Congress returned to work this week with a daunting agenda and tight deadlines. Among the high-profile items facing legislators is a nearly $8 billion White House request for emergency funding related to Hurricane Harvey. Lawmakers also must pass a continuing resolution to fund the federal government by Oct. 1 to avoid a shutdown. Tax reform and defense spending likely also will be debated.
John Meigs, M.D.
In the health care realm, the Children's Health Insurance Program, the Teaching Health Center Graduate Medical Education program and National Health Service Corps will all expire on Sept. 30 without congressional action.
That loaded lineup got even more bloated Sept. 5 when the Trump administration ordered an end to the Deferred Action for Childhood Arrivals (DACA) program. The president urged Congress to find a legislative solution before the immigration policy is phased out in six months.
That strategy seemed ironic considering that President Barack Obama created DACA by executive order in 2012 after Congress had tried and failed (despite bipartisan support) to pass the Development, Relief, and Education for Alien Minors Act in 2007, 2009, 2010 and 2011. If Congress fails to act again, some DACA participants could face deportation as early as March.
DACA provided legal protection to roughly 800,000 young people who entered the country illegally as children, allowing them to receive a renewable two-year period without the threat of deportation. The program also gave them the right to work legally in the United States.
The AAFP is monitoring this issue closely because it will affect thousands of our patients and potentially could affect some of our members directly. According to the Association of American Medical Colleges, 34 students with DACA status matriculated to U.S. medical schools in 2016,(www.aamc.org) and about 70 students with DACA status were enrolled last year. Although the AAFP doesn't track DACA status, we know that roughly one in four U.S. medical students are Academy members.
According to the AAMC, roughly half of U.S. medical schools had indicated they were willing to consider DACA applicants prior to the administration's Sept. 5 announcement to end the program.
Although the number of medical students with DACA status is relatively small, our health care system can ill afford to lose any source of future physicians. The AAMC estimates a shortage(www.aamc.org) of between 61,700 and 94,700 physicians -- including 14,900 to 35,600 primary care physicians -- by 2025.
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Now it is up to an increasingly divided Congress to do what it has repeatedly failed to do in the past -- find a legislative solution to this politically sensitive matter. One would hope that lawmakers won't wait five months and 28 days to start working on this issue in earnest.