DACA and the Next Amnesty Are Missing Big Public Health Opportunities

CIS — Suppose your community is taking on millions of new members — wouldn’t it be a good idea for their sake, as well as for those of the existing community — if their health were checked on their way through the door?

That’s what Ellis Island, in a rough and ready way, was all about. And for more than half a century we have insisted that arriving immigrants present themselves to medical professionals for orderly examinations; all this away from a central intake point like Ellis Island.

Such a screening, currently, checks on the health of the arriving immigrant, makes sure that he or she is aware of any problems, and, importantly, demands that the applicant has received the latest set of vaccinations. That protects against many, but not all, medical problems and seeks (pretty effectively) to prevent the spread of disease among the rest of us.

But none of these precautions apply to the current Deferred Action on Childhood Arrivals (DACA) program, nor have I or my colleagues at CIS seen any signs that a medical screening will be part of the president’s executive amnesty.

That’s a shame, because here — as with the arrival of children into their first public school classes — we have a population that can be told that they must be screened and vaccinated; both for their protection and for that of the entire population.

One of my colleagues suggested that since the administration’s own description of DACA leaned heavily on the involvement of children, perhaps the decision makers had the impression that most of the DACA beneficiaries would be covered by U.S. school health systems. The problem with that view, which may very well prevail, is that DACA rules do not, in fact, require that the beneficiaries ever attended school, anywhere. The program’s “educational requirement” can be satisfied if the illegal says that he or she is enrolled in a class of some kind on the day that the application is signed.

Getting back to the medical examinations, one of the often overlooked parts of our current immigration program is the need for new arrivals, and aliens living here wanting to adjust their status to that of permanent resident alien, to go through a well-established medical screening process, usually at their own expense. No matter what you may think of national health care schemes, this is not an exercise in socialized medicine.

The screening is not a complete review of the migrant’s health. It is more narrowly designed to detect easily transferable diseases, such as TB, syphilis, and gonorrhea; and to make sure that those with such conditions are identified and are under treatment. It is also designed to identify “physical or medical disorders associated with harmful behavior”, “drug abuse/drug addiction”, and to record such matters on the form I-693. Some would-be migrants are excluded each year for failing these examinations, as lots were in the days of Ellis Island, but currently the emphasis is more on prevention than exclusion.

The examination is useful, but it is of the once-over-lightly variety. The doctor gets enough of the alien’s medical history to complete the I-693. Then there are skin, urine, and blood tests for various conditions, most not mentioned here. The once universal demand for a chest x-ray in connection with TB is now only required in a few specific sets of circumstances.

The list of vaccinations needed is a long one, with currently 14 diseases/conditions noted; the list is created and updated by the Centers for Disease Control.

The Cost. The government selects the physicians making these examinations; most of whom are in private practice and these examinations are simply part of their daily work. The government (i.e., the Department of Homeland Security) does not set the fees they charge, apparently expecting the market to do that for them.

The aliens needing this examination would be well advised to do a little comparison shopping before settling on a physician for this work. I called seven different doctors’ offices on the approved list in the Northern Virginia/ Washington, D.C., area the other day for price quotes and got seven totally different quotes, as follows:

Northern Virginia: $125 plus variable costs of vaccinations
Northern Virginia: $190 plus vaccinations
Northern Virginia: $240 plus vaccinations
Washington, D.C.: $250 and a referral to free vaccinations for D.C. residents
Washington, D.C.: $250-$1,000
Washington, D.C.: $300 for everything, payment must be in cash
Northern Virginia: $330 plus vaccinations

Oddly, the lowest and the highest costs cited above came from two practices located directly across the street from each other. I do not know what entity is offering the free vaccinations; I asked two of the Virginia offices if this was available in their area, and the answer was no.

Linguistic Note. I will close with a little note on a couple of the linguistic quirks of this part of the often awkwardly described immigration system, such as the use of the term “voluntary departure”, when the exit from the nation is compulsory. The medical professionals handling these examinations are called panel physicians, if the work is done overseas, or civil surgeons, if done in the United States, not that they do any surgery in this work and hopefully no physicians are ever uncivil.

Similarly, one of the immunizations used by the civil surgeons is the HIB (or Hib) vaccination; this has nothing to do with the nonimmigrant worker category H-1B, and it is described as follows on a medical Internet site:

HIB immunization: This immunization is designed to prevent diseases caused by Haemophilus influenzae type B (HIB), a bacteria responsible for a range of serious “invasive” diseases including meningitis with potential brain damage and epiglottitis with airway obstruction.

Widespread vaccination against HIB has apparently all but wiped it out. That’s good, but what the verbiage of the immigration system needs is a massive transfusion of English majors who will conduct a comprehensive reform of immigration … terminology.

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