. "We're putting out public statements, saying these executive orders are problematic — they're threatening, and we think they shouldn't happen," Sammen points out. "And we also recently signed on to the iDrive initiative" — also known as House Bill 17-1206, titled the "Eligibility Colorado Road & Community Safety Act," which would expand a 2013 measure that lets immigrants receive driver's licenses by sanctioning card reissues and renewals, among other things.
In Sammen's view, "We don't think these issues are separable. You can't say immigrant rights are different from transportation rights or health rights."
Darweesh v. Trump: Amicus Brief
