What’s the news: The AMA is strongly urging the Trump administration to withdraw a proposed rule that would deny asylum seekers entry to the U.S. by linking their country of origin, or the nations they travelled through, to the likelihood they have a communicable disease.

Advocating for immigrants

All patients deserve timely access to quality medical care. The AMA is fighting to secure this right for immigrants in the US. 

“The AMA is concerned that the proposed rule would legitimize discrimination against vulnerable asylum seekers, create a right to refuse to provide certain treatments or services, and arbitrarily discriminate against individuals based on border patrol agents uninformed medical determinations or an individual’s country of origin,” AMA Executive Vice President and CEO James L. Madara, MD, wrote in a letter to U.S. Attorney General William Barr, acting Homeland Security Secretary Chad Wolf, and Deputy Director of U.S. Immigration and Customs Enforcement Matthew Albence.

The letter outlines humanitarian and public health arguments against the proposed rule on “Reasonable Grounds for Denying Asylum Based on Communicable Diseases.” According to Dr. Madara, the measure would:

  • Place asylum seekers in greater peril and provide the U.S. Department of Homeland Security (DHS) and border-patrol agents with unwarranted and heightened authority that will be detrimental to the nation’s health security.
  • Weaken the principle of making public health determinations based on evidence.
  • Hamper the ability of international medical graduates (IMGs) to enter, train and practice in the U.S.
  • Endanger the lives and safety of torture survivors.

Why it’s important: The AMA is deeply committed to ensuring the health and safety of all individuals regardless of immigration status.

“The AMA believes that physicians have a professional responsibility to advocate for social and political changes that ameliorate suffering and contribute to the well-being of all humans,” Dr. Madara’s letter says.

The proposed rule would allow DHS and U.S. Department of Justice to unduly raise the bar for asylum seekers and make it close to impossible for survivors to succeed in Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT) withholding of removal or asylum-seeking claims based on their country of origin, path of travel, or likelihood of coming into contact with a disease.

Related Coverage

4 reasons to withdraw proposed barriers for asylum seekers

The proposed rule acknowledges that “there is no precedent for Congress or the administration defining the national security bar to include communicable diseases.” Dr. Madara’s letter notes that this is an attempt “to set a new and unfounded precedent that would equate…the possibility of border agents getting sick from asylum seekers looking for refuge to ‘terrorist activity.’”

The proposed rule would inappropriately give DHS the ability to make public health determinations, would remove or diminish the ability of the Health and Human Services Department (HHS) to determine what is and is not a communicable disease of public health significance, and “erode the foundation of making public health determinations established by evidence-based methodology.”

“The AMA strongly believes that decisions on testing and the exclusion of immigrants to the United States be made only [on a case by case basis] by the U.S. Public Health Service, based on the best available medical, scientific, and public health information,” the letter states.

Moreover, the proposed rule would disproportionately and adversely impact IMGs since it would bar those who “come in contact with” COVID-19 as well as any future communicable disease of public significance.

“Instead of encouraging those with medical knowledge and expertise to come to the United States, especially during a public health crisis, the proposed rule would delay and potentially completely remove the ability of IMG physicians, residents, and fellows to obtain visas due to their country of origin and the very nature of their vital work,” Dr. Madara wrote.

Creating an environment where individuals feel safe accessing care is a core public health function. Instead, the proposed rule would create a “mindset of fear” that leads asylum seekers to decline medical care.

“The proposed rule would make it close to impossible to provide and effectively deploy the resources needed to eliminate health disparities affecting immigrants, refugees, or asylees and thus, would undermine the intended public health goals of the proposed rule,” the letter states.

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Impact of COVID-19 on minoritized and marginalized communities

The proposed rule could also work against AMA policies that define violence as a major public health threat and oppose torture in any country for any reason.

“The proposed rule would allow individuals across the world to be returned to violence and continued torture without the possibility of being granted asylum in the United States, simply due to the fact that they are from or passed through an area that has a communicable disease of public health significance as determined by DHS,” Dr. Madara’s letter states. As such, the proposed rule would create a system that cripples the asylum-seeking process from inception to its new categorically barred completion in a manner that is antithetical to human rights and sound medical decisions.

Learn more: The AMA also recently noted its opposition to a similar proposed rule on “Procedures for Asylum and Withholding of Removal; Credible Fear and Reasonable Fear Review.” The AMA said the proposed rule would impose new barriers at every stage of the asylum process and will inflict standards that are impossible to meet for the vast majority of worthy applicants.

Read four reasons to withdraw proposed barrier for asylum seekers.

Also, find out how the AMA has been advocating for the administration and Congress to work with medical and mental health care experts to develop policies that ensure the health of children and families is protected throughout the immigration process.

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