The ripple effect of uncertainty and fear

In a panel discussion about Community Catalyst’s new report, The Power of Fear and Trust, we partnered with Protecting Immigrant Families to speak with four state partner organizations who work directly with Latinx* immigrants: Latino Action Network Foundation, United Methodist Health Ministry Fund, Every Texan, and Florida Health Justice Project. 

Together, we talked about how — and why — uncertainty and fear have driven a wedge between immigrant communities and their willingness and ability to access a range of public health benefits that they are both eligible for and deserve. While this is true across all immigrant communities, this report and panel discussion focuses on Latinx immigrants specifically. In addition to being one of the most impacted communities by the pandemic, data shows that Latinx immigrant communities are the least likely to proactively seek out enrollment services.

Panelists

Dr. Jessally De La Cruz, Executive Director, Latino Action Network Foundation
David Jordan, President & CEO, United Methodist Health Ministry Fund
Karla Martinez, Policy Analyst, Every Texan
Alison Yager, Executive Director, Florida Health Justice Project

We’re only as strong as the movement

One of the key findings of the report is that we’re only as strong as the movement. Policymakers, funders, immigrants’ rights, and health justice advocates are poised to come together to meet people where they are, offer measurable and culturally competent information, fixes, and much-needed partnership over the long-haul. That’s why our continued dialogue with such amazing advocates for Latinx immigrant communities is so essential. We’re building power toward a society where everyone has what they want and need to thrive.

Right now, there is a real moment of urgency for discussions about building and mobilizing a trusted movement to enroll Latinx immigrants in public benefits like Medicaid and SNAP. Because of anti-immigrant attitudes and racism, immigrant communities are hit particularly hard by the end or “unwinding” of the COVID-19 Public Health Emergency (PHE). During the pandemic, continuous enrollment in Medicaid helped millions of people to afford and maintain their health care coverage. Now, those gains are being reversed as states begin Medicaid redeterminations processes. 

The end of the PHE is conflated with federal discussions about the repeal of President Biden’s public charge rule, which implemented a much clearer, more moderate framework for public charge than existed before.

We want to ensure that Medicaid enrollees don’t lose their coverage as continuous enrollment ends. And we want them to feel safe to enroll, without fear. Latinx immigrant families are a priority community for such efforts — our findings have shown how quickly and deeply negative experiences can permeate, given the harm that has been inflicted on them continuously throughout history.

Key moments during our conversation

Fear is rooted in reality

The panelists clearly laid out where fear comes from that prevents many Latinx immigrants from enrolling in public benefits like Medicaid and SNAP: dangerous policing and deportation, state and national leaders that put forth harmful narratives about immigrants, and a harmful medical system that puts them and their children’s lives at risk.

The persistence of fear
“The fear that exists in our communities is very real. When I was a child, growing up in Texas in an undocumented family, I hit my head and had to get stitches right here [indicates her forehead]. And my parents were extremely worried about taking me to the hospital because they felt that we would get deported. And so, it is something that — I lived this, what, over 30 years ago and it’s still happening today.” –Adriana Cadena, Protecting Immigrant Families 

The need for support from leaders
“I think that oftentimes organizations like ours [Every Texan] are trying to do patchwork and fill in holes and trying to reach people that are difficult to reach but – if we had more support and coordination from — in Texas specifically — our Texas leaders, we’d be able to focus a little bit more on those people that are harder to reach.”  –Karla Martinez, Every Texan

The chill hasn’t thawed
“There is a sense that the chilling effect of the public charge rule has maybe dissipated, and I really wanted to affirm what all us [on today’s webinar] know, which is that we’re still seeing that fear, that hesitation, every day on-the-ground and I wanted to be able to speak to that.” –Alison Yager, Florida Health Justice Project

The unknown
“People are scared for their lives and for their livelihood. This is deeply rooted in racism, and discrimination that people face on a daily basis. And, I think often, the [perceived] potential of deportation or the criminal potential consequences, in itself, outweighs the potential benefits that people could get from accessing health benefits — so they rank access to health benefits a little bit lower when it compares to having economic security and thriving economically. So I think part of our job is also to shift the narrative around that, and make sure that health is also prioritized. And when you are healthy, and can go to the doctor, and get access to the food that you’re eligible for, you can continue to work and contribute. But there’s also this fear of ‘what’s to come’ or the unknown.”  –Karla Martinez, Every Texan

Some Community-Led Solutions

Partners working with immigrants outlined some key steps they are taking to build trust in their communities, including partnering with community health workers and promotores and ensuring people are spoken to in languages they understand with accurate translation and interpretation services.

The vital role of community health workers
“As a foundation we’ve really worked to support the building of the profession, the recognition of the profession, of the community health workers … recognizing that it creates an opportunity to help folks enter the health care workforce to support training culturally competent providers and really help folks fill the gaps with trusted folks in their community.” –David Jordan, United Methodist Health Ministry Fund

Where the rubber hits the road
“I think we’re all in the country just like, you know, in shock, at times, and some times a little numb. But New Jersey, we often tout as a blue state, right? A blue, progressive, welcoming [to] immigrants state — but, for us, the fear and the mistrust really happens where the rubber meets the road, so when people are directly discriminated against. So for example, trying to enroll in Cover All Kids, and having someone say: ‘Oh no, you’re not eligible because you have to wait five years.’ … So that’s where we find that the community health worker is so important, because they bear witness to when these gaps in service happen, and when this implicit bias and discrimination happens. Even something so simple as a pregnant woman going to the E.R., you know, and being turned away or her pain minimized, and then going with maybe a doula or a promotoreas [a Spanish term for community health workers] to the E.R. and actually getting the care that she needs in the language that she needs to understand it. Those are some very basic civil rights, some basic human rights, but where the rubber meets the road — that’s where those violations happen.” –Dr. Jessally De La Cruz, Latino Action Network Foundation

Talking to people in languages they understand
“We need to prioritize the funding needed for interpretation, for translation services … and paying people for their time when we’re asking them to engage with us. So, best practices: meeting people where they’re at, talking to them in languages they understand, and also just — [acknowledging that] community members are experts too, they’re experts in their communities, and sometimes we need to just listen to what they actually need and not go into a community expecting that we know the answer.” –Karla Martinez, Every Texan

Final thoughts

The panel left us with hope and vision for a world which values immigrant communities and supports us all to get healthy.

Immigrant communities are worth it
“The system is designed and rigged against us and immigrant communities. So it’s going to be a fight, an uphill battle, and a work in progress. But, we are worth it, and immigrant communities are worth it. So we’re going to keep fighting because everybody deserves the right to eat when they’re hungry and go to the doctor when they need to.” –Karla Martinez, Every Texan


A strong community supports everyone
“We need to be prepared to continue to fight, prepared to look at where there’s more common ground with one another, and not give up because it’s not acceptable for folks to go without health care, to go without heat, to go without food, and to go without a strong community supporting everybody. We just need to keep at it.” –David Jordan, United Methodist Health Ministry Fund

Access versus quality of care
“Access and quality of care are two different things. And we can win one battle, but if we still have providers and a health care system that does not value us, that does not see our full humanity, and is plagued by implicit bias and discrimination then having the access is not justice.” –Dr. Jessally De La Cruz, Latino Action Network Foundation

This is a time for…
“I think this is a time for us to double down on creative solutions, on inclusive language, on changing the narrative, on building new forms of alliances, on thinking outside of the box in terms of our policy opportunities. I think this is the time for us to really dig deep, and not let them win.”  –Alison Yager, Florida Health Justice Project

At Community Catalyst, we will continue to work with state, local, national and tribal partners to build power toward a society where health is a right for all.