It Shouldn't Be This Hard For Immigrants to Access Health Care

 

For clarity, these show notes and this podcast episode will be inclusive of undocumented immigrants and immigrants with legal status.

In the United States today, there are more than 8 million citizens who live with at least one family member who may be undocumented. Yesenia Chavez with the National Latina Institute for Reproductive Health (NLIRH) and Jaclyn Dean with the National Asian Pacific American Women’s Forum (NAPAWF) talk to us about the fight for access to healthcare for immigrants.

Children make up the majority of the millions of citizens who live with at least one family member. In fact, 6 million of these citizens are children. This means that many types of immigration enforcement actions come with severe emotional, mental, developmental, physical and financial repercussions for both the children and the undocumented individuals.

Immigrants are not able to legally access public benefit programs until they have proven their permanent resident status, and only after five years of having that status. These programs can help provide housing, food, and health security to these communities. It is important to note that this same five-year bar also prevents access to the Affordable Care Act insurance marketplace. This means that opportunities for immigrant individuals and families are already limited, and immigrants often rely on a patchwork of insurance sources to cover healthcare. If their employer does not cover insurance or if they do not qualify for Medicaid, then immigrants often have to turn to paying for emergency care out of pocket, or seeking help through a community health center.

46% of immigrant, non-citizen women of reproductive age in the U.S. are privately insured, 19% rely on Medicaid for their insurance, and 34% are completely uninsured. The uninsured rate for immigrant women of reproductive age who are living in poverty is 48%. Nearly half of all immigrants in the U.S. are women and children.

About two thirds of Asian American and Pacific Islanders (AAPI) are foreign-born, and 35% of AAPI individuals in the U.S. have limited English proficiency. This means that communicating about one’s medical needs in the English language may not be an entirely comfortable scenario. There are also many differing cultural and spiritual values that don’t exist in Western medicine that AAPI individuals are not comfortable sharing. These medicine types may also cost more if they are not covered by insurance. AAPI individuals, of all racial groups, feel that they are most looked down upon by their providers and the least likely to feel that their background is understood by their providers. On top of these barriers, reproductive healthcare is not widely referenced or perceived as a valid health need among AAPI individuals. The pre-existing stereotypes, biases, miscommunications and lack of trust in the Western medical system makes accessing reproductive healthcare difficult for AAPI individuals and families.

Nearly 1 in 3 non-elderly Hispanic individuals lack insurance coverage in the United States. Given the lack of access to insurance coverage as well as susceptibility to lower wages based on immigrant status, Hispanics are half as likely as non-Hispanic whites to have health insurance. Hispanic and AAPI communities can face similar (and different) battles when it comes to receiving healthcare in the U.S., and the base issues include language barriers and lack of culturally competent care. For many undocumented Latinos, accessing care can be stunted due to fear of legal repercussions due to immigrant status.

Public charge is a legal determination that U.S. immigration officials use when immigrants are seeking legal entrance to the U.S. or looking to change their legal permanent residence status, and is essentially a tool that will determine whether or not an immigrant will heavily rely on the government for support for basic necessities. In October of 2018, the administration published a proposed rule to drastically expand the definition of public charge to include Medicaid, SNAP, TANF, and many other public benefits, including Section 8 Housing vouchers. If this proposed rule went into effect, it would likely force immigrants to choose between the well-being of themselves and their children and their status in the U.S. Because Medicaid is now included in the public charge test, many immigrant women would likely forgo health care including contraception, family planning, maternity and post-partum care and STI testing and treatment.

In order to ensure immigrants are able to access affordable healthcare, the five-year bar preventing immigrants from accessing public benefit programs and insurance needs to be removed. The Health Equity and Access Under the Law Act (HEAL) seeks to repeal this five-year bar.

Photo by Luke Stackpoole on Unsplash

Transcripts

Jennie: Welcome to rePROs Fight Back a podcast on all things repro. I'm your host Jennie Wetter. In each episode, I'll be taking you to the front lines of the escalating fight over our sexual and reproductive health and rights at home and abroad. Each episode, I will be speaking with leaders who are fighting to protect our reproductive health and rights to ensure that no one's reproductive health depends on where they live. It's time for repros to fight back.

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Jennie: Welcome to this week's episode of rePROs Fight Back. Today we are going to talk about challenges immigrants face when trying to access health care. I think today's episode is extra fun because I'm going to have a conversation with two great people, which we haven't done on the podcast before. So first so that everybody gets used to their voices, I'm actually gonna let them introduce themselves so you can know who is who. I'm so first Yesenia, you want to go?

Yesenia: Yeah, so my name is Yesenia Chavez. I am the immigrant women's health and rights policy analyst at the National Latina Institute for Reproductive Health. And we are an organization, the largest, um, national reproductive justice organization, working to secure the health, dignity and justice for the 28 million Latinas in the United States.

Jennie: And then next we have Jaclyn. Jaclyn?

Jaclyn: Hi, I'm Jaclyn, Jaclyn Dean and I'm the policy manager at the National Asian Pacific American Women's Forum or NAPAWF. We are the only national organization that's working to advance and advance those social, social justice and human rights of AAPI women and girls in the US. We work using a reproductive justice framework and we work in reproductive health and rights, economic justice and immigrant rights. And we have chapters all around the US and organizers on the ground building this movement together.

Jennie: Great. Okay. So before we dig into like, what's happening right now around immigrants accessing health care, let's just do a little basic scene setting. So what does the landscape look like right now?

Yesenia: I do want to say that when we're talking about immigrants for Jaclyn and I, we are being inclusive of undocumented folks and um, immigrants with legal status, whether that's legal, permanent resident, um, or some type of legal, um, visa. The, the, in the United States today, there are more than 8 million citizens who live with at least one family member who may be undocumented. Um, children are the majority of the US citizens. Um, that's about 6 million citizen children under the age of 18 who live with either a parent or a family member who is undocumented. I just want to say that what this means for any type of immigration enforcement actions is that the, um, there is significant physical, developmental and economic repercussions, not only for the individuals who are undocumented in that family, but also the children who, um, who are within that family. I think when we're talking about immigrants accessing health care, something that's really important for everyone to understand is that a lot of public benefit programs are not something that immigrants are able to access until they have, um, their legal permanent resident status and after five years of gaining, um, their LPR status. So it's essentially a five year ban that has been placed on access to public benefit programs that we know, um, such as Medicaid, CHIP, um, WIC, all of those, these are all programs that we know help provide economic security, food security, housing security, all of that, um, to our communities.

Jaclyn: Yeah. And it's also important to mention that the five-year bar not only includes, um, a bar on public benefits, but also access to the ACA insurance marketplace. So for even for, for them to even purchase an insurance plan on that marketplace, they still have to wait five years. Um, so they're limited there. The opportunities are already pretty limited. And what this means is that immigrants are kind of relying on this patchwork of, of health services. So, um, if their employer doesn't cover their insurance because of the ACA restrictions, or if they don't qualify for Medicaid, then they ultimately kind of rely on paying out of pocket for emergency care or they have to go to a community health center um, which, you know, depends on where you live, how available those community health centers are. But generally community health centers are great in that they provide a lot of, um, low cost services and many of them also, um, do so, do so through culturally competent care and um, have a lot of language access to help with, with immigrants. But just, you know, to, to, to look at generally what access for immigrant women looks like according to the Guttmacher Institute, immigrant women, so noncitizen immigrant women in the US um, of reproductive age, 46% are privately insured, 19% are on Medicaid and a whopping 34% are uninsured.

Jennie: Wow, that's a lot.

Jaclyn: That is a lot. And it gets even worse if you're poor. So immigrant women who are living in poverty and who are every productive age, um, because they're barred from using Medicaid, the uninsured rate is 48%. So you're talking about nearly a half of immigrant women who are living in poverty, who don't have health insurance and have to pay a lot more money to get their health coverage.

Jennie: And probably money that they don't have if they're already living in poverty.

Yesenia: Right. And something that keep in mind with that is a nearly half of all immigrants in the US are women and children. So we're talking about families here and um, the population is, uh, most is, is at least half um, women.

Jennie: Each community has different and similar but sometimes different barriers that prevent them from accessing health care. So, um, Jaclyn, do you maybe want to talk about some of the barriers that um, Asian American and Pacific islanders face?

Jaclyn: About two thirds of Asian Americans and Pacific Islanders. So I'll say AAPI, um, when we refer to that population, about two thirds of us are foreign born. So we're not born in the U S and 35% of AAPIs in the US have limited English proficiency. So this means that they are not entirely comfortable communicating their needs in the English language. So that's a pretty big number. It's about a third. And when you think about what that means in terms of accessing their health care and being able to communicate their needs to their doctors, um, you know, and then add on medical terms on top of that, it can be really hard. And another thing is a lot of API immigrants don't really feel comfortable discussing their really specific health beliefs and practices to their doctors because they have a lot of other traditional and spiritual cultural values that may not really resonate with Western medicine. So for example, I was raised on Chinese herbal medicine, um, which was not covered by insurance. And so my parents paid a lot of money out of pocket for me to see a Chinese herbal doctor instead of, um, you know, relying, going to, um, a regular physician. Another study found that AAPIs are most likely of all racial groups to feel looked down upon by their providers and the least likely likely to perceive that their background was understood by their providers. So there's a lot of misunderstanding and not a lot of trust in western medicine. For example, in the Hmong community there are, there are very few medical terms that are used and there's a lot, there are a lot of beliefs that your health is connected to your spirituality. And so that's really hard to communicate um, when seeking health care. And then when we're talking specifically about reproductive health care, it's not really a thing in Asian culture. It's not something that, um, Asian-Americans really, really talk about. Um, you know, it's not, it's sometimes not perceived as a real, a real health need. Um, so you know, for example, it's, it's not common for Asian-Americans to go to see gynecologists and to see, um, to seek reproductive health care unless they're planning on having a family. There's a lot of stigma about talking around sex, about, around talking about sex and reproductive health that can make it really difficult for AAPIs, especially young people to seek their reproductive health services. And then if you're an immigrant, you can imagine all of the other barriers in place that would prevent you from, you know, seeking your reproductive health care.

Jennie: And then you've also seen like things that are targeting, you know, stereotypes with Asian-Americans where you see like sex selective abortion bans in the states and we don't need to like dig into that cause that's like a whole other thing. Yes. Like, um, you do see kind of the use of, um, you know, stereotypes to then target that community which can't foster then trust in the medical community.

Jaclyn: Yes, exactly. Lots of, lots of stereotypes and posts on us about which genders we prefer or how we handle our pregnancies. And that only makes things worse for us when we're trying to seek health care.

Jennie: Yesenia, do you want to touch on, um, specific challenges with the Latinx community?

Yesenia: So I would say that a lot of, um, similarities between the Latinx and AAPI community that Jac;um just spoke about. But I'll just speak, um, to us, specifically, Hispanics account for a significant portion of the uninsured population, um, with about nearly one in three non elderly Hispanics lacking coverage and given their susceptibility to lower wages due to potentially immigrant status um, and, uh, limited access to employer sponsored coverage. Um, Hispanics are about half as likely as non Hispanic whites to have private health insurance. Um, that's about 39% versus 71%, which is pretty obnoxious. Um, and you know, Medicaid fills the, some of this gap in private coverage, but it certainly does not offset the difference. Um, and it leaves Hispanics more than twice as likely as whites to be uninsured, which is about 32% versus 13%. Um, so we are clearly facing some of the same battles. Um, and I think obviously as Jaclyn was speaking about language, um, and culturally competent care is far and few in between. And I think that's something that our community needs in order to be able to trust the medical provider, but also just to certainly understand what medical care they are receiving. And, um, so this is a specific challenge to the community and I think we'll go into specifics later, but I think for undocumented, um, Latinas accessing health care looks a lot like, uh, you know, feeling afraid of potentially having any type of repercussions due to their immigrant status. And that's due to having seen, um, certain providers having, uh, collaborated with government officials. Um, even though health care providers are able to protect their patients from, um, any type of, uh, backlash for their immigrant status, I think there's just this fear that there will be a collaboration because they've seen it in the news or they're just, um, just generally afraid, um, to seek care.

Jennie: Particularly in the Latinx community like the fear is so kind of pervasive right now and that's like two fold, right? Like the health impacts of just dealing with that every day in the stress of it every day has profound health impacts on people and, two, feeling like maybe you can't access the care because you're worried about what will happen when you go. I mean those are two huge challenges that they have to deal with.

Yesenia: Yeah, definitely. And I think our communities, um, are working every day and trying to pay their bills, have food on the table, have shelter for their children. And I think at the end of the day, health care becomes something that they, it, they will have as a choice and kind of put to the sidelines, um, because at the end of the day, they want to make sure they have, um, their kids are fed and that's, that's what's going to take priority over anything else. And especially if they see it as something that, uh, that they have barriers to seeking, it's going to be hard for them to feel comfortable seeking care.

Jennie: So that kinda brings us to what's happening right now. And, um, it's something that people may have heard about but might not have. Um, and if they have, they might not know what it is. And that's what's referred to as the public charge. Um, I think Yesenia, you were going to tell us a little bit about what that is.

Yesenia: Yeah, so public charge, um, is already part of us immigration policy. Um, but what is currently ongoing is a proposed expansion of this. So what public charge is, is it's a legal determination that US immigration officials use. If immigrants are seeking entry to the United States or seeking to adjust their status to legal permanent resident, um, it is not something that impacts legal, permanent residents seeking US citizenship. Um, but this, this essentially, um, it's something that's used during the application process. Um, and it determines whether or not someone, public charge is essentially trying to, is a determination to try to figure out if someone will rely heavily on the government for support for basic necessities such as food, housing and access to health care.

Jaclyn: So just to take a step back and give you a little bit of the broader history of public charge and then, you know, how we got to where we are. So public charge was first implemented in 1882. Um, like Yesenia said to basically deny and trade to immigrants who immigration officials thought would be dependent on the government. Um, back then this was interpreted to mean that immigrants had to show that they had $25 upon arriving to the United States. And for the first 30 to 50 or so years, that was actually a pretty high standard. Um, and a lot of immigrants were turned away because of this public charge rule. But then by the second half of the 20th century, um, it became pretty lenient. And, uh, it was pretty rare for somebody to be turned away, um, due to the, this public charge test, until the 1996 illegal immigration reform and immigrant responsibility act, um, otherwise known as IIRAIRA. Many bad things in this immigration law but we'll talk about one of them, which is that, um, it codified public charge to include an examination of quote, totality of circumstances. So this meant they weren't going to just look at how much cash you had on hand, but they were also going to look at other factors like your income, your education, your health, um, your family, and you know, basically looking at everything to see if you would rely on the government for, um, for public benefits. But then in 1999, the Clinton administration clarified this to just mean people who are on cash assistance from the government. So solely, um, temporary assistance for needy families or TANF, um, and social security income. So this is, um, this, that's where we are today. Right now the public charge, the public charge test is used only to apply to immigrants who are using those to, um, cash benefits.

Jennie: So things have changed obviously with the election. Uh, not, the 2016 elections since this will have aired after the 2018 election. Um, but there has been a new proposed rule and change, um, that would change public charge. Um, do you wanna tell us a little bit about the new, the change?

Yesenia: In October of 2018, um, the administration published a proposed rule to drastically expand the definition of public charge to not just include the cash assistance programs that Jacqueline was speaking about. Um, this would encompass Medicaid, the supplemental nutrition assistance program, also known as SNAP, um, and other public benefits such as, um, prescription drug co drug cost support, um, which is under the Medicare part Dprogram, and housing assistance such as, um, section eight housing vouchers. Um, these would all be included under this proposed rule and this expansion of the definition of public charge.

Jennie: That's quite an expansion, definitely.

Jaclyn: Yeah. And another thing about the proposed rule for public charge is that it doesn't just include these benefits. You kind of see a return back to this whole idea of totality of circumstances. So now they're also looking at your education, your income, you know, what percent of the federal poverty line you're at, and even everything down to your, your English proficiency into considering whether or not, you know, you would be, you're a public charge. And even something like having a large family is considered a negatively weighed factor, uh, which is obviously very problematic because we should be able to have as large a family as we want without any repercussions. Um, you know, very basic reproductive justice value. Uh, we should be able to decide if, when, how we, we want to start or grow our family. And so you see this disproportionate burden on immigrants having to prove that not only they're following all the rules, but that they have to make a certain amount of income and stay off these benefits and have a good education. And so it's really, you know, once you have all of these circumstances in there, um, you know, it makes it really difficult for one to really figure out if they would be deemed a deemed public charge.

Jennie: What would it mean um, if this were an acted, if this proposed rule went into effect?

Yesenia: The expansion of the definition of public charge would essentially force immigrants, um, to choose between their wellbeing and that of their children or their immigrant status um, and their future immigration proceedings. Um, which is what you're looking at is asking people to choose between feeding their children or having access to staying in this country legally. And it's a new way of doing family separation, which I know has been across the news and everyone is super familiar with. But this is a different form of it.

Jaclyn: Right. Because if one of your family members is on one of these benefits and is at risk of being considered a public charge and they can't stay in this country, that's another form of family separation. Um, and I think people really need to realize that and we're pretty consistent calling it out for what it is because we see a lot of family separation in almost, I want to say every immigration policy that has come out of this administration. In terms of reproductive health, because Medicaid is now included in this public charge test, this means that all of the required benefits, um, concerning reproductive health that are included in Medicaid, our services that a lot of immigrant women would have to forego if they want to stay in this country. So that includes family planning and contraception, all the no cost contraception that is included in Medicaid, um, STI testing and treatment, um, maternity care from prenatal care and postpartum care. These are all things that are required by Medicaid and obviously incredibly important for women's health. I mean, can you imagine being an immigrant woman, um, and having to deal with everything that you are, that you already go through being in this new country and all these language barriers and not having access to, you know, all the, all of the tests that come before your pregnancy and taking care of yourself after you give birth. You know, these are all crucial services that immigrant women would be really afraid to access if they're seeking their LPR status or their green card.

Jennie: I would think this would also just have a real chilling effect that people hear, you know, it reported that this proposed rule is coming and they would be scared to access services that they still have a right to.

Jaclyn: Absolutely. There, there has already been a chilling effect throughout this year. So there was a league draft that came out earlier this year in February or March and um, we heard from um, somebody who works at Asian Health Services over in California that um, in one of these communities centers the week that this leaked rule was dropped, half the people didn't show up for their appointments because they were too scared to use their, their Medicaid benefits. Um, you know, even if they weren't sure that this charge, this public charge test would even apply to them. There's this scare that, you know, we're not gonna risk anything anyway. I mean, if you are in that position, you wouldn't want to.

Yesenia: Right. And the level of uncertainty is just so high. Um, people don't even realize that eligibility has not changed to access these programs. Like anyone, as it stands, anyone can access, um, these immigrants can access these programs. It's just a matter of not understanding that this isn't even law yet. This isn't implemented in any kind of way. And that there's a whole process between the leaks, um, the proposed rule, um, to comment collection. All of that is gonna take so much time for this to be implemented, but nobody understands that. And the second that this was leaked into the news, we saw that impact on our communities and the chilling effect is very real.

Jaclyn: And I think it's really important to add something that we didn't mention about the public charge test is that it's not retroactive. So it, this only applies once, if the rule goes into effect, it only applies if immigrants are using benefits after that date. So they are still safe to use benefits now even because the test hasn't, or the, the new rule hasn't, hasn't been implemented yet. And I think that's also another part of the, the rule that is scaring people away.

Jennie: I mean that's an important clarification for people who are, you know, thinking about this really makes me think of another community within this that is particularly targeting those people with disabilities who often rely on Medicaid.

Jaclyn: Yeah, exactly. And you know, the inclusion of Medicare and prescription drugs is, would be especially debilitating for people with disabilities. And so now you're looking at people with many intersecting identities. If you're immigrant, if you're poor, you have a disability, it's really an attack on the most marginalized. Jennie: Um, so this goes beyond, um, Medicaid and it impacts other programs that we don't talk about as much. And one of those is SNAP. So maybe we'll talk about how that would affect, um, the, this community.

Jaclyn: Absolutely. So SNAP, um, the Supplementary Nutrition AssistancePprogram, otherwise known as food stamps, about half a million Asian American and Pacific Islander immigrants rely this program to provide food for their family. And generally in the AAPI community, food insecurity impacts 9% of Asian Americans and 24% of native Hawaiians and Pacific Islanders. So this is a really a really big issue for us. And when you include SNAP in there, I mean, it's like you send, you said you're literally forcing them to make a decision if you want to provide food for your kids or if you want to risk your want to risk your status. And this is only based on individual use of benefits, but to us, you know, an attack on individual use of benefits is an attack on entire family. There's no way you can separate the two.

Yesenia: Right. And another way to look at SNAP is that it's the nation's largest anti hunger program, which means that it lifts millions of individuals with low incomes out of poverty, um, to make sure they can afford an adequate diet. So for Latinos, um, what that looks like is SNAP in 2016, um, helped about 10 million Latinos put sufficient food on the table, um, and it's lifted about 2.5 million Latinos, um, out of poverty in 2015. We have the stats to back us up to tell the story of how programs like these provide economic security for families, entire families, not just one individual, but as Jaclyn said, the whole family to make sure that they're able to head to a better future and be able to be, um, economically stable, uh, which is really important for communities to get out of poverty.

Jennie: Talking about all of this has also made me think, you know, these programs are also just under attack in general, right? Like we've already heard, you know, with the tax cuts passed last year that oh now we don't have enough money so we're going to have to cut programs helping the most marginalized and most at risk people, which would be Medicaid and SNAP and other programs like that which could very well come under attack in the near future.

Jaclyn: And Medicaid has been on attack since all of the fights to try and repeal the ACA. And Medicaid fights are also happening in this states with a lot of waivers and trying to cut down on the types of services that states are able to provide through medicaid.

Yesenia: I think what's really specific to our communities is that about 3.8 million AAPI and 10.1 Hispanic immigrants live in a household in which at least one family member uses one of one or more of these types of programs. That's really important to know as we're talking about, um, the access to these programs.

Jennie: Absolutely. There's a lot of people who could be impacted, right.

Jaclyn: It's a very harsh standard. I think once, they said that 47% of American citizens themselves would not even pass this public charge test.

Jennie: That's crazy. Crazy is not the right word. So let's change it to maybe a little bit of a positive frame on things and that what would need, what would we need to do to ensure immigrants are able to access affordable healthcare?

Jaclyn: So first of all, we need to remove this whole five year bar, that access, that immigrants have to wait before they can access any of these benefits. And that's, that's first and foremost because in the five years that immigrants are waiting on their status, that's oftentimes the times that they need it most. And there is a piece of legislation out there, um, called the HEAL for Immigrant Women and Families Act. So HEAL stands for health equity and accountability under the law. And what it seeks to do is to repeal this five-year bar so that immigrants can access health care specifically for women and children to access the reproductive health care that they need. Um, so it's been introduced in the House by Michelle Lujan Grisham and, uh, we are hoping to introduce it in the House and Senate next year as well.

Yesenia: Um, yeah, so I think that something else to have in consideration is that there are sensitive locations that protect immigrants access to health care. As it stands in 2011 actually, ICE, the immigration and Customs Enforcement Agency, um, published a, a memo, um, that restricted immigration enforcement action by immigration agents at certain sensitive what they call sensitive locations. So that looked like places of worship health facilities, including hospitals and clinics, schools, um, and other places such as, uh, funerals, weddings, and public demonstrations like rallies. So something like, um, the sensitive locations, uh, is a tool to protect our communities and their ability to not have fear, um, when they're trying to take care of themselves and have access to health care, um, for either themselves or their children and families. Even though the current administration has in some ways disregarded the sensitive locations, um, policy that the previous administration had published, I think it's important to note that there has not been a complete, um, repeal of this policy. So, um, folks should feel more comfortable accessing health care based on this memo that was published a couple of years back.

Jaclyn: And another thing going back to, to health coverage is to protect the ACA. As we mentioned earlier 40, 46% of immigrant women in the US are privately insured. And so the more that we can do to protect the ACA and protect, you know, access to contraception and family planning within the ACA, um, you know, the more that we can protect immigrant access to reproductive health in addition to access to public benefits. Another thing I mentioned earlier was community health centers and the importance of community health centers and that they're often the place that immigrants rely for their health care. And a lot of funding has actually been slashed for community health care. Um, that's kind of one of the sneakier attacks on health care by the Trump administration is um, reducing a lot of, um, federal funding for community health centers. And that needs to be stopped. We need to fund our community health centers and make sure that all of the federal programs such as Title X, are able to provide the reproductive healthcare that they were intended to through these community health centers, um, that provide culturally competent care and, um, language access. Yesenia: And you know, we, I think NAPAWF and Latino Institute both urge, um, this administration, Congress, all government agencies to work to expand these public programs, um, not restrict them, not instill fear in our communities to have to, uh, create barriers to accessing these programs. That's super critical and we hope that the next congress that maybe is friendlier to immigrants could create some type of accessibility and expansion of these programs.

Jennie: Okay. So I always like to end the program with an action. What can people do to fight back? What do you guys have? What can people do to fight back?

Yesenia: Well, thank you so much for that question. I think that's really why we're here is we want to give you all the information you need so you feel comfortable advocating for immigrant communities and their access to health care, food security and housing. And, um, the proposed rule that was published on October 10th, um, was made available to the public to comment for 60 days. So it has a public comment period open until December 10th. And all of our organizations are currently in the process of advocating for our community members to write their, um, write a letter to the administration, um, informing them of how this, how this rule will impact our community and their access to any of these programs. So, um, we encourage everyone to visit the protectingimmigrantfamilies.org website, which will provide for more context to this rule, but also allow you to submit a letter to the administration in opposition to this rule that will have damaging impacts on our communities.

Jennie: And we'll make sure to include the link to that in our take action section.

Jaclyn: And the more comments that we submit to the administration, the longer it will take them to implement this rule. So the better arguments that we make, the more unique stories that we have, um, the administration has to read and respond to each of these arguments. So the more that we inundate their federal register with all of our comments and opposition, the longer it's going to take them to actually make the rule happen. And each day that this role is delayed is another day that immigrant families don't have to worry about putting food on the table for their family in return for losing their immigration status.

Yesenia: Yeah. And if you aren't someone who is worried about how this rule is going to impact you, or if you're a pro health provider who is worried about your patients, I think something to really, um, take away from this conversation is that this rule is not yet in effect and that's really important to keep in mind. And, um, if you have immigrant patients to share with them, that they're not alone, that there's still time to fight back if they have questions there is this website that has a bunch of resources. Um, but I think we really just need to push out there that the federal agency has a required by, is required by law to respond to each and every single one of these comments that are being submitted. Um, so anything that you are able to, um, write to the administration is super important and key into, um, delaying this rule from implementation.

Jennie: Thank you so much Jacqueline, and Yesenia, this has been wonderful.

Jaclyn: Thanks for having us.

Yesenia: Thank you so much. This was great.

Jennie: For more information, including show notes from this episode and previous episodes, please visit our website reprosfightback.com. You can also find us on Facebook and Twitter at rePROs Fight Back. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.