How Cutting Sanctuary City Funding Hurts Healthcare

The crackdown on sanctuary cities

On April 21, the Department of Justice sent letters to nine municipalities identified as “sanctuary cities,” including Chicago and New York, requesting them to prove that they cooperate with federal immigration authorities.  Failure to do so would sever their access to federal funds.

“Sanctuary cities” isn’t a legal term, but it refers to those that generally refuse to cooperate with federal immigration enforcement efforts.  They’re protective of immigrants and refugees and often provide social services to those populations.

Since President Trump signed an executive order targeting these cities in January, a California federal judge blocked its implementation. The judge held that it overstepped Trump’s executive authority and wrote, “Federal funding that bears no meaningful relationship to immigration enforcement cannot be threatened merely because a jurisdiction chooses an immigration-enforcement strategy of which the president disapproves.”

Then, on May 23, Attorney General Jeff Sessions released a clarifying memo which defined sanctuary cities as those which “willfully refuse to comply” with federal immigration law.  The memo also narrowed the President’s order by indicating that it will withhold only Department of Justice or Department of Homeland Security grants – not all federal funding – from sanctuary cities.

Where immigration law and public health collide

While these attempts to strong-arm cities into directing local law enforcement resources towards enforcing federal immigration law, restrictions on federal grants will bleed into all aspects of government services.  “These dollars go to everybody. You cut these grants — these are grants that protect the whole population,” said Dr. Georges Benjamin, executive director of the American Public Health Association. 

Local and state governments rely heavily upon federal funding. According to the Physicians for a National Health Program, nearly two-thirds of American healthcare expenditures are funded by taxes.  Baltimore’s health commissioner, Dr. Leana Wen, noted that “The DOJ has been excellent partners before for many of our efforts … It would have a negative impact if we were to lose any federal funds.”

As the opioid crisis rages, these municipalities also face challenges in securing the funds that have historically gone to local health agencies for prescription drug monitoring programs and opioid antagonist drugs.  “This is a big problem. It gets worse if you don’t have the resources to address it,” Benjamin said.

Although the loss of Department of Justice and Department of Homeland Security grants will most dramatically affect law enforcement-related funding, some fear that other federal agencies could follow suit and also pull funding. For example, if municipalities lost federal support from the Department of Housing and Urban Development, it could jeopardize HIV treatment, family planning services, and routine immunization outreach.

As the legality of the executive order winds through the courts, the uncertainty makes it difficult for health programs to plan for future ‘worst case scenarios.’  Dr. Benjamin adds, “If I’m not sure about a grant that’s coming, and I’m not sure I can hire people, I’m not going to spend the money. The money may not be legally tied up, but you are, financially.”

Our sources:

Matt Zapotsky, Justice Department budget plan seeks to force ‘sanctuary cities’ to enforce immigration laws, Chicago Tribune (May 23, 2017). 

Shefali Luthra, Trump’s Vow To Squeeze ‘Sanctuary Cities’ Could Play Havoc With Health Programs, Kaiser Health News (May 1, 2017).

Maria Sacchetti, Trump blasts federal court ruling that blocks his ‘sanctuary city’ order, Washington Post (Apr. 26, 2017).

Mark Almberg, Government funds nearly two-thirds of U.S. health care costs: American Journal of Public Health study, Physicians for a National Health Program (Jan. 21, 2016).

© 2017 Jackson LLP

about the author

Erin K. Jackson is Jackson LLP’s Managing Partner. She is responsible for all aspects of firm management, is a sought-after speaker for healthcare conferences, and is a published author. She is specifically focused upon the intersection of the patient experience in healthcare with the legal and ethical responsibilities of providers. | email
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