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8/10/2019 Exhibit 14 - Declaration of Karl Eschbach, Ph.D.
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EXHIBIT 14
pp. 0749
8/10/2019 Exhibit 14 - Declaration of Karl Eschbach, Ph.D.
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1
IN THE UNITED STATES DISTRICT COURT
FOR THE SOUTHERN DISTRICT OF TEXAS
BROWNSVILLE DIVISION
STATE OF TEXAS, et al., ))
Plaintiffs, )
)
v. ) Civil Action No. 1:14-cv-00254
)
UNITED STATES OF AMERICA, et al., )
)
Defendants )
DECLARATION OF KARL ESCHBACH,Ph.D.
My name is a!l "sc#$ac#, and % am ove! t#e a&e of 1' and f(lly cometent in
all !esects to ma*e t#is decla!ation. % #ave e!sonal *no+led&e and ee!tise of t#e
matte!s #e!ein stated.
I. Qualifia!i"#$
1. % am a demo&!a#e!, +it# a P#.D. f!om t#e dea!tment of sociolo&y at
a!va!d nive!sity /12), and a ost-docto!al t!ainees#i in demo&!a#y
sonso!ed $y t#e National %nstit(te of C#ild ealt# and (man Develoment at
t#e nive!sity of isconsin, Cente! fo! Demo&!a#y and "colo&y /1-15). % am
P!ofesso! and Di!ecto! of Po(lation 3esea!c# at t#e nive!sity of eas Medical
!anc# in 6alveston, eas.
2.
My !esea!c# seciali7ations a!e in t#e a!eas of !acial and et#nic
demo&!a#y and #ealt# disa!ities, +it# a a!tic(la! foc(s on isanic and t#e
Ame!ican %ndian o(lations. % #ave ($lis#ed ee!-!evie+ed !esea!c# a!ticles on
ille&al mi&!ation and on #ealt# and #ealt#ca!e (se amon& immi&!ants. % #ave
pp. 0750
8/10/2019 Exhibit 14 - Declaration of Karl Eschbach, Ph.D.
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2
se!ved as t#e elected C#ai! of t#e Ca(c(s of 3ef(&ee and %mmi&!ant ealt# in
association +it# t#e Ame!ican P($lic ealt# Association, and #ave se!ved $y
aointment of t#e 8ec!eta!y of 9ete!ans Affai!s on t#e Dea!tment of 9ete!ans
Affai!s ealt# 8e!vices 3esea!c# and Develoment 8cientific Me!it 3evie+ oa!d,
+it# a !incial assi&nment to eval(ate !oosals e!tainin& to o(lation
disa!ities in #ealt# ca!e (se and o(tcomes. % +as aointed $y 6ove!no! 3ic* Pe!!y
to se!ve as t#e 8tate Demo&!a#e! of eas, and #eld t#is osition f!om 200' to
2010. As t#e 8tate Demo&!a#e!, % #ad a stat(to!y !esonsi$ility to advise t#e
le&islative and eec(tive $!anc#es of t#e 6ove!nment of eas on t#e imlications
of demo&!a#ic t!ends on 8tate se!vice demands. As a!t of t#ese d(ties, % !evie+ed
c(!!ent info!mation a$o(t t#e vol(me of (na(t#o!i7ed mi&!ation to t#e state of
eas.
.
Attac#ed to t#is decla!ation a!e t!(e and co!!ect coies of t#e follo+in&
doc(ments:
Aendi 1 incl(des my c(!!ic(l(m vitae and lists my ($lications in t#e last
ten yea!s.
Aendi 2 sets fo!t# t#e cases in +#ic# % #ave testified in deosition o! at t!ial
d(!in& t#e last fo(! yea!s.
II. S"%& "f I#'ui()
4.
% #ave $een !etained in t#is case $y t#e ffice of t#e Atto!ney 6ene!al
of eas to analy7e t#e follo+in& t#!ee iss(es: /1) +#et#e! t#e 2012 Defe!!ed Action
fo! C#ild#ood A!!ival /DACA) !o&!am ca(sed an inc!ease in t#e (na(t#o!i7ed
pp. 0751
8/10/2019 Exhibit 14 - Declaration of Karl Eschbach, Ph.D.
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immi&!ant o(lation, and +#et#e! t#e 2012 Defe!!ed Action fo! Pa!ental
Acco(nta$ility /DAPA) !o&!am li*ely +o(ld ca(se a concomitant inc!ease in t#e
(na(t#o!i7ed immi&!ant o(lation; /2) t#e met#od fo! co(ntin& t#e (na(t#o!i7ed
immi&!ant o(lation and t#e n(m$e! of (na(t#o!i7ed immi&!ants t#at !eside in
eas; and /) +#et#e! (na(t#o!i7ed immi&!ants !eceive a dis!oo!tionate amo(nt
of (ncomensated #ealt#ca!e.
III. Su**a() "f O%i#i"#$
5.
ased on my ed(cation, (stment of stat(s. As
a !es(lt, t#e n(m$e! of (na(t#o!i7ed immi&!ants +ill inc!ease in t#e
nited 8tates $y ma*in& self-deo!tation a less att!active otion. 8econd,
t#e DAPA !o&!am +ill li*ely ma*e it mo!e att!active fo! (na(t#o!i7ed
immi&!ants to mi&!ate to t#e nited 8tates. 6iven t#at t#e DAPA !o&!am
pp. 0752
8/10/2019 Exhibit 14 - Declaration of Karl Eschbach, Ph.D.
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4
is t#e second time t#e &ove!nment #as offe!ed defe!!ed action stat(s to a
class of (na(t#o!i7ed immi&!ants and #as !ovided t#em +o!*
a(t#o!i7ations, individ(als may $e enco(!a&ed t#at if t#ey ente! t#e nited
8tates ille&ally, t#e &ove!nment +ill &!ant t#em t#e same $enefits in a
f(t(!e !o&!am. %t is t#e!efo!e !easona$le to concl(de t#at +it# t#e
imlementation of t#e DAPA !o&!am, ot#e! t#in&s e(st as
+as !esent ost-DACA.
$.
%t is my oinion t#at t#e lo+ !ates of !ivate ma!*et #ealt# ins(!ance
cove!a&e fo! (na(t#o!i7ed immi&!ants !esidin& in t#e nited 8tates, as
+ell as t#ei! ecl(sion f!om cove!a&e f!om most ($lic !o&!ams and f!om
ma!*et ec#an&es (nde! t#e Affo!da$le Ca!e Act !es(lt in dis!oo!tionate
(se of (ncomensated ca!e, !es(ltin& in a s($stantial $(!den on states and
s($-state >(!isdictions +it# #eavy !e!esentation of (na(t#o!i7ed
immi&!ant o(lations.
#e $asis fo! eac# of t#ese findin&s is elained in mo!e detail $elo+.
IV. C"u#!i#+ !h& U#au!h"(i&- I**i+(a#! P"%ula!i"#
?.
=ollo+in& t#e imlementation of t#e %mmi&!ation 3efo!m and Cont!ol
Act /%3CA), t!ends in !esident (na(t#o!i7ed o(lations #ave $een st(died (sin& a
!esid(al met#odolo&y to infe! t#e si7e and c#a!acte!istics of t#e (na(t#o!i7ed
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8/10/2019 Exhibit 14 - Declaration of Karl Eschbach, Ph.D.
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5
o(lation $y s($t!actin& t#e *no+n le&ally !esent immi&!ant o(lation f!om t#e
total immi&!ant o(lation estimated f!om nited 8tates Cens(s (!ea( s(!veys.1
@.
#is met#odolo&y #as &ained +ide accetance amon& demo&!a#e!s and
immi&!ation sc#ola!s. Conco!dant estimates of t#e !esident (na(t#o!i7ed o(lation
#ave $een !e&(la!ly !od(ced (sin& t#is met#odolo&y $y t#e statistics office of t#e
Dea!tment of omeland 8ec(!ity,2and $y t#e Pe+ isanic Cente!, a non-!ofit
!esea!c# instit(te. A !et!osective ann(al time se!ies fo! t#e e!iod f!om 10 to
2010 +as ($lis#ed as ee!-!evie+ed !esea!c#.4
'.
a$le 1 $elo+ s#o+s t#at t#e estimates of t#e si7e of t#e (na(t#o!i7ed
o(lation !od(ced in t#ese t#!ee imlementations of t#e !esid(al met#odolo&y a!e
#ily conco!dant.
1 3o$e!t a!!en Beff!ey 8. Passel, A Count of the Uncountable: Estimates of
Undocumented Aliens Counted in the 1980 United States Census, 24 D"M63AP @5
/1'@); =!an* D. ean et al., The Quantification of Migration et!een Me"ico and the United
States, in 1 M%63A%N """N M"%C AND " N%"D 8A"8:%NA%NAE 8D1-'
/Meican Minist!y of =o!ei&n Affai!s .8. CommFn on %mmi&!ation 3efo!m, 1').2!yan a*e! Nancy 3ytina, DeFt of omeland 8ec(!ity, ffice of %mmi&!ation
8tat., Estimates of the Unauthori#ed $mmigrant %o&ulation 'esiding in the United States:
(anuar) *01*/201). Beff!ey 8. Passel DF9e!a Co#n, Pe+ 3esea!c# Ct!. isanic !ends P!o>ect,
Unauthori#ed $mmigrant Totals 'ise in + States, -all in 1./Nov. 1', 2014).4 3o$e!t a!!en Bo#n 3o$e!t a!!en, Unauthori#ed $mmigration to the United
States: Annual Estimates and Com&onents of Change, b) State, 1990 to *010, 4@ %NFE
M%63A%N 3"9. 2? /201).
pp. 0754
8/10/2019 Exhibit 14 - Declaration of Karl Eschbach, Ph.D.
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?
Tal& /0 E$!i*a!&- U#au!h"(i&- I**i+(a#! R&$i-! P"%ula!i"# u$i#+ !h&
R&$i-ual M&!h"-, 1 S"u(&$, f"( S&l&!&- 2&a($
ea!
Dea!tment of
omeland 8ec(!ity
Pe+
isanic
Cente! a!!en a!!ennited 8tates
10 Na na .500
2000 '.4?0 '.?00 '.?00
200@G 11.@'0 12.200 11.'1
2010 11.50 11.400 11.@25
2012 11.40 11.200 Na
201 Na 11.00 Na
eas
10 na na 0.4402000 1.00 1.050 1.12@
200@G 1.?'0 1.550 1.?1?
2010 1.@@0 1.?50 1.?0'
2012 1.'0 1.?50 Na
8o(!ces: a*e! 3ytina, su&ranote 2; a!!en a!!en, su&ranote 4; Passel Co#n,
su&ranote .
G200@ is t#e ea* yea! to date fo! t#e (na(t#o!i7ed o(lation of t#e nited 8tates in all
t#!ee estimate se!ies, +it# s($se
8/10/2019 Exhibit 14 - Declaration of Karl Eschbach, Ph.D.
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@
V. Th& I#flu& "f DACA a#- DAPA "# U#au!h"(i&- I**i+(a#!
Mi+(a!i"# Pa!!&(#$
10.
o conside! t#e effect of DACA and DAPA, it is imo!tant to d!a+ on a
concet(al (nde!standin& of #o+ t#ese olicies a!e li*ely to affect t#e $e#avio! of
(na(t#o!i7ed immi&!ants. na(t#o!i7ed mi&!ation is a !ocess t#at occ(!s ove! time
!at#e! t#an a fied event. Potential (na(t#o!i7ed mi&!ants face an initial decision
a$o(t +#et#e! to ma*e an (na(t#o!i7ed ent!y. 8($seo$-secific s*ills.5
11. #e most imo!tant facto!s infl(encin& t#ese c#oices a!e li*ely to $e
$ased on !elative +a&es and >o$ oo!t(nities in t#e nited 8tates and in t#e co(nt!y
of o!i&in.? %mmi&!ation olicies, incl(din& t#e level of $o!de! and +o!*lace
enfo!cement, also !e!esent one facto! t#at infl(ences an individ(alFs decision
+#et#e! to mi&!ate o! not to mi&!ate to t#e nited 8tates.7
5Do(&las 8. Massey !istin ". "sinosa, /hats ri2ing Me"ico3U4S4 Migration5 A
Theoretical, Em&irical, and %olic) Anal)sis, 102 AM.B.8C. /1@).?6o!don . anson, $llegal Migration from Me"ico to the United States, 44 B."CN.
E%"3A3" '? /200?); 6o!don . anson Antonio 8ilim$e!&o, $llegal $mmigration,
order Enforcement, and 'elati2e /ages: E2idence from A&&rehensions at the U4S43Me"ico
order, ' AM."CN.3"9. 1@ /1).@ Catalina Am(edo-Do!antes et al., 6o! o Tougher $mmigration Measures Affect
Unauthori#ed $mmigrants5, 50 D"M63AP 10?@ /201); Pia M. !!eni(s Madeline
Havodny,o Amnest) %rograms 'educe Undocumented $mmigration5 E2idence from $'CA,
40 D"M63AP 4@ /200); anson 8ilim$e!&o, su&ranote ?.
pp. 0756
8/10/2019 Exhibit 14 - Declaration of Karl Eschbach, Ph.D.
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'
12. #e dynamism of t#e (na(t#o!i7ed immi&!ant o(lation is !eflected in
t#e follo+in& ta$le:
Tal& 30 E$!i*a!&$ "f !h& T"!al U#au!h"(i&- I**i+(a#! P"%ula!i"# "f !h& U#i!&-
S!a!&$ a#- A##ual C"*%"#!$ "f P"%ula!i"# Cha#+&0 /445635/5
Met#od of Eeavin& t#e Po(lation
ea!
na(t#o!i7ed
%mmi&!ants,
Ban. 1
/1)
Ann(al Net
C#an&e
/2) I /) J /4)
"nte!ed
t#e
Po(lation
/)
Eeft t#e
Po(lation
/4) IK /5 to ')
"mi&!ated
/5)
Ad>(sted
to
Ea+f(l
8tat(s
/?)
3emoved
$y D8
/@)
Died
/')
2010 11,@25
200 11,' /1@4) '4 55' 24 104 1?5 4?
200' 12,00 /110) 4 54 252 100 150 4?
200@ 11,'1 2@ 55' 51 25' 4 1 4?
200? 11,@14 2?@ @4 4'2 25? ?4 11@ 45
2005 11,1@ @ '@ 4@? 250 @ 10 442004 10,@' '1 4@4 24@ '4 100 42
200 10,?2 2'? @@ 4 244 120 '' 41
2002 10,25 44 0? 4@ 2@ 115 '1 40
2001 ,?20 ?' 1,14? 50' 22 1@? @1 @
2000 ',?00 1,020 1,' ? 1' @ ?5
1 @,'2@ @@ 1,12 5' 1' ?0 ?5 5
1' @,210 ?1? 54 ' 1'2 ?1 ?5 0
1@ ?,@? 44' @5 11 1@0 54 5 2'
1? ?,21 4@2 @5? 2'4 1?1 55 41 2?
15 5,@20 5@1 '22 251 150 42 ? 24
14 5,25 4?@ @00 2 1' ' 5 22
1 4,25 2@ 55@ 22 10 45 4 20
12 4,5'@ 55 220 124 4 4 1
11 4,15 452 ?4 1@ 11? 5 2 1@
10 ,500 ?5 '1? 1'1 10 ' 25 15
8o(!ce: a!!en a!!en, su&ranote 4.
1.
#is ta$le s#o+s t#at t#e (na(t#o!i7ed immi&!ant o(lation !eflects
not only ne+ a!!ivals $(t also fo(! +ays in +#ic# eole leave t#e o(lation: /i)
emi&!ation o! vol(nta!y self-deo!tation; /ii) ad>(stment to la+f(l stat(s; /iii)
!emoval; and /iv) mo!tality.
14. DACA and DAPA !e!esent imo!tant olicy c#oices t#at oe!ate $y
defe!!in& enfo!cement action in +ays t#at inc!ease eli&i$ility to +o!* and allo+
individ(als to !emain in t#e nited 8tates +it#o(t fea! of immediate deo!tation.
pp. 0757
8/10/2019 Exhibit 14 - Declaration of Karl Eschbach, Ph.D.
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#e DACA !o&!am, +#ic# +as initiated $y P!esident $ama in B(ne 2012, allo+s
ce!tain (na(t#o!i7ed immi&!ants +#o ente!ed t#e co(nt!y $efo!e t#ei! siteent#
$i!t#day to !eceive +o!* a(t#o!i7ation and eemtion f!om deo!tation. At t#e
initiation of t#is !o&!am, t#e Pe+ 3esea!c# Cente! estimated t#at ( to 1.@ million
eole mit $e eli&i$le fo! t#e DACA defe!!ed action stat(s.' %t is my (nde!standin&
t#at as of Decem$e! 1, 2014, 8C%8 #as &!anted DACA stat(s to a$o(t ??,000
individ(als.
15.
%n Novem$e! 2014, P!esident $ama anno(nced t#e DAPA !o&!am,
(!o!tedly aimed at !ed(cin& (na(t#o!i7ed immi&!ation at t#e $o!de!. Amon& t#e
initiatives incl(ded in t#e eec(tive action, t#e ne+ olicy +o(ld allo+ a!ents of
nited 8tates citi7ens and la+f(l e!manent !esidents +#o #ave $een !esent in t#e
co(nt!y since Ban(a!y 1, 2010 to !e
8/10/2019 Exhibit 14 - Declaration of Karl Eschbach, Ph.D.
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10
immi&!ants al!eady !esent in t#e nited 8tates. As to eac# of t#ese cate&o!ies,
DACA and DAPA c#an&e t#e calc(lation of $enefits associated +it# comin& to, o!
!emainin& in, t#e nited 8tates.
1@. =o! t#ose individ(als di!ectly cove!ed $y DACA and DAPA, t#e olicies
inc!ease t#e si7e of t#e (na(t#o!i7ed o(lation insofa! as t#ey defe! t#e deo!tation
of (na(t#o!i7ed immi&!ants +#o meet ce!tain eli&i$ility c!ite!ia and +#o +o(ld
ot#e!+ise #ave $een identified $y t#e Dea!tment of omeland 8ec(!ity and s($>ect
to deo!tation +it#in t#e time e!iod secified in t#e !o&!ams.10 A second
(nam$i&(o(s effect is t#at t#e !o&!ams +ill !ed(ce t#e incentive to self-deo!t $ased
on t#e !ovision of +o!* a(t#o!i7ation and t#e !emoval of fea! of deo!tation.
1'. DACA and DAPA may also infl(ence t#e decisions of otential mi&!ants
and ot#e! (na(t#o!i7ed immi&!ants al!eady !esent in t#e nited 8tates.
8ecifically, t#ese individ(als may $e enco(!a&ed $y t#ese !o&!ams to immi&!ate
+it#o(t a(t#o!i7ation o! to !emain in t#e nited 8tates $eca(se of a otential a$ility
to !eceive an ad>(stment desite a fail(!e to
8/10/2019 Exhibit 14 - Declaration of Karl Eschbach, Ph.D.
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1. %n s#o!t, t#e effect of DACA and DAPA is to incentivi7e !esidents of
ot#e! co(nt!ies to come to t#e nited 8tates. #e olicies also enco(!a&e individ(als
+#o a!e al!eady !esent in t#e nited 8tates to !emain +it# t#e #oe t#at t#ey +o(ld
#ave a f(t(!e ad>(stment of stat(s. ased on my ed(cation,
8/10/2019 Exhibit 14 - Declaration of Karl Eschbach, Ph.D.
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in t#e la$o! ma!*ets of a!eas +#e!e t#e o(lation +as concent!ated, +#ile en#anced
enfo!cement +o(ld !ed(ce f(t(!e &!o+t# of t#e o(lation.11
22.
%n t#e 25 yea!s afte! %3CA +as imlemented, t#e!e #as not $een a
si&nificant dec!ease in t#e n(m$e! of (na(t#o!i7ed immi&!ants ente!in& t#e nited
8tates. %nstead, t#e (na(t#o!i7ed o(lation #as s(!&ed to 11.@ million individ(als
since its imlementation. =(!t#e!, a!!en and a!!enFs estimates imly a &!o+t#
of '.5 million $et+een 10 and 200@, nea!ly times t#e le&ali7ed o(lation at t#e
time %3CA +as assed.12
2.
"val(ations of t#e imact of %3CA #ave concl(ded t#at t#e !o&!am
failed to accomlis# its &oals.1 #e !esident (na(t#o!i7ed immi&!ant o(lation +as
initially !ed(ced t#!o( ad>(stments in stat(s $(t s($seecto!y of &!o+t#, as !eflected in a$le 1. Many analysts concl(ded t#at
t#e !incial !est!(ct(!in& t#at occ(!!ed in !esonse to %3CA +as lon&e! so>o(!ns o!
e!manent s#ifts of !esidence in t#e nited 8tates $y e!sons +#o +o(ld #ave
ot#e!+ise #ave sent la!&e! o!tions of time in t#ei! co(nt!y of o!i&in.14 #is flo+ of
(na(t#o!i7ed ent!ants ac!oss t#e $o!de! +as !esonsive to many infl(ences,
11
Beff!ey 8. Passel et al., Undocumented Migration Since $'CA: An 2erallAssessment, in NDCM"N"D M%63A%N " N%"D 8A"8: %3CA AND "
"P"3%"NC" = " 1'08251-2?4 /=!an* D. ean et al. eds., 10).12Seea!!en a!!en, su&ranote 4.1at#a!ine M. Donato et al., Stemming the Tide5 Assessing the eterrent Effects of
the $mmigration 'eform and Control Act, 2 D"M63AP 1 /12); !!eni(s Havodny,
su&ranote @.14elinda %. 3eyes et al., P($. Policy %nstit(te of Cal., 6olding the ine5 The Effect of
the 'ecent order uild3U& on Unauthori#ed $mmigration/2002).
pp. 0761
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1
incl(din& !ima!ily e!cetions of !elative emloyment oo!t(nities and +a&e
!ates.15
24.
ne so(!ce of data (sed to eval(ate t!ends in (na(t#o!i7ed immi&!ation
flo+s is t#e time se!ies of a!e#ensions of e!sons attemtin& ent!y +it#o(t
a(t#o!i7ation. #e inte!!etation of t!ends in a!e#ension data is not
st!aitfo!+a!d.1? =o! eamle, an inc!ease in a!e#ensions may !eflect an
inc!eased vol(me of attemted (na(t#o!i7ed ent!y, o! it may !eflect a c#an&e in t#e
effectiveness of $o!de! enfo!cement o! in t#e efficiency of sm(&&lin& oe!ations in
t!anso!tin& (na(t#o!i7ed immi&!ants ast $o!de! s(!veillance +it#o(t detection.
A!e#ension and !omt !emoval of e!sons +#o attemt ent!y may inflate
a!e#ension co(nts !elative to t#e vol(me of e!sons +#o s(ccessf(lly ente! t#e
nited 8tates ille&ally if (na(t#o!i7ed immi&!ants ma*e !eeated attemts to ente!
(ntil t#ey a!e s(ccessf(l. Analysts #ave identified some of t#ese confo(ndin&
infl(ences on t!end data on immi&!ations, and find it (sef(l to identify t!ends in
mi&!ation flo+s, +it# allo+ance fo! confo(nde!s.1@
25. #e n(m$e! of (naccomanied c#ild!en /AC) a!e#ensions #as
inc!eased in t#e ast si yea!s and #as s(!&ed in t#e last t+o yea!s. At t#e time
DACA +as initiated, t#e yea!ly total fo! $o!de! a!e#ensions of AC in = 2012
15anson, su&ranote ?; anson 8ilim$e!&o, su&ranote ?41?#omas B. "sens#ade, Using $S order A&&rehension ata to Measure the -lo!
of Undocumented Migrants Crossing the U4S43Me"ico -rontier, 2 %NFE M%63A%N 3"9. 545
/15).1@anson 8ilim$e!&o, su&ranote ?; ean et al., su&ranote 1.
pp. 0762
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15
ent!y ost-DACA leads, at minim(m, to t#e concl(sion t#at t#e!e is no evidence t#at
DACA olicy #as cont!i$(ted to a dec!ease in (na(t#o!i7ed immi&!ation. ne of t#e
stated (!oses of t#e olicy #as $een to !edi!ect t#e enfo!cement activities of t#e
Dea!tment of omeland 8ec(!ity to #ie! !io!ity activities. (t >(st t#e !eve!se
#as occ(!!ed. #ile DACA #as not $een s#o+n to $e t#e !incial ca(se of t#e s(!&e,
it is !easona$le to #yot#esi7e t#at it #as cont!i$(ted to a climate of eectations
amon& e!sons contemlatin& an (na(t#o!i7ed ent!y t#at stat(s ad>(stments may
$e availa$le to !esident (na(t#o!i7ed c#ild!en.
2@.
A conse!vative s(mma!y of t#e stat(s ad>(stment !ovisions of %3CA
and DACA is t#at t#e!e is no t#eo!etical $asis o! emi!ical evidence t#at s(c# an
ad>(stment cont!i$(tes to a !ed(ction of f(t(!e (na(t#o!i7ed ent!y o! o(lation
&!o+t# ecet fo! t#e $oo**eein& ad>(stment of !eclassifyin& some (na(t#o!i7ed
ent!ants and !esidents as a(t#o!i7ed. %t seems vi!t(ally ce!tain t#at t#e +o!*
a(t#o!i7ation and defe!!al of deo!tation +o(ld #ave a di!ect effect of dec!easin&
vol(nta!y !et(!n and deo!tation, +it# t#e effect of inc!easin& t#e si7e of t#e !esident
(na(t#o!i7ed o(lation in eas and t#e nited 8tates.
2'. #e!e is also !easona$le t#eo!etical &!o(nd fo! $elievin& t#at $ot# t#e
demonst!ation effect to f(t(!e otential (na(t#o!i7ed ent!ants of !eeated ost #oc
stat(s ad>(stments, as +ell as t#e eansion of an a(t#o!i7ed !esident o(lation
t#at may anc#o! f(t(!e (na(t#o!i7ed immi&!ation, +o(ld #ave t#e eected effect of
inc!easin& s($se
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1?
is t#at stat(s ad>(stment !o&!ams #ave !eceded inc!eases !at#e! t#an dec!eases of
stoc*s and flo+s of (na(t#o!i7ed immi&!ation.
VII. U#au!h"(i&- I**i+(a#!$ R&&i8& a Di$%("%"(!i"#a!& A*"u#! "f
U#"*%$a!&- H&al!ha(&
2. #e!e is s($stantial evidence t#at (na(t#o!i7ed immi&!ants #ave fe+
oo!t(nities fo! sonso!ed #ealt# ca!e t#!o(o(t t#e nited 8tates. 3ates of
!ivate ma!*et ins(!ance a!e lo+ amon& (na(t#o!i7ed o(lations. A !ecent st(dy
com$inin& info!mation f!om t#e Cens(s (!ea(Fs 8(!vey of %ncome and P!o&!am
Pa!ticiation and Ame!ican Comm(nity 8(!vey estimated t#at @1 of (na(t#o!i7ed
immi&!ant ad(lts lac*ed any fo!m of #ealt# ins(!ance,1'a findin& t#at is conco!dant
+it# mo!e di!ect s(!vey estimates fo! !e&ional and local s($-o(lations.1
0. na(t#o!i7ed immi&!ants do not (se #ealt#ca!e at #i !ates.
na(t#o!i7ed immi&!ants aea! to #ave lo+e! !ates of mo!$idity t#an .8. native
o(lations. #is is a common findin& fo! immi&!ant o(lations $eca(se mi&!ation
is f!eoin immi&!ation st!eams. %t is also li*ely t#at oo!e! access to ca!e means t#at
(na(t#o!i7ed immi&!ants a!e mo!e li*ely to #ave (ndia&nosed conditions, and #ence
fail to !esent fo! t!eatment.20
1'
3andy Cas et al., Mi&!ation Policy %nst., A emogra&hic, Socioeconomic, and6ealth Co2erage %rofile of Unauthori#ed $mmigrants in the United States/May 201).
1Dana P. 6oldman et al., egal Status and 6ealth $nsurance Among $mmigrants, 24
"AEA==. 1?40 /2005).20 8ilvia elena a!cellos et al., Undiagnosed isease, Es&eciall) iabetes, Casts
oubt on Some of the 'e&orted 6ealth ;Ad2antage< of 'ecent Me"ican $mmigrants, 1
"AEA==. 2@2@ /2012); assim a!!af et al., Emergenc) e&artment Ser2ice Use Among
$mmigrant and on3$mmigrant =rou&s in the United States, 1? B.%MM%63AN M%N3%
"AE55 /2014).
pp. 0765
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1@
1. #en t#ey do &et sic*, immi&!ants a!e less li*ely to see* medical ca!e
t#an ot#e! o(lations $eca(se of lo+e! !ates of #ealt# ins(!ance cove!a&e and ot#e!
$a!!ie!s to ca!e.21 #e one ecetion to t#is atte!n of lo+e! #ealt# ca!e (se is t#at
(na(t#o!i7ed immi&!ants (se a #ie! vol(me of se!vices t#an most ot#e!
o(lations fo! la$o! and delive!y.22
2. #en t#ey do (se #ealt#ca!e, (na(t#o!i7ed immi&!ants
dis!oo!tionally (se (ncomensated ca!e. sin& an alication of t#e !esid(al
met#od desc!i$ed a$ove to c!eate estimates of (na(t#o!i7ed immi&!ant o(lations
to data f!om t#e Medical "endit(!e Panel 8(!vey, P!ofesso! 8timson and
collea&(es estimated t#at $et+een 2000 and 200, (na(t#o!i7ed immi&!ants +e!e
mo!e t#an t+ice as li*ely as .8. natives to (se (ncomensated ca!e, and #ad #ie!
!ates of (se of (ncomensated ca!e t#an all ot#e! immi&!ant stat(s &!o(s.2
21Ma!c E. e!* Cla(dia E. 8c#(!, The Effect of -ear on Access to Care Among
Undocumented $mmigrants, B.%MM%63AN "AE151 /2001); Ma!c E. e!* et al., 6ealth
Care Use Among Undocumented atino $mmigrants, 1 "AEA==. 51 /2000); at#!yn
De!ose et al., $mmigrants and 6ealth Care: Sources of >ulnerabilit), 2? "AEA==. 125'/200@).
22e!* et al., su&ranote 20; C. Annette D(a!d Ma!* . Massin&, Trends in
Emergenc) Medicaid E"&enditures for 'ecent and Undocumented $mmigrants, 2@ B.AM.
M"D.A88FN 10'5 /200@).2 Bim P. 8timson et al., Unauthori#ed $mmigrants S&end ess Than ther
$mmigrants and US ati2es on 6ealth Care, 2 "AEA==. 11 /201); Bim P. 8timson
et al., E >isits and S&ending b) Unauthori#ed $mmigrants Com&ared /ith egal
$mmigrants and US ati2es, 2 AM B."M"36"NC M"D. ?@ /2014).
pp. 0766
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1'
Tal& 10 H&al!h Ca(& S%-i#+ ) Na!i8i!) A#- L&+al S!a!u$ Of
R&$%"#-!$ T" Th& M&-ial E9%-i!u(& Pa#&l Su(8&), 3555654
S!a!u$
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
U#au!h"(i&- L&+al Na!u(ali&-
I**i+(a#! (&$i-! i!i US #a!i8&
PERCENTOFPOPULATIONHAVIN;0
Any #ealt# ca!e eenses ?0 @2 ' '@
Any (ncomensated ca!e 5. 4.@ 2. 2.'
EXPENDITURES
Ave!a&e ann(al /millions
of 200 O) 15,@0 2',4@ 52,?21 1,02',22
Pe!cent of 8 eendit(!es 1.4 2.5 4.@ 1.4
8o(!ce: 8timson et al., Unauthori#ed $mmigrants S&end ess, su&ranote 2 /".1).
. ealt# ca!e !ovide!s in states, incl(din& eas, t#at #ave a
dis!oo!tionate $(!den of !esident (na(t#o!i7ed o(lations, #ave a
dis!oo!tionate $(!den of !ovidin& (ncomensated ca!e. "stimates f!om t#e
!esid(al met#od !esented in a$le 1 a$ove a!e t#at t#e (na(t#o!i7ed immi&!ant
o(lation in eas is $et+een 1.?5 and 1.' million as of 2012. #e eas ealt#
and (man 8e!vices Commission /8C) #as estimated t#at t#e 8tateFs ($lic
#osital dist!ict facilities inc(!!ed a!oimately O5?.' million in (ncomensated
ca!e fo! (na(t#o!i7ed immi&!ants in = 200? and O@1?.' million in = 200'.24
4.
#ese (na(t#o!i7ed immi&!ants dis!oo!tionally !eside in a fe+
>(!isdictions, incl(din& t#e a!!is Co(nty ealt# Dist!ict and Dallas Co(nty ealt#
Dist!ict. As a !es(lt, t#ese >(!isdictions #ave a dis!oo!tionate $(!den of
24 e. ealt# (man 8e!vs. CommFn, 'e&ort to the United States Congress on
Ser2ices and enefits %ro2ided to Undocumented $mmigrantsat 4-10 /200') /8C 200'
3eo!tQ); e. ealt# (man 8e!vs. CommFn, 'e&ort on Ser2ices and enefits %ro2ided to
Undocumented $mmigrantsat ?-12 /2010) /8C 2010 3eo!tQ)
pp. 0767
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1
(ncomensated ca!e. =o! eamle, o(t of t#e estimated O5?.' million in
(ncomensated ca!e !ovided to (na(t#o!i7ed immi&!ants $y ($lic #osital
facilities in = 200?, a!oimately O215.4 million +as inc(!!ed at a!!is Co(nty
facilities and O14.@ million +as inc(!!ed at Dallas Co(nty facilities.25 (t of t#e
estimated O@1?.' million in (ncomensated ca!e !ovided to (na(t#o!i7ed
immi&!ants $y ($lic #osital facilities in = 200', a!oimately O2.@ million +as
inc(!!ed at a!!is Co(nty facilities and [email protected] million +as inc(!!ed at Dallas Co(nty
facilities.2?
5.
na(t#o!i7ed immi&!ants !esidin& in eas also !eceive #ealt#ca!e
se!vices and $enefits f!om seve!al ($lic !o&!ams t#!o( t#e 8tateFs 8C. =o!
eamle, (na(t#o!i7ed immi&!ants a!e eli&i$le fo! eas "me!&ency Medicaid, +#ic#
!ovides Medicaid cove!a&e limited to eme!&ency medical conditions, &ene!ally
defined to mean conditions t#at, in t#e a$sence of immediate medical attention, co(ld
!easona$ly $e eected to lace t#e atientFs #ealt# in se!io(s >eoa!dy o! ca(se
se!io(s imai!ment o! dysf(nction to t#e atientFs $odily f(nctions o! o!&ans.2@
Acco!din& to !eo!ts comiled $y 8C, t#e total estimated cost to t#e 8tate fo! t#e
!ovision of "me!&ency Medicaid se!vices to (na(t#o!i7ed immi&!ants !esidin& in
eas +as a!oimately O'0 million in = 200@, O?2 million in = 200, and O@1
million in = 2011.2'
258C 200' 3eo!t, su&ranote 24, at ?-10.2?8C 2010 3eo!t, su&ranote 24, at '-12.2@e. ealt# (man 8e!vs. CommFn, eas o!*s and$oo* /2014) /&lossa!y),
a2ailable at #tt:LL+++.dads.state.t.(sL#and$oo*sLeaso!*sL&lossa!yLinde.#tmRemc.2'8C 200' 3eo!t, su&ranote 24, at ; 8C 2010 3eo!t, su&ranote 24, at 4;
e. ealt# (man 8e!vs. CommFn, 'e&ort on Te"as 6ealth and 6uman Ser2ices
pp. 0768
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20
?. na(t#o!i7ed immi&!ants also may $e entitled to !eceive eas
C#ild!enFs ealt# %ns(!ance P!o&!am /C%P) Pe!inatal Cove!a&e, +#ic# !ovides
!enatal ca!e fo! t#e (n$o!n c#ild!en of +omen +#ose income is ( to 200 fede!al
ove!ty level and +#o do not
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pp. 0770
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Appendix 1 to
Declaration of Karl Eschbach, Ph. D.
pp. 0771
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Date: 12/2014
CURRICULUM VITAE
NAME: Karl Eschbach
PRESENT POSITION AND ADDRESS:
Professor and Director of Population Research,
Department of Internal Medicine, Division of Geriatricsniversit! of "e#as Medical $ranch
%01 niversit! $lvd&
Galveston, "' (()))*01((
+aescha-utm&edu
.40 2*0 3ffice
.40 %2*1(( Moile
EDUCATION:
2001*2002 I5 6ello7, 8ealth of 3lder Minorities, "M$ 9eal! enter on 5;in;
1%*1) I8D post*doctoral fello7ship, enter for Demo;raph! and une 14 $&5& summa cum laudein 9ociolo;!, niversit! of Penns!lvania, Philadelphia, P5
PROFESSIONAL AND TEACHING EXPERIENCE:
2010* Professor .7ith tenure Department of Internal Medicine*Geriatrics?
200(*2010 5ssociate Director, Institute for Demo;raphic and 9ocioeconomic Research, niversit! of "e#as
at 9an 5ntonio .Interim Director, 200(*200(*2010 5ssociate Professor to Professor, Department of Demo;raph!, niversit! of "e#as at 9an
5ntonio
200%*200( 5ssociate Professor, Department of Internal Medicine*Geriatrics @
Graduate 9chool of $iomedical 9ciences, Department of Preventive Medicine and
ommunit! 8ealth, niversit! of "e#as Medical $ranch, Galveston
1 Aisitin; 5ssistant Professor, Dept& of 9ociolo;!, Rice niversit!
1)B2004 5ssistant to 5ssociate Professor, Department of 9ociolo;!, niversit! of 8ouston
1) Cecturer, Dept& of 9ociolo;!, niversit! of =isconsin, Madison&
12*1% Cecturer, ommittee on 9ocial 9tudies? Research 6ello7, Malcolm =iener enter for
9ocial Polic!, enned! 9chool of Government, 8arvard niversit!
HONORS
niversit! of Penns!lvania, $&5& a7arded summa cum laude? $enEamin 6ran+lin ational 9cholar, 14
Research 5ssociate, enter for Immi;ration Research, niversit! of 8ouston, 1*2004
Memer,
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2
9enior Research 5ssociate, niversit! of 8ouston, enter for Pulic Polic!, 9eptemer 200(*
DeanFs 57ard for Research < .PI /%0/201%*/%0/2014 &0 al Mnths
5rchivin; 6our e7 Datasets from the Con;itudinal 8ispanic
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3
Co&%le#e' Gra"#$Co"#rac# S!%%or#
1R01 51%42() Good7in, > .PI 0(/1(/200 B 0/%0/201% 1&20 cal mths
I8 2)0,000
nderstandin; Mechanisms of
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4
Methodist 8ealthcare Ministries
Pro,ections of -besity and %iabetes Pre&alence for Counties in Texas& /200(*2/200
Role: Principal investi;ator .5ssumed from ;rant to 9teve 8& Murdoc+
R21 5"0024 ational enter for omplementar! and 5lternative MedicineCM Use in Hispanics ./0 1ears -ld in US 2 Mexico.>ose Coera, MD, PI %/200)*2/200(
Role: o*investi;ator
Grant L 4%& 8o;; 6oundation for Mental 8ealth, 5ustin, "e#as&
Psychological distress among Mexican3origin populations in the United States4
2002*200%
Role: Principal investi;ator&
nited 9tates& Department of the Interior& Minerals Mana;ement 9ervice&
The 'mpact of -uter Continental Shelf cti&ity on Selected Communities and 'nstitutions on the 5ulf
Coast4 .>ohn Petterson, PI 1*2001Role: o*investi;ator
"rull 6oundation, Palacios "e#as&
Migrant %eath at the US 3 Mexico 6order.estor Rodr;ueK, PI 1)*1(
Role: o*investi;ator
TEACHING
Co!rses Ta!(h#
5;in;
8ealth Promotion
Introductor! 9ociolo;!
Political 9ociolo;!
Population/demo;raphic techniNues
Racial and ethnic relations
Research methods
9ocial
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5
ushan; Patel .2002*4 "M$, Preventive Medicine @ ommunit! 8ealth
Rosa Davla .200%*( niversit! of "e#as*8ouston, 9chool of Pulic 8ealth
>& 6red "homas .2004*( "M$, Preventive Medicine @ ommunit! 8ealth .hair
6ran+ Cemus .2004*( "M$, Preventive Medicine @ ommunit! 8ealth
$ret 8o7re! .200* "M$, Preventive Medicine @ ommunit! 8ealth
Mar! $ollin;er .200*10 "95, Demo;raph! and 3r;aniKation 9tudies
"hu!!unh Do .2011*201% "M$, Preventive Medicine @ ommunit! 8ealth5l!ssa 9hell .2012*201% "M$, Preventive Medicine @ ommunit! 8ealth
Ca7rence Panas .2011*201% "M$, Preventive Medicine @ ommunit! 8ealth .hair
itha Mathe7 .201%*2014 "M$, 9chool of ursin;
Proess)o"al Ser*)ce
9tate of "e#as representative to 9& $ureau of the ensus 9tate Data enter Pro;ram, 6ederal*9tate
ooperative on
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6
5merican Pulic 8ealth 5ssociation
Gerontolo;ical 9ociet! of 5merica
Population 5ssociation of 5merica
Population Reference $ureau
.OURNAL$GRANT REVIE/ER:
ournal of
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7
)&
M, Rodri;ueK P, a+os 5& 8ouston 8ei;hts Cityscapes41? 4.2:24)*2)&
&
9& ei;horhood omposition and Incidence of ancer
amon; 8ispanics in the nited 9tates& Cancer& 200)? 10%.):10%*1044&
1& $ratter >C,
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8
22&
5l 9nih 9, 3ttenacher >, Mar+ides 9, uo O6, 9& "he P, >u 8, RaEi M, u 8, , Curie , 6lac+ >M, Mattei >&, 5,
6urumoto*Da7son 5, 8an+in >R, DeGraffinreid, & 5dvancin; the 9cience of 8ealth Disparities
Research& Ethnicity 2 %isease4 200(? 1(.%:42(*4%%&2&
"ovar >>, 5n;el R>, , ital and Health Statistics& 9eries 2,
umer 14, 3ctoer 200&
pp. 0779
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9
%&
Cac+an , P, 6reeman >C, Good7in >9& 9& orrelates of $acterial
Pneumonia 8ospitaliKations in P, =ilson 6,
8/10/2019 Exhibit 14 - Declaration of Karl Eschbach, Ph.D.
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10
)4&
9hell, 5M, Pee+ M, 9, 6reeman >C,
8/10/2019 Exhibit 14 - Declaration of Karl Eschbach, Ph.D.
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11
4&
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,oo4 Re*)e0s
1& The Micro3Macro "in$&&& 5le#ander et al& .$er+ele!: niversit! of alifornia Press& 1( in
ualitative 9ociolo;! 12.4:42(*42? 1&
2& Micro3Sociological Theory& & 8elle and 9&& ournal? 200%&
Prese"#a#)o"s a# Co"ere"ces$U")*ers)#)es
1&
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13
Department of 8ousin; and ran Development =or+in; Group meetin; on X9ustainin; Diverse
ran ommunities,Y Co!ola niversit! of hica;o, 1&
11&
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14
estenaum $, Meetin; or;aniKers&
%0&
utchin M, ul! 2, 200)&
&
urrent population trends in "e#as& " 9chool of Ca7 C< 9!mposium, 5ustin, "', ovemer ,200(&
(& Demo;raphic trends in post*secondar! enrollment& ational 5ssociation of 9tate "reasurers, 9an
5ntonio, "', Decemer %, 200(&
& Prospectus for a ative 5merican 8ousin; eeds 5ssessment& ational 5merican Indian 8ousin;
ouncil 5nnual Meetin;, Cas Ae;as, A, Decemer ), 200(&
& Population chan;e in "e#as& "o and from 2000& "e#as Monthl!
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15
1)&
Impacts of ille;al immi;ration on "e#as and the "e#as econom!& Dallas 6rida! Group, 5pril 11,
200&
1& urrent research on health and healthcare issues of 8ispanic population in "e#as& 9an 5ntonio
5ssociation of 8ispanic >ournalists& 9an 5ntonio, "', 5pril 12, 200&
1(& urrent trends of population chan;e in "e#as& "e#as 5ssociation of ran ounties, Roc+7all,
"'& 5pril 24, 200&
1&
"e#as 9tate Data enter 5nnual Meetin;, 5ustin, "', Ma! (, 200&1& Invited testimon! on current trends in population chan;e in "e#as affectin; 7or+force rene7al&
8ouse 9elect ommittee on 8i;her and Pulic une 2%, 200&
2& urrent population trends in "e#as& "e#as Department of Insurance, Propert! asualt! Division,
5ustin, "', >une 2), 200&
2(& Invited testimon! on population trends affectin; healthcare 7or+ force needs in "e#as& Invited
testimon! to Eoint 8ouse committees on International and $order 5ffairs, Pulic 8ealth, and
5ppropriations, Representatives "rac! in;& Dianne =hite Delisi, R!an Guillen, hairs& 5ustin,
"', >une %0, 200&
2& urrent population trends in "e#as and ph!sician 7or+force rene7al& "e#as 8ealth are Polic!
ouncil, Partnership 9ucommittee& 5ustin, "', >ul! 1, 200&
2& Invited testimon! on population trends affectin; non*metropolitan "e#as& 9enate ommittee on
International Relations and "rade, 9enator r&, hair, 5ustin, "', 5ustin "', 5u;ust
1%, 200&
%0&
"rends in population affectin; the rene7al of the "e#as 7or+force, "e#as =or+force Investment
ouncil& 5ustin, "', 9eptemer ), 200
%1&
urrent trends in population chan;e in "e#as and 9an 5ntonio& MasterFs Ceadership 6orum,
3ctoer 1, 200&
%2& urrent trends in population chan;e in "e#as and the apitol Re;ion& Geor;eto7n Rotar!,
3ctoer %, 200&%%& Invited testimon! on indi;ent health care& "e#as 8ouse ommittee on Pulic 8ealth, >odie
Cauener;, hair& 3ctoer 1%, 200
%4& urrent trends in population chan;e in 9outheast "e#as& Ceadership 9outheast "e#as& 3ran;e,
"', 3ctoer 2%, 200&
%)& Population chan;e and 7or+force rene7al in the "e#as Panhandle Re;ion& 5marillo, "', 3ctoer
pp. 0786
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16
%1, 200&
%&
Population han;e and 8ealth and 8ealthcare eeds in "e#as& 9an 5ntonio 8ispanic hamer of
ommerce& "hird 5nnual 8ealthcare 9ummit and =ellness anuar! , 200&
4)&
urrent trends of population chan;e in "e#as and the 3R"
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17
)&
urrent "rends of han;e in the Population of "e#as and Re;ion %& Re;ion % ul! (, 200&
2&
urrent Demo;raphic "rends and the 6uture of "e#as& Masters Ceadership Pro;ram, 9an5ntonio& 3ctoer , 2010
%& 8ispanics in the nited 9tates and "e#as in an une 2, 2012&
4& Galveston it! Population, =or+force and 8ousin;, 10*2010&
a& Gulf oast Interfaith, Galveston, "'& 9eptemer 2011&
& Galveston ount! Mutual 5ssistance Partnership, >anuar! 2012&
c&
Rotar! of Galveston Island, Galveston, "' 6eruar! 2012&
d&
6amil! 9ervice enters of Galveston ount!& Dic+inson, "', March 2012&
e&
Galveston 6oundations Roundtale, Decemer, 201%&
pp. 0788
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Appendix 2 to
Declaration of Karl Eschbach, Ph. D.
pp. 0789
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List of Karl Eschbachs Depositions/Testimonies in the Past Four Years
State v. Leon Davis
Cause Nos. 13-01-00685-CR; 13-05-05517-CR
9th Judicial District Court, Mot!o"er# Cout#, $e%asDate o& $esti"o#' Ma# (1, (01)