How will DACA repeal impact our healthcare?

Like other American’s, I’ve been following the news on the Deferred Action for Childhood Arrivals (DACA) program, especially now that the Trump Administration decided to cancel it.  People disagree with the program for a number of reasons, although the libertarian-leaning Cato Institute estimates rolling DACA back would cost the government $60 million and cause a 10-year loss of $280 billion.  From a strictly economic perspective, it makes sense in my mind to keep the program.  Still, there may be compelling reasons beyond simple economics to keep or repeal the program.  I wanted to explore DACA from a public health perspective. People have some strong opinions on the best way to handle illegal immigrants and trying to tease out the public health implications also requires addressing the economic consequences too.  Those economic concerns are part of what drives people’s strong emotions, but it’s near impossible not to discuss them in relation to public health.    

First, let’s define exactly who we’re talking about.  There are around 11 million undocumented persons living in the United States, of them, 1.9 million or so are “Dreamers,” or persons between the ages of 15-36 who were brought to the United States as children.  On average they were brought here at the age of 6. Of those 1.9 million, 800,000 or so have signed up for DACA.  Since many parents try to protect themselves and their children from deportation, they may never have revealed their illegal status to their children.  As a result, Dreamers may or may not be aware that they are in the US illegally.  To qualify for DACA, the individual must have lived here for 10 years, they can’t have been convicted of a felony, they must’ve graduated high school, obtained a GED or been honorably discharged from the military…So we’re not talking about people who entered the country illegally as an adult.  We’re not talking about convicted drug dealers, rapists or murderers.  We are talking about people who know no other country than the United States. They are here illegally, no doubt, but they’re functioning, productive members of society. The 3 areas I’m interested in is the impact repealing DACA will have on our ability as a country to deliver health care, the impact on the quality of our healthcare and the impact of the costs to our healthcare system.

Concern #1: One issue in relation to our nation’s ability to deliver healthcare to our aging population is the shortage of physicians entering medical school.  It’s estimated by 2025 the US will suffer a shortage of 90,000 physicians.  Reportedly around 65 Dreamers have applied to medical school, many more are probably already in residency programs, although the actual number is unclear.  An average resident cares for 3,000 people throughout their residency, losing those residents will adversely affect hospitals ability to care for patients resulting in a “dangerous health crisis” according to the Association of American Medical Colleges. The American Medical Association also released a letter Tuesday urging Congress to step in and address this crisis.  Finding creative ways to stop this shortage should include Dreamers.

Concern #2: Closely related to delivery is quality.  It stands to reason if you’re having a difficult time delivering health care, the quality will drop.  In addition to physicians, nurses, CNA’s, even a Houston paramedic are at risk of being deported further exacerbating this crisis.  The evidence is clear, as fewer healthcare professionals are available to care for patients, the quality drops and patients suffer increased morbidity and mortality.  Keeping the people here who are already trained costs nothing and actually helps save money, which leads to #3.

Concern #3: What about the cost of healthcare on our country?  Dreamers under DACA are able to legally obtain work.  This enables the government to collect money for Social Security and Medicare.  While it’s true DACA workers could utilize those benefits too, seeing that they’re at oldest, 36, it’ll be decades before that’s a reality and we have a baby boomer generation who needs help now.  Regardless of your personal opinion on Social Security or Medicare, losing the additional income Dreamers provide to those programs would reduce our ability to care for our sick and aged (it’s not mentioned but I assume you believe we should care for the infirmed and elderly).  Projections estimate a $24.6 billion loss to Medicare and Social Security over 10 years with the end of DACA. There are other public health benefits with DACA, like improved education and driver’s licenses, but those seem to really heat people up.  Look, I don’t claim to have all the answers, or maybe any, but forgetting the humanitarian considerations, the implications of deporting Dreamers from the US doesn’t seem to make sense from a public health perspective.  The financial strain on our healthcare system would be greater without Dreamers than with them.  DACA, like the ACA, may not be a perfect solution, but it’s better than the status quo.  Some Americans may say, “It doesn’t matter, you’re here illegally, go back to where you came from.”  Fair enough.  But does “cutting off our nose to spite our face,” so to speak, make sense?  People break the law all the time with no consequences because law enforcement realizes there are worse criminals out there who deserve their attention.  I’ve been pulled over for speeding and not ticketed; or the Phish show I was at 20 years ago when a plain clothes officer stopped my buddy, made sure he wasn’t selling heroin, then gave him his weed back.  I guess the police had better ways to spend their time that day… Point is, as a country we need to decide the best way to spend our resources, particularly our healthcare resources and pursuing this group specifically seems like a waste, and could actually be detrimental.

Look, I don’t claim to have all the answers, or maybe any.  Forgetting the humanitarian considerations, the implications of deporting Dreamers from the US doesn’t seem to make sense to me from a public health perspective.  The financial strain on our healthcare system would be greater without Dreamers than with them.  DACA, like the ACA, may not be a perfect solution, but it’s better than the status quo.  Some Americans may say, “It doesn’t matter, you’re here illegally, go back to where you came from.”  Fair enough.  But does “cutting off our nose to spite our face,” so to speak, make sense?  People break the law all the time with no consequences because law enforcement realizes there are worse criminals out there who deserve their attention.  I’ve been pulled over for speeding and not ticketed; or the Phish show I was at 20 years ago when a plain clothes officer stopped my buddy, made sure he wasn’t selling heroin, then gave him his weed back.  I guess the police had better ways to spend their time that day… Point is, as a country we need to decide the best way to spend our resources, particularly our healthcare resources and pursuing this group specifically seems like a waste, and could actually be detrimental.