Dear Chairs Kennedy and Livingstone,

Thank you for the opportunity to submit testimony in strong support of House Bill 135/Senate Bill 76: An Act establishing basic needs assistance for Massachusetts immigrant residents.

As Director of the MGH Center for Immigrant Health and a primary care pediatrician at MGH Chelsea Pediatrics, it was not lost on me during the pandemic that foreign-born workers made up more than a fifth of our state’s essential workforce. The brave individuals keeping our state’s hospitals, grocery stores, and other vital industries running included approximately 5,600 TPS holders and 2,000 DACA recipients, none of whom are currently eligible for benefits like SNAP.

The onset of the COVID-19 pandemic coincided with the tightening of the public charge rule, fear of which prompted an estimated 1.3 million eligible immigrant essential workers across the country to forgo SNAP benefits, even as they were putting their lives on the line just to make ends meet.

Food insecurity meant less ability to stay home to isolate, fomenting the spread of infection. We saw this play out to devastating effect in Chelsea and in our hospital’s inpatient COVID-19 units. Prior to the pandemic, on any given day about 9% of the inpatient census at MGH were patients who spoke primary languages other than English, but during the first COVID-19 surge in spring 2020, on average 41% of the beds were filled with patients who spoke other languages, and at one point that number rose to as high as 65%.

Now these same families who risked so much and kept our state running during the pandemic are struggling to put food on the table due to rising inflation. Earlier this year, more than 1 in every 4 patients screened in MGH primary care practices who spoke languages other than English endorsed having food resource needs, as opposed to approximately 1 in every 17 English-speaking patients.

I have seen families standing in long lines in the freezing cold waiting to collect food boxes in Chelsea. Even with the important extension of universal free school meals, I hear from parents working multiple jobs, including overnight shifts, that they still worry they may have to choose between paying rent and buying food. These are choices that no family should ever have to make. How can I counsel parents to work on a healthy diet with their children to reduce future risk of diabetes, high cholesterol, and hypertension, when they need to worry about how they will stretch their dollars to buy high calorie items to keep their children’s stomachs from grumbling right now? How can I expect them to take time off from work to bring their children to medical appointments when that means lost income for putting food on the table?

Studies have shown that food insecurity is associated with chronic disease and increased healthcare expenditures, whereas receiving SNAP has been shown to correlate with better medication adherence, less obesity and heart disease, fewer low birth weight infants, and better long term educational attainment. Food is medicine, and it is far more cost effective to feed people well than to pay for their preventable chronic medical conditions down the line.

Though the public charge rule has reverted back to its prior iteration, the chilling effects remain, and I continue to receive questions about it from my patients. Broadening immigrant SNAP eligibility would not only help currently ineligible families, but at a time when anti-immigrant rhetoric is again beginning to escalate, it would also send an important message to those immigrants already eligible that this crucial benefit is safe to use.

As a pediatrician, I cannot overemphasize that there is nothing more central to physical and mental health, to learning and development, and to basic human dignity than having adequate food to eat. My immigrant patients and colleagues and all of our immigrant neighbors, who have demonstrated themselves time and again to be such a vital and integral part of our communities and the Commonwealth, deserve as much. Thank you for your consideration.

Sincerely,

Fiona Danaher, MD, MPH
Director, MGH Center for Immigrant Health
Pediatrician, MGH Chelsea