The Impact of the “Muslim Ban” Executive Order on Healthcare Utilization in Minneapolis-St. Paul, Minnesota

Background: On January 27, 2017, President Trump issued Executive Order (EO) 13769, “Protecting the Nation from Foreign Terrorist Entry into the United States,” which suspended the U.S. Refugee Resettlement program and prevented citizens from seven Muslim-majority countries (Iraq, Syria, Iran, Libya, Somalia, Sudan, and Yemen) from traveling or immigrating to the U.S. The impact of EO 13769 on healthcare utilization among people from EO-targeted nations is unknown.  Methods: We conducted a retrospective review of primary care and emergency department (ED) visits to HealthPartners clinics and hospitals in Minneapolis-St. Paul, Minnesota, home to the largest Somali Muslim community in the U.S. We compared visit counts, missed appointments, and visits for stress-responsive diagnoses before and after EO issuance among three groups: 1) adults born in EO-targeted nations, 2) adults born in Muslim-majority nations not listed in the EO, and 3) U.S.-born non-Latinx adults. We evaluated visit trends using linear regression and differences between groups using difference-in-difference analyses.  Findings: From 2016 to 2017, 252,594 patients were included in the analysis: 5,667 (2.2%) in Group 1, 1,254 (0.5%) in Group 2, and 245,673 (97.3%) in Group 3. In early 2016, primary care visits and stress-responsive diagnoses dramatically increased for individuals from Muslim majority nations (Groups 1 and 2). Following EO 13769 issuance, there was no change in missed clinic appointments and an increase in ED visits among individuals from EO-targeted nations, particularly in the first 30- to 60-days after issuance.   Interpretation: Increases in clinic utilization among people born in Muslim majority countries before EO 13769 issuance and subsequent increased ED utilization by people from EO-targeted nations likely reflect elevated cumulative stress due to an increasingly hostile climate toward Muslims in the U.S., rather than one specific policy change. Funding Statement: This study was not supported by any funding source. Declaration of Interests: The authors have no conflicts of interest to disclose. Dr. Gonsalves is supported by the National Institutes of Health National Institute on Drug Abuse (1DP2DA049282-01 and 2 R37 DA15612-16) and the National Institute of Allergy and Infectious Diseases (5R01AI042006-23). Dr. Padela receives grant support from the US Department of Health and Human Services Health Resources and Services Administration, the Greenwall Making a Difference Program, and Patient Centered Outcomes Research Institute. Dr. Samuels is supported by an Advance Clinical and Translational Research (Advance-CTR U54GM115677) Mentored Research Award. Ethics Approval Statement: This study was approved by the HealthPartners and Yale Institutional Review Boards.