Layoffs come as the health center sees more patients forgo coverage due to a ‘chilling effect’ from Trump’s immigration rhetoric and ‘public charge’ policy
Virginia Garcia Memorial Health Center has cut 34 jobs and frozen 47 open positions across its network of 18 clinics in the Willamette Valley.
The majority of positions cut or frozen are middle-management jobs, though three clinical positions have been cut, said Gil Muñoz, CEO of the nonprofit primary care clinic, which emphasizes care to migrant farmworkers and others who face barriers to health care.
“We have through all of this have looked to preserve the services that Virginia Garcia provides,” Muñoz said. “At the service level, our core clinical staff, our priority was to maintain those to be strong and look at some of our overhead and some of our administrative expenses and cutting back in some of those areas.”
Muñoz said clinic revenues are down due in part to rising rates of uninsured people among its core population of patients. The number of uninsured patients is up 5% from two years ago, he said. Just under 25% of Virginia Garcia patients are uninsured now, spokesperson Kasi Woidyla told Street Roots.
The Oregon Health Authority reports a slight dip in the number of people without insurance in the state, with preliminary data showing 94% of Oregonians have insurance in 2019 versus 94.7% in 2015. Those numbers are still much higher than those from the years right before the Affordable Care Act’s most significant reforms went into effect in 2014. Between 2011 and 2013, the number of insured Oregonians hovered around 85%.
The OHA has not broken out its most recent data by race or immigration status, but 2017 data segmented by race shows Oregonians identifying as Hispanic were far more likely to go without insurance than the general population: 21.2% of Hispanic Oregonians said they had been uninsured at some point during the previous year, versus 11.1% of Oregonians generally. About 15.3% of Hispanics said they were uninsured at the time they were surveyed, versus 6.2% of Oregonians overall.
More than 80% of uninsured Oregonians are eligible for either the Oregon Health Plan or financial assistance paying for private insurance. Nearly 15% of Oregonians who were uninsured at the time of the survey said they hadn’t applied for OHP because they didn’t want public assistance. OHA spokesperson Allyson Hagen said 20% of Hispanic Oregonians who were uninsured at the time of the survey did not apply to OHP because they didn’t want government assistance. (Survey participants were not asked about immigration status.)
Those numbers underline what Virginia Garcia staff say is the driving force behind the current cuts: a reluctance on the part of immigrants, particularly those from Latin American countries, to seek any form of public assistance.
‘Chilling effect’
The last three years of anti-immigrant rhetoric from President Trump – starting with the day he announced his campaign for presidency – have created what Muñoz describes as a “chilling effect” and intensified fear and confusion in immigrant communities.
That fear has continued to intensify in the recent weeks, and in particular, immigrants are increasingly afraid to sign up for any form of public assistance, including public insurance, Muñoz said.
Federal judges have temporarily blocked the administration’s proposed “public charge rule,” which was set to go into effect Oct. 15. That rule would make it harder for immigrants to get visas or green cards if they’ve received certain kinds of public assistance.
The rule has been blocked from implementation by several federal judges and has also been the subject of lawsuits by more than a dozen entities, including the state of Oregon, which joined three other state governments and Washington, D.C., to challenge the proposed rule. It outlines precisely the consequences advocates say are already unfolding — and foresees state and local governments paying the price.
“As Defendants themselves acknowledged, the Rule will cause grievous harm to immigrants and their communities. It will increase the prevalence of disease, drive up the costs of medical care, and increase poverty,” the complaint reads. “It will encourage immigrants to disenroll from federal health care, supplemental nutrition assistance, and housing programs for which they are otherwise eligible. And it will chill the participation of immigrants and families with mixed immigration status in public benefit programs generally, even for individuals not directly subject to a public charge test, and even with respect to benefits and services that are not enumerated in the Rule.”
The suit also says responding to the rule will impose “substantial administrative costs for Plaintiffs’ agencies that respond to the confusion and fear it will engender and disrupt health and social services systems that serve as safety nets for Plaintiffs’ residents. The negative public health repercussions of reduced access to healthcare and housing and poorer nutrition will ultimately be paid for by Plaintiffs.”
Old doctrine, expanded scope
The “public charge doctrine,” or the idea that immigrants should be able to support themselves financially and not be a burden to society, is one that’s been part of U.S. immigration policy conceptually for more than 100 years, said Roger Rosenthal, executive director of the Migrant Legal Action Program, a nonprofit non-governmental support and advocacy center in Washington, D.C. But it was more of a guiding policy than a written rule until the late 1990s, when there was a push to put it in writing. Clinton administration officials issued a written policy that, in the totality of an individual’s circumstances, had the potential to exclude an individual from a green card and permanent residency if they received one or more of three forms of cash assistance — Temporary Assistance for Needy Families (TANF), General Assistance (GA) or Supplemental Social Security Income (SSI).
The Trump administration proposed to expand the list of programs that might pose a problem for those seeking a green card, including public housing, Section 8 housing vouchers, the Supplemental Nutritional Assistance Program (SNAP or Oregon Trail), and Medicaid.
These federally funded programs aren’t open to undocumented people — that is, to individuals who have entered the country without permission or who have overstayed their visas, Rosenthal said.
“We had a woman come in yesterday who was pregnant, and the (immigration) attorney was with her. He specifically told her, ‘Do not access care,’” Woidyla told Street Roots. “We encouraged her to still get care because she was pregnant, but she opted to not. There’s a lot of confusion around public charge, and we’re not going to counter her attorney; she needs to do what’s best for her.” (Under Oregon’s Reproductive Health Equity Act, passed in 2017, all pregnant Oregonians can access prenatal care, regardless of immigration status.)
Woidyla also said even patients who already have green cards have declined to seek care or to re-enroll in public insurance because they fear their immigration status could be jeopardized.
Rosenthal’s organization provides training and support to organizations all over the country that work directly with immigrants, and he said the fear and confusion Virginia Garcia officials describe is very similar to what he’s heard from other organizations and advocates. He’s heard of individuals declining to participate in programs like free or reduced school lunch programs or English as a second language classes at school because they’re afraid that will jeopardize their ability to get a green card in the future. None of these programs are on either the Clinton or Trump list of programs that might cause a problem. While the clinic is working hard to clear up confusion and dispel fear among its patients with informational events and other materials, the work is increasingly difficult in an environment where the rhetoric and the rules regarding immigrants are constantly shifting and intensifying.
Muñoz said the layoffs are the first the organization has made since it was founded 44 years ago. The clinic is named for a 6-year-old girl who died of blood poisoning from a cut on her foot. Her parents, who were Mexican migrant workers, sought but were unable to find treatment due to language and cultural barriers as well as working conditions in the camp where they had come to pick strawberries.
“It’s hard to do exactly a one-to-one relation of these things, but for the last two years there’s been a steady drumbeat from the administration that is anti-immigrant – and that is largely the population that Virginia Garcia serves. It’s hard to keep up. At every turn there is a new policy that is hard on the immigrant community,” Muñoz said.
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