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Image of border fence, credit: Greg Bulla
This Thursday at 11:59 PM, Title 42 will expire, ending the most restrictive immigration policy in a generation. As part of the public health emergency declared in February of 2020, the intention of Title 42 was to help minimize the spread of Covid-19. It’s doubtful this did much good, but this policy was quite effective at slowing the rate of immigration. It gave the government unprecedented authority to immediately expel those entering illegally. Many conservatives are hoping this continues. Many liberals welcome Title 42’s demise.
For Republican front-runner Donald Trump, this couldn’t come at a better time. He has risen in the polls while his opponent, Ron DeSantis, has sunk. Now, Trump’s pet issue is set to become front page news again. This is the sort of fortuitous string of events we’ve come to associate with "Teflon Don." It comes at a bad time for Biden who has simultaneously been trying to tackle the larger issue of inflation. To this point, the president has not been able to pass any sort of large-scale legislation on immigration—though it’s hard to fault him for this given how rare legislative success has been on this issue in recent decades.
Some facts on immigration:
- The U.S. has more immigrants than any other nation, with nearly 45 million people living in the U.S. who were born beyond its shores.
- Over 11 million of whom are undocumented or unauthorized immigrants.
- In May of 2022, border apprehensions spiked to 240,000, the highest level in 20 years.
- More than 3 million migrants have crossed illegally in the last 18 months.
If immigration wasn’t a humanitarian crisis before, it certainly appears poised to become one. Just across the border in Tijuana and Ciudad Juarez, tens of thousands of migrants have gathered, a likely indicator of the pent-up demand of the last three years and the anticipation of Title 42’s end. There is a general sense in Texas and elsewhere that we are wholly unprepared for what is to come.
Because my background is in public health, I can’t help but see the parallels between the problems of immigration and the problems of healthcare. Just like our hospitals that lacked beds, staff, and supplies to meet the rising demand during the height of Covid, border towns also lack the resources to respond to the steady influx of immigrants.
Immigration and healthcare are endlessly complex and both problems predate Covid. For decades, hospital emergency departments (ED) have been overflowing. My hometown hospital (Strong Memorial, affiliated with the University of Rochester) is one such example. There are articles from the 1990’s about its overcrowded ED and waiting room. Within just a few months of expanding the emergency department in 2001, every single-patient room had been converted into a double. They are currently in the middle of another renovation that will triple the size of the ED. It remains to be seen if this will be a solution and for how long.
That hospitals could be so overrun by a virus was shocking to everyone except those who worked in health care. Covid didn’t create this problem, it just shed a spotlight on it.
America’s immigration system and its facilities are just as overdue for renovation, even if it’s just a short-term solution. The last meaningful comprehensive reform happened when Reagan was in office. Much has changed in the world since then. Most migrant processing facilities were built for significantly lower levels of immigration—some are already at double their capacity. Scores of migrants have been camping on sidewalks outside makeshift shelters in places like El Paso, Texas, which recently declared a state of emergency in anticipation of Thursday. Other border towns like Laredo and Brownsville have also followed suit.
There are simply not enough lawyers, enforcement agents, volunteers, or supplies to process and care for all of these individuals. The churches and non-profits providing aid in these areas are fearful that the situation will get worse after Thursday.
If there is to be any relief, it likely won’t come in the form of legislation. Expanding the size of these processing facilities is a necessary step in the right direction, but this (obviously) isn’t going to happen in the next two days. Some are holding out hope that the judicial system will intervene in the meantime challenging the end of Title 42.
All of this distracts from a deeper disconnect that is at the heart of our issues in health care and at the border, and a flaw of human psychology: that nothing is really a problem until it happens to you. This is a relative of optimism bias. We all think we won't get Covid, or that we’ll be fine if we do. We all secretly suspect we will be the exception to the consequences of unhealthy habits—until we have a heart attack. We have to see or experience something to believe it.
This might explain why Republican governors sent bus and plane loads of migrants to New York, D.C., and Martha’s Vineyard in recent months. Presumably, this was their attempt to make these places feel the weight of the problem.
I’m sure many nurses would have liked to send Covid patients to areas that thought it was all just a hoax to show them how real it was. Imagine the outrage if Mount Sinai Hospital in Manhattan bused patients down to Florida. Or to the doorstep of (then) Covid-denier Sean Hannity. It probably wouldn’t have gone over so well.
In a not-so-surprising sign of hypocrisy, FOX News was quick to criticize NYC Mayor Eric Adams for doing exactly what conservative lawmakers have done—sending migrants elsewhere to ease the city’s burden. I digress.
If you’re a conservative, or live in a border town, the bus/plane stunts of Republican Governors Greg Abbott and Ron DeSantis were justified. Desperate times. And if you’re a liberal, you see the cruel, blatant disregard for human life—treating immigrants like pawns in a game. But while we quibble about "whose 'right' is righter," we aren’t developing solutions to address the root issue of health care and immigration: that demand is far greater than supply. We’ll explore this more next week.
