In Reply We agree with Dr Dourgnon and Mr Das that federal anti-immigrant rhetoric and executive actions combined with widely publicized immigration raids are likely to deter undocumented immigrants from seeking needed health care. Fear among immigrants is currently so widespread that even in San Francisco, a city with a well-known sanctuary policy for health care settings, there appears to be a decrease in immigrants seeking appointments or accepting referrals. Clinicians in other sanctuary cities are reporting similar decreases in immigrant patient visits.1 This decline is consistent with past experiences of the effects of expansion of immigration enforcement. A 2014 study2 of the impact of Arizona state law that empowered police to detain individuals who could not prove their legal status upon request (SB 1070) found that among teen mothers and their children, routine preventive health care for the children dropped after the law was implemented. More recently, the Los Angeles police department voiced concern about a 25% drop of reports of sexual assault among Latinos in early 2017 compared with the same period last year.3 This occurred despite the longstanding police department policy of not sharing routine information with immigration authorities.
Fernandez A, Rodriguez RA. Consequences of Recent Anti-Immigration Policy—Reply. JAMA Intern Med. 2017;177(10):1535–1536. doi:10.1001/jamainternmed.2017.3486