DALLAS _ The line of patients starts well before sunrise, as early as 4 a.m. at Agape Clinic in Old East Dallas. Their troubles are many.
No one will be shut out for lack of money.
One patient, a teenage boy, arrived at the clinic dangerously close to shock, telling doctors that a border official seized his insulin as he returned from Mexico. Another, a young boy, had an arm fracture so serious, he needed to see an orthopedic surgeon. Others waiting in the line suffered from anxiety and depression triggered by fears that deportation could split the family.
They make their way here and to other low-cost and no-cost clinics or medical fairs. This is what the informal medical system looks like, especially for working-class immigrants.
Lately it has become increasingly clear to the care providers that a growing number of children are using these services, and it is stressing the system.
These days, more immigrants fear that sharing personal information while using government-backed medical care could end up threatening their chances at getting permanent residency in the U.S. The number of children in clinics like Agape is rising even as the number of children getting federal medical assistance declines.
The Trump administration's push to reduce immigrants' dependency on federally funded services is, experts say, leading to a decline in the number of insured children. The administration wants to implement what it calls the "public charge rule," which would make immigrants ineligible for visas and green cards that give them legal permanent residency if it is found that they are overly dependent on federally funded social services.
The federal government says that declines in Medicaid and The Children's Health Insurance Program enrollment are due to a strong economy. The new public charge rule is stalled in federal courts, but it has been widely reported that the proposal has already created fear and confusion among immigrants. It has many people turning to alternative care.
At Los Barrios Unidos Community Clinic, Cesar Varon-Ortiz, the eligibility manager, said confusion about the use of federal programs is common there. Los Barrios started decades ago in a trailer on an unpaved road in West Dallas. It expects 90,000 patient visits this year, up from about 83,000 two years ago. Most patients are Spanish speaking.
Even attorneys seem confused, and they are telling clients not to apply for benefits, Varon-Ortiz said. "It's a lot of miscommunication," he said.
Vanna Slaughter, senior program manager for the City of Dallas' Welcoming Communities and Immigrant Affairs, said immigrant parents are disenrolling their U.S. citizen children from federal programs like Medicaid and the Children's Health Insurance Program even though the children are eligible for the programs.
"Everyone is still so confused about it," Slaughter said. "People don't know what they are eligible for. So they just get off everything."
That has increased the demand for help through the informal medical system. "I am just deluged," Slaughter said.
At Agape, the clinic expects 18,000 patient visits this year. Two years ago, less than a fourth of Agape's patients were children. Now nearly a third are, said Gary Foster, Agape's chief of clinical operations and a nurse practitioner.
Foster said it's frustrating to see immigrant patients struggle to patch together health care, especially with so many policy proposals that place more restrictions on immigrants.
"I'll do whatever I can to make it better for them," Foster said.
