Dear friends,

It’s my pleasure to hand over this month’s newsletter greeting to my esteemed colleague, HealthBegins’ Vice President of Business Operations, Tatiana A. Perez. Enjoy!

Best,

Rishi Manchanda, MD, MPH.

It was March 2021, deep in the midst of COVID, and LA and Orange County communities were drowning in vaccine hesitancy. At the health system where I worked then, we knew that hesitancy wasn’t just about misinformation—it was about mistrust earned through decades of Latine patients being dismissed, overlooked, and harmed by healthcare systems. Vaccine appointments were open, but eligible patients weren’t taking them.

So we quickly collaborated with trusted community voices and media partners. Within a week, we built a workflow, organized volunteers across departments, and personally made calls late into the night. By morning, we had scheduled 90 vaccine appointments. The next day, we booked 175 more.

That night felt like a turning point—not just for vaccination rates, but for something more fundamental. We were rebuilding trust that had been broken for generations.

Today, that progress is being systematically dismantled.

Trust in healthcare isn’t a nice-to-have. It’s as essential as procedures, prescriptions, and treatments. Without it, patients delay care, avoid screenings, and suffer in silence. With it, they share symptoms honestly, follow treatment plans, and seek help early when it matters most.

But trust is fragile. And recent policy changes are shattering what took years to build during the pandemic, with consequences that will ripple through families, communities, and healthcare systems for decades.

This federal administration is rolling back protections that states fought to establish. California’s Health Care for All initiative, sliding-scale fee programs that simplify access to care for non-citizens, policies that allowed doctors to honor their oath to “do no harm” regardless of immigration status—all of this progress is being systematically dismantled.

For communities like mine, this isn’t just policy—it’s retraumatization. These changes aren’t creating new distrust; they’re reactivating what was always there, confirming what people always suspected: that seeking care could put them at risk.

I’ve watched this play out in my own living room. A close family member spent years avoiding essential care after being dismissed by providers. We are finally helping her navigate care for her stage 4 kidney disease. But now, despite all my professional expertise, I’m watching policies deepen trust gaps that took years for us to start healing. Now, providers must verify immigration status for people seeking life-or-death care. Where I once told non-citizen family members, “It’s safe to seek care,” now I’m not sure.

Healthcare leaders are caught in an impossible position. They see the value of providing care to everyone, but feel pressured to meet compliance requirements that conflict with quality care. It’s a heartbreaking tension that forces institutions to choose between their mission and their funding. Yet when policy priorities conflict with quality care, trust suffers.

The systemic costs are staggering. When communities avoid preventive care, emergency room use skyrockets, pregnancy complications increase, and chronic diseases go unmanaged until they reach crisis levels. 

The impact also extends beyond immigrant communities. LGBTQ+ individuals, already wary of discrimination, are increasingly reluctant to disclose their identities to healthcare providers. Five years of progress in health equity is eroding across marginalized communities.

Even under these pressures, we must protect and prioritize trust. Leaders can start with these steps:

• Consider the full cost. Financial impact assessments must include the long-term consequences of trust erosion, not just immediate compliance costs.

• Implement protective policies. Healthcare organizations can establish practices that ensure safety for immigrants accessing care, using sliding fee scales and charitable care funding rather than federal grants for undocumented patients.

• Communicate support clearly. Marginalized communities need to hear explicit, consistent messaging about their safety and feel welcome in healthcare spaces.

Watching five years of progress unravel is heartbreaking. Trust, once broken, takes generations to rebuild. But I still think about that night in 2021—and how quickly things can change when we choose to center trust and community care over bureaucratic barriers.

We still have a choice. Every patient encounter, every policy decision, every conversation is an opportunity to build bridges or tear them down. The communities we serve are watching, and they’re deciding whether we can be trusted with their lives.

We must be worthy of that trust.

— Tatiana A. Perez