Melissa Belli

For The Oregonian/OregonLive

Belli, M.D., is a family physician at a community clinic in Cornelius. She lives in Portland.

In recent weeks, the conversations I hear from patients and across the community have shifted in unmistakable ways. Parents tell me they no longer feel safe driving their children to school. Others ask whether it’s risky to pick up groceries or fill a prescription. Many are staying home unless absolutely necessary. This fear is not just reshaping daily routines — it’s undermining health.

I am a family physician in Oregon, writing in my personal capacity about what I see in my exam rooms and what my patients share with me. What I am witnessing now is unlike anything in my career.

Even before the recent surge in activity by Immigration and Customs Enforcement, Oregon’s health care safety net was strained. During the state’s review of eligibility for more than a million Oregon Health Plan members, many families faced confusion about their premiums, coverage and temporary gaps in care. We saw the effects immediately: missed appointments and delayed follow-ups for patients already living on the edge. But what is happening now goes far beyond administrative challenges.

In just the past few weeks, no-show rates have spiked across all age groups. Babies are missing well-child visits. Children are falling behind on routine vaccines — measles, whooping cough, polio. Patients dependent on insulin, seizure medications, psychiatric medications or cardiac drugs are rationing doses. Pregnant women are delaying prenatal care. One patient with active tuberculosis has stopped picking up his medications, putting himself and others at risk. These are not optional visits. They are lifelines.

Fear is becoming its own social determinant of health.

That fear extends far beyond clinic walls. Parents in several neighborhoods are too afraid to take their children to school. Trusted friends now walk small groups of kids to class, so their parents do not risk being detained in front of them.

At a local community food bank, attendance dropped sharply after ICE activity. Volunteers quickly shifted to discreet porch deliveries, echoing the improvisation of the early pandemic. These acts of community protection are admirable, but such measures should not be necessary in a state that values dignity and public health.

The economic impact is immediate as well. A large share of Oregon’s essential workforce — farmworkers, caregivers and service workers — comes from Latino communities. At this time of year, many families earn extra income making Christmas wreaths and seasonal crafts. This year, workshops are understaffed, and Latino-owned businesses are seeing steep declines in customers. The financial strain compounds the fear.

All of this is happening in communities that already carry significant trauma. Many of my Latino patients have endured extreme poverty, narco-terrorism, domestic violence and dangerous journeys to the United States. These experiences do not disappear — they accumulate. Now, the renewed fear blanketing their neighborhoods is reopening old wounds and creating new ones.

While immigration enforcement is federal, Oregon is not without options. As lawmakers approach the short legislative session, safeguarding the Oregon Health Plan and the clinics that serve mixed-status families is crucial. Budget reductions would fall hardest on Latino communities already under strain, further destabilizing care for patients delaying essential visits.

The governor’s Medicaid strategy group can also help by acknowledging how fear is disrupting population health. Tracking missed appointments and lapsed medications — and sharing clear, consistent information about OHP coverage through trusted community partners — would offer stability at a time when families feel adrift.

Even within tight budgets, Oregon can lean on strategies that proved effective during COVID-19 —expanded telemedicine, medication-by-mail, and strong community health worker programs. These steps can help families stay connected to care without leaving home. At the same time, Oregon could pressure ICE to safeguard the health of those it detains.

Strain on detainees, families, and clinics inevitably spills over into the broader health system. When people avoid preventive care or lose access to medications, emergency departments become the default safety net. Missed appointments turn into crises. Interrupted medications lead to complications. Patients detained without adequate medical care risk emergencies that end up in hospitals. These crises are costly, dangerous, and entirely predictable.

I became a doctor to relieve suffering. Today, I am watching preventable suffering unfold for reasons entirely outside the realm of health. This crisis is not caused by a virus or a natural disaster. It is being created by a policy of fear, and it is endangering the wellbeing of entire communities.

This moment demands attention, clarity and compassion. Oregon has long prided itself on building systems that support dignity and health for all who live here. We now have an opportunity — and a responsibility — to choose a different path, one grounded in safety, humanity and the shared belief that health should never be something people must risk everything to access.

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