Question 4 is an investment in health

Without licenses, many undocumented immigrants miss doctor appointments

“WELL, I’M SCARED to drive to the appointment,” my patient Henry finally admitted over the phone. I heard him catch his breath and hold it. He hadn’t been in for a medical checkup in years. He had been pushed out of Chelsea when his rent was raised, and now lives a 45-minute drive from the clinic. “It’s just that my friend was picked up driving without a license a few years ago and just got deported.” he went on to tell me in Spanish. “I can’t risk it. I need to be here for my kids.”

As a primary care doctor in Massachusetts, I’ve heard hundreds of stories like Henry’s. The current bars to driver’s licenses for undocumented people in the state are harming the health of hundreds of thousands of Massachusetts residents, including the undocumented individuals who would otherwise be eligible for licenses, their family members, and their communities. Voting Yes on Question 4 will preserve a hard-fought victory for undocumented immigrants and is a sorely needed investment in the health of the Commonwealth.

Under the current regulations, many people are forced to miss medical visits, which can lead to delayed diagnoses and disastrous outcomes for would-be drivers and their family members. For Henry, who is now in his 40s and has a history of high blood pressure in his family, I fear that he may develop undiagnosed hypertension that, without treatment, could cause heart attack or stroke. Expanding access to licenses will reduce these barriers to care. For example, when Utah’s driver’s license bill went into effect, undocumented immigrant mothers who obtained licenses were able to access more consistent prenatal care, which has long been shown to improve birth outcomes.

Lacking a drivers’ license also impacts many other areas of life that, in turn, impact health. One of my patients has been working in a nanny job under poor conditions for months, but is afraid to leave. Her ability to find a better paying job is sharply limited because she can only consider positions close to public transportation. In addition to employment, lack of mobility limits access to healthy foods, education, and social connection, all of which are essential to preserving health. I’ve seen children break down crying as they talk about how hard it is to walk far distances to school in the snow because their parents are unable to take them in a warm car.

Furthermore, the stress associated with lacking a license can itself impact health. Some people make the difficult decision to drive without a license, due to economic or other necessities, but then live in constant fear that a random traffic stop could lead to detention, deportation, and separation from their families. Living with chronic stress and fear of family separation has been shown to contribute to mental health problems and chronic disease development amongst parents and children alike.

Those who would oppose expanded eligibility claim that allowing undocumented immigrants to apply for a driver’s license will create public safety problems. Evidence from the 16 other states that have already implemented drivers licenses for undocumented immigrants show evidence quite to the contrary. Expanding eligibility to licenses improves public safety and public health. In Connecticut, the incidence of hit and runs dropped by 9 percent. In California, the number of registered organ donors increased by 18 percent.

I’m reassured that all of my patients will have their vision tested prior to getting behind a wheel (a service that we don’t routinely offer to adults unless they express issues with their vision). I’ll be able to report concerns about driver safety (for example, people with worsening dementia or somebody with an active seizure disorder) to the RMV for all of my patients. I’m certain that my undocumented patients ,whom I ask to stop driving due to safety concerns related to their health, do follow my instructions, but having the connection with the RMV adds an extra layer of assurance for all people on the road.

Expanding eligibility for driver’s licenses in Massachusetts will improve the health of many of the patients I serve, and the public at large. As we strive to recover from the pandemic and support the ongoing contributions of essential workers, this change is long overdue. Not only will some of the barriers to health care, good jobs, and education be broken down, as a Commonwealth we will be better able to make sure that all motorists on the road are tested, safe, and medically cleared to drive. Finally, voting Yes on Question 4 will preserve a critical right to transportation and mobility that is essential for preserving public health.

Juliana Morris is a primary care doctor in Chelsea and an instructor at Harvard Medical School.