As the nation swings from one polarizing policy debate to another – from health care to taxes to immigration – the connections among these issues can get lost in the rhetoric. The common impacts of those three particular issues are, however, nowhere more visible than in Latina health care access and outcomes. We’re talking about millions of Americans: children, the elderly, low and middle income, citizen and noncitizen alike. Latinas, a sizeable demographic within each of these populations, are especially vulnerable because of the ways in which ethnicity, gender, income, documentation status, and age intersect. Latinas’ lives and livelihoods are on the line.

Regarding health care, the early Trump administration has seen Congress repeatedly fail to repeal the Affordable Care Act (otherwise known as ACA or “Obamacare”), while allowing the Children’s Health Insurance Program (CHIP) to expire and ending the ACA’s individual mandate in the tax bill (before voting to reauthorize CHIP funding in a bipartisan spending bill). Relatedly, President Trump’s decision to end Obamacare enrollments earlier than usual, reduce outreach, and remove government subsidies from­­ insurers indicates further upheaval in the country’s healthcare system.

The tax bill signed into law by President Trump in December 2017 will likely have further detrimental impacts on Latinas.

Proponents of the bill argued that it would improve U.S. economic growth by permanently reducing corporate tax rates to 20 percent and temporarily reducing taxes for middle-class families, yet the nonpartisan Congressional Budget Office (CBO) estimates that the tax bill will add $1.5 trillion to the national deficit over the next ten years and ultimately result in lower income individuals and families – those earning less than $30,000 yearly – paying higher taxes by 2019, and middle income individuals and families earning less than $75,000 yearly paying higher taxes by 2027. Latinas comprise 7.2 percent of the national workforce, with 32 percent of Latinas employed in the service industry. But, they earn an estimated 55 cents to the dollar that white non-Hispanic males earn and constitute 13.68 percent of the working poor. Latinas’ median annual income is typically less than $75,000, meaning that, under the Trump tax changes, many will see a reduction in their already lower than average incomes, especially as they work in low wage jobs.

And although the tax bill is considered separate from health policy, its passage has implications for the health coverage of Latinas, some of whom are among the 13 million Americans now projected to be uninsured by 2027 (an estimated 5 million of those will have, in the past, been able to purchase health insurance through Obamacare marketplaces).

Prior to Obamacare’s implementation, 43 percent of Latinos lacked health insurance. Under Obamacare, the uninsured rate for Latinos dropped to nearly 25 percent by 2016. But because the tax bill quietly rescinded the individual mandate, removing the tax penalty for not having health insurance, it is expected that Latinas’ (along with other ethnoracial groups’) health coverage will return to pre-Obamacare levels, since the tax bill will lower their take-home pay and increase the cost of obtaining coverage.

Relatedly, Congress’ inaction allowed CHIP to lose funding in October 2017, affecting the health coverage of some Latinas’ children. CHIP was established in 1993 to provide health insurance to low- and middle-income children whose families were ineligible for Medicaid and otherwise could not afford insurance for their children. The federal government allocates funding to individual states for program administration, and states have included CHIP funding in their annual budgets to cover low and middle-income kids’ insurance costs. Although the bipartisan spending bill has reauthorized CHIP funding for the next 10 years, it did not reauthorize funding for the community health centers where CHIP recipients go to receive health care. Through CHIP, nearly 8.5 million children were provided health insurance in 2015; among national CHIP beneficiaries, an estimated 37 percent were Latino, 24 percent were black, and 34 percent were white. Funding CHIP without funding health care centers spells grave consequences for low-income kids, so many of whom are Latinx.

Of course, it is difficult to fully understand the social and political implications of diminished healthcare access for Latinas without considering immigration policy.

First, President Trump announced that he was ending the Obama-era Deferred Action of Childhood Arrivals (DACA) program in September 2017, which provided deportation relief and work permits to an estimated 800,000 undocumented young adults—mostly of Latin American ancestry—who were brought to the U.S. as children. With the September end date, the federal government had until March 5, 2018 to receive DACA applications for renewal. Despite some inaccurate media and anecdotal reports, DACA does not provide a path to citizenship and DACA recipients cannot legalize their undocumented parents. Although the deadline for the program’s renewal was on March 5^th, federal court challenges to ending DACA resulted in the program remaining open to receive applications. Recently, the Supreme Court declined to hear a case on DACA, allowing the federal court decisions and DACA to stay in place. Nevertheless, Congress has remained unable to find a permanent resolution, leaving DACA recipients, a sizeable percentage of whom are Latinas, in limbo.

President Trump’s administration has also begun the process of ending Temporary Protected Status (TPS) for Salvadorans, Nicaraguans, Haitians, and Sudanese refugees. TPS is a status granted to victims of natural disasters, political conflict, and war, temporarily protecting from deportation and making them eligible to receive certain federal benefits like health insurance (i.e., Medicaid, Medicare). Latinas and their children who have TPS will see their ability to access health care erode even further, especially those who obtained coverage through the ACA Medicaid Expansion.

Cumulatively, these macro-level policies will affect the life of nearly every individual in the U.S.  in some way, shape, or form. But, these policies will have a disproportionately negative impact on Latinas, who are, by dint of structural racism, increasing anti-immigrant sentiment in public policy, and working in low-wage “bad jobs,” particularly vulnerable to exclusion from health care, social mobility, and full membership in the body politic.

Even those policies that are, on the surface, racially, ethnically, and socioeconomically neutral carry consequences that will fall heavily on women and those who are racially, ethnically, and socioeconomically disadvantaged.

At every level of policy making and enforcement, we must ask: Whose life or livelihood is on the line when government funds for community health centers expire, when individual health coverage is no longer mandated, or when immigrants lose protected status? Increasingly in this country, the answer is Latinas’. As a society, where the federal government does harm, we must find ways, whether through subnational governments with inclusive immigration and health policies or non-governmental organizations, to mitigate that damage.