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Trump attack on ‘sanctuary cities’ could hurt health programs

By SHEFALI LUTHRA

For Kaiser Health News

The Trump administration’s tough stance on immigration has some local health department officials worried it could spur cuts in federal funding and complicate a wide variety of programs, from efforts to battle the opioid epidemic to domestic violence initiatives.

The Department of Justice (DOJ) sent letters April 21 to nine jurisdictions — including the state of California and cities such as Chicago, New Orleans, Philadelphia and New York — threatening to deny them agency funding because of their status as “sanctuary cities.” That federal assistance broadly supports criminal justice initiatives, but it often reaches well beyond police departments and courtrooms to include violence prevention programs and other efforts to address social factors that affect health.

“These dollars go to everybody. You cut these grants — these are grants that protect the whole population,” said Dr. Georges Benjamin, executive director of the American Public Health Association.

Local health officials also worry that other federal agencies may follow Justice in stringently implementing a controversial Jan. 25 executive order signed by President Trump that mandates federal agencies take action to ensure localities comply with federal immigration laws and help deport people in the country illegally. That order — which has been blocked temporarily by a federal judge — could jeopardize a broad swath of vital community health services, not only for undocumented immigrants but for legal residents and citizens, too.

Rhetoric Vs. Reality

The term “sanctuary cities” describes locales — cities, but also states, counties and other community entities — with policies known as “separation ordinances,” which separate local government responsibilities from those of federal immigration authorities.

They often direct local police officers not to ask about the immigration status of victims, witnesses or suspects unless it is directly relevant to the case. They also exempt local law enforcement from complying with detainment or notification requests from the Immigration and Customs Enforcement (ICE) agency. In some circumstances, the local or state agencies declare that they won’t meet requirements to ask about immigration status when people apply for benefits.

Officials from these jurisdictions say helping federal authorities detain someone — especially if that person turns out to have valid documentation — could be a violation of due process. The officials say that if they comply, they could be at a legal risk. They also argue that enforcing some of the federal directives is a waste of resources or could deter immigrants from reporting crimes or assisting in investigations because they are afraid of police.

But there is no hard-and-fast definition of ”sanctuary cities” or federal delineation of which jurisdictions would be targeted under Justice Department directive.

“There’s been a lot of rhetoric around sanctuary cities,” said Laura Vazquez, a senior legislative analyst at the National Council of La Raza, a Latino advocacy group. “That has resulted in cities being confused. … They’re concerned if their city is losing funding.”
What’s at risk? Take the opioid epidemic. DOJ has worked hand in hand with the Department of Health and Human Services to spearhead the federal government’s response — and allocates millions of dollars to local agencies for activities like prescription drug monitoring, helping people access the most effective models of treatment and equipping police officers with anti-overdose medications.“The DOJ has been excellent partners before for many of our efforts,” said Dr. Leana Wen, Baltimore’s health commissioner. “It would have a negative impact if we were to lose any federal funds.”

“This is a big problem. It gets worse if you don’t have the resources to address it,” Benjamin said.

In Baltimore, Wen said, the impact would likely be felt by the city’s Safe Streets program, a health department initiative meant to undermine gang violence with an emphasis on curbing shootings. The federal department has over the years put millions of dollars toward it, enabling public health officials to work with schools, local churches, community organizations and other groups. And, depending on the jurisdiction, other public health interventions could also be squeezed: domestic violence response programs, drug courts and mental health courts, among other things.

There’s also a lack of clarity about which cities might be affected. New Orleans, for instance, doesn’t self-identify as a sanctuary city but received the letter from Justice. The source of its scrutiny: Police officers don’t routinely question witnesses or victims about immigration status, said Zach Butterworth, the city’s director of federal relations. He argued the city’s policies are consistent with federal law and have been vetted by legal authorities.

A cut in federal funds would be a setback, said Marsha Broussard, who directs the city’s health department. Ironically, she added, the city’s programs supported by Justice mostly benefit legal residents, since New Orleans has a fairly small undocumented population.

Legal Uncertainty, And A Broad Impact

Though the idea of losing the Justice grants causes concern, health department heads said the bigger worry is that other federal agencies will follow suit. Losing federal support from HHS, the Department of Housing and Urban Development and others could jeopardize activities ranging from HIV treatment, family planning services and Zika preparedness to routine immunization outreach and screening homes for lead.

“Obviously it wouldn’t be good, and it would hamstring our efforts” to lose those funds, said James Garrow, a spokesman for Philadelphia’s public health department.

San Francisco — whose health department received at least $68 million in federal funding — filed suit in January seeking relief from Trump’s executive order, arguing the funding ban is unconstitutional. A federal judge in the city issued a preliminary injunction on Tuesday. The Trump administration has indicated it will appeal.

Other legal challenges are pending in Richmond, Calif., the Massachusetts towns of Chelsea and Lawrence, and Seattle. There’s also interest in Portland, Ore., and New York City. Their legal argument: The sanctuary cities directive is unduly coercive.

In addition, the New York attorney general has issued a legal guidance arguing the Trump administration lacks authority to stop “sanctuary” policies. That has encouraged some municipalities to adopt strategies at odds with the federal stance, such as not asking people about their immigration status and not enforcing civil warrants from ICE.

The legal uncertainty makes it harder for health programs planning around what federal defunding might mean in practical terms. And, until then, Benjamin said, they might have to scale back.

“If I’m not sure about a grant that’s coming, and I’m not sure I can hire people, I’m not going to spend the money,” he said. “The money may not be legally tied up, but you are, financially.”

Locally, that matters, Wen said.

“We are on the front lines. We are the ones safeguarding health and wellness of our cities every day,” she said. “Having our residents suffer is not an option.”


Hospitals need to do more to address the rising tide of despair and resulting addictions

 

Jeff Goldsmith, writing in Hospitals & Health Networks, says that U.S. hospitals need to do more to address the growing epidemic of despair as reflected in the opioid epidemic and Americans’ declining life expectancy.

Mr. Goldsmith is national adviser to Navigant Healthcare and associate professor of public health sciences at the University of Virginia.

Death rates have risen for eight of the 10 leading causes of death in America. The life-expectancy decline was entirely in the under-65 population.

The  obesity epidemic and other social factors would seem to be playing big roles.

Mr. Goldsmith writes: “It is going to take more than the ‘right incentives’ and a surge of healthcare consumerism to alleviate the despair…. While the new administration and Congress struggle with health reform issues, hospitals should directly address the ‘forgotten’ in their communities.”

Among his suggestions:

“Hook them up. A lot of the folks who end up in your emergency department for self-inflicted conditions will survive to fight another day. You may be able to save their lives, but your ED cannot fix the underlying conditions that brought them to you. What you can do is (1) listen to them, (2) gauge their readiness to address their problems, and (3) hook them up — to primary care, to Alcoholics Anonymous/Narcotics Anonymous, to weight loss programs, to rehab and recovery specialists, to mental health professionals, to churches or community agencies. Absent these connections, odds are that they will return to you with their problems unaddressed.”

“Advocate for continued coverage of mental health and substance abuse treatment.”

“Explore the psychiatric emergency services center. fast-growing, innovative form of care is an inexpensive, locked-unit, short-stay special hospital for people with acute psychiatric conditions, including drug problems. It is specifically geared to stabilization and detoxification of people in acute psychiatric distress and is often physically separate from the hospital. Such centers are proliferating and solve a significant problem: freeing up ED personnel to focus on the nonpsychiatric portion of their patient flow. Though it is still early days, some evidence from the field suggests that 80 percent or more of patients treated in PES are discharged to home. And because of the thorough workup they receive, the remaining 20 percent are matched to the right inpatient setting (acute, rehab, etc.) with much improved continuity of care.

“Lead your community’s economic development activities.

“The underlying cause of many of the health problems we have been discussing is a lack of economic opportunity. Do not rest until your hospital is not the largest employer in your community.”

To read more, please hit this link:

 


Mass. sets up Digital Healthcare Council

Massachusetts Gov. Charlie Baker has established the Digital Healthcare Council to guide policy about the  burgeoning digital healthcare industry in the state, which is an internationally renown technology center.

The advisory council, which stems from  the Massachusetts Digital Health Initiative, launched last January, will bring together leaders from academia, government, healthcare delivery, insurance, life sciences, medical devices  to discuss how digital technology can improve healthcare, increase the number of high-paying jobs in the state and reduce  healthcare costs.

“For Massachusetts to become a national leader in digital health, we need to continue to build on the momentum our Digital Health Initiative has already produced,” said Governor Baker. “This council will collaborate to move past barriers in the healthcare industry and solve significant challenges to make advances in patient care, lower healthcare costs and address public health crises, like the opioid epidemic.”

 


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