This year, BARHII will provide periodic federal policy updates summarizing important federal level decisions and analyzing their predicted cumulative effect on the social determinants of health in our region.  We welcome your feedback on these policy updates.  We intend to refine the content and structure to ensure updates are informative and actionable for our  members.  Please send your comments to MNewcomb@BARHII.org .

Issue: Program Utilization: California Health Departments have shared early anecdotal reports of clients dropping out of or not enrolling in Women and Infants with Children (WIC), CalFresh, and other programs that help ensure adequate health and nutrition.  The concern is there may be a chilling effect of accessing services due to proposed policies and feared repercussions.

Health Equity Concerns: Fear of deportation  inhibits critical, health supportive behaviors like attending medical appointments or enrolling in public services.

BARHII Action: The BARHII Data Committee, with the assistance of Dr. Paul Maizlish will be meeting February 21st at 2:30pm to discuss “Monitoring Potential Impacts of Federal Policies on Utilization of Local Health Department Programs by Vulnerable Populations.” If you’re interested in attending, please contact MNewcomb@BARHII.org.  We may be reaching out to you in the coming weeks to see if your health department wishes to participate in this effort. BARHII member health departments like Napa, Alameda, and San Francisco have also taken steps to strengthen policies protecting undocumented clients and communicate these commitments to their clients to ensure continued care.

Issue: Deportation, Fear and Confusion  In late January the President issued  three executive orders to limit immigration to the United States, block refugees from predominantly Muslim Countries, step up deportations and make sanctuary jurisdictions ineligible for federal funding (at the discretion of the Secretary of State).  Elements of these orders (the border wall and hiring of an additional 15,000 new immigration agents) are contingent on funding approval from Congress, and as of last week, a  Federal Appeals Court upheld a previous ruling to block the travel ban. Despite this decision, an appeal or new executive order are likely and the conditions remain uncertain. This was underscored by an “enforcement surge” last week that detained 160 people in Southern California, and many more around the county.

Health Equity Concerns: These orders have sparked fear and confusion for refugees and immigrants, which past studies have linked to  post-traumatic stress syndrome in children,  low birth weights and other health conditions.

BARHII Action: On January 20th, BARHII convened over 45 Bay Area public health staff, and the ACLU for a discussion of public health’s rights to maintain safe space for clients.  The session included opening comments from Immigrant Rights organization SIREN, who spoke about growing fear in immigrant communities and new state legislation to ensure their safety. See here for more information about public health responses to increased deportation fears. 

Issue: Repercussions for Welcoming Places and/or Sanctuary Cities: These executive orders could  jeopardize funding for public health, health services and other government functions if the Secretary of State chooses to enforce the provision denying funding to sanctuary jurisdictions. While most have not applied the label of “Sanctuary City”, many jurisdictions in the Bay Area  could potentially be considered Sanctuaries, as could the entire State of California. Despite the threat of reduced Federal Funding, it is Congress, not the President that is responsible for appropriating funding, and  legally, the federal government cannot withhold funding that is not directly related to the content of order--such as healthcare or public health dollars. 

Health Equity Concerns: Local governments (cities, counties, and special districts) directly receive approximately  $8 billion a year in federal funds. Cuts to these funds could jeopardize public services, public health prevention and healthcare.

BARHII Actions: The BARHII Policy Committee is sharing analysis of these threats—as well as the broader range of federal and state policies related to immigration. Two BARHII jurisdictions have also filed legal challenges to this proposed threat to funding. For more information, or to participate in BARHII’s Policy Committee (next meeting, 2/15/17 at 9:30) contact MNewcomb@BARHII.org.  

Issue: Nullify Fair Housing Rule: A pair of bills have also been introduced ( S.103,  H.R. 482) to nullify the Affirmatively Furthering Fair Housing rule.  Health,  equity and  housing advocates have identified this rule as a key opportunity to reduce segregation and improve housing conditions in low-income communities. In addition to eliminating this fair housing rule, the house bill could  eliminate federal funding for data collection and analysis related to racial disparities in health, education, and other areas. Both bills are currently in committee.

Health Equity Concerns: If passed, these bills would perpetuate economic and racial segregation, reinforcing already dramatic differences in health outcomes and life expectancy by neighborhood. They would also cut support for racial/ethnic data in measurement and evaluation, a key tool to address health disparities.

BARHII Action: The BARHII Policy Committee is tracking and prioritizing these bills, as well as soon-to-be-announced state legislation to ensure fair housing in California. For more information, or to participate in BARHII’s Policy Committee (next meeting, 2/15/17 at 9:30) contact MNewcomb@BARHII.org.  

Issue: The Affordable Care Act/Prevention Fund: On January 20th, an Executive Order was signed to cut parts of the Affordable Care Act (ACA). While repealing and/or replacing the ACA requires an act of Congress, the order does give broad powers to federal agencies allowing them to  change, delay or waive parts of the ACA. Specifically it allows them to  waive the individual mandate to buy insurance, and grant flexibility to insurers and the state to charge higher premiums and sell insurance across state lines. Despite this order, lawmakers have appeared to step back from the  late January timeline for repealing and replacing the ACA that was initially proposed in Congress. The Administration recently suggested that a replacement plan would not be ready until the end of this year or 2018,  although the Speaker of the House is suggesting a March timeline. 

Health Equity Concerns: Repeal of the ACA would eliminate the  Prevention and Public Health Fund, which supports many critical health department positions dedicated to Policy, Systems and Environmental change. Repeal of the ACA would also cause an estimated  5 million Californians to lose insurance coverage.  

BARHII Action: In partnership with Public Health Alliance of Southern California, BARHII will be exploring communications project with Design Lab to promote the critical value of Prevention. 

Issue: Draft Order Could Limit Medical/Food Access: A draft executive order has been leaked which, if signed, would prohibit immigration for those likely to need public benefits (known as “a public charge”), and make current immigrants responsible for the costs of past benefits or subject to deportation.  The order also expands the definition of programs considered for public charge, including programs like WIC, school lunches, Medicaid, and ACA subsidies.

Health Equity Concerns: If passed, this executive order would make it far more difficult to provide healthcare and other health-promoting services to undocumented immigrants or documented green-card holders. These residents could face deportation and/or back charges for prior benefit use.

BARHII Action:  The BARHII Policy Committee is tracking the not yet released order. For more information, or to participate in BARHII’s Policy Committee (next meeting, 2/15/17 at 9:30) contact MNewcomb@BARHII.org.  

The Bottom-line for Health Equity: Taken together, these policies pose significant threats to population health in the Bay Area. Many low-income households, especially immigrant families now face increased fear and mental health impacts, and decreased access to prevention, health, and other public services. In the longer term, these policies could cut critical health department positions dedicated to Policy, Systems and Environmental change, increase already dramatic differences in health outcomes and life expectancy by neighborhood, and make measurement of racial health disparities more difficult. 

The Public Health Alliance of Southern California has turned Human Impact Partner's Public Health Actions for Immigrant Rights Guide into an excellent presentation.

In addition to these resources, there are many providers who can help with information about immigration rights, including the following list:

If you are interested in having BARHII staff offer a training on this material to your staff or elected officials, please contact Melanie Newcomb at MNewcomb@BARHII.org.