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Proposed changes to ‘public charge’ rule could hurt public health

The Trump administration has proposed an immigration policy that could seriously harm public health efforts, potentially reversing gains made in healthcare access and trust earned in our communities.

In fact, there are already reports that legal immigrants who are eligible for critical public assistance programs are disenrolling or steering clear out of fear and confusion.

The administration’s proposed changes to the “public charge” rule would make receipt of certain public assistance, like Medicaid, grounds for denying a legal immigrant a green card. For decades, such denials have applied only to those likely to become primarily dependent on the government for subsistence. This new rule goes much further.

The Kaiser Family Foundation has estimated that the changes would lead to disenrollment of as many as 4.9 million Medicaid/Children’s Health Insurance Program enrollees across the nation. CHIP is not in the proposed change, but the analysis predicts that fear will cause parents of even U.S.-born children to steer clear of participation.



As the CEO of L.A. Care Health Plan, the largest publicly operated health plan in the country, I can tell you that we have estimated that more than 170,000 of our 2.2 million members alone could be impacted by this sweeping expansion of grounds for denial.

There is no doubt that the proposed changes would harm the health of immigrants, their families and others. Many will likely drop out of Medicaid and SNAP, the nutrition assistance program formerly known as food stamps, to safeguard their eligibility for permanent legal residency. Without insurance, these people will likely have to forgo preventive healthcare. What happens then? How can we, as a nation, force families to choose between nutritious food and necessary medical care or the opportunity to become a citizen?

Immigrant or not, people will inevitably need healthcare. With the cost of care beyond the means of many affected by the rule change, they will wait and wait, until ultimately they require emergency care—the costliest of all care, often requiring much more complex treatment. Costs go up for everyone when emergency departments are overused, and that means all taxpayers pay more for healthcare.

In California, where half of all children have a foreign-born parent, the rule would have an especially big impact. The American Academy of Family Physicians in September noted that if the proposed change is enacted, it will “endanger public health,” not just immigrant health. The physicians say that by avoiding necessary medical care legal immigrants will increase the risk to their own health and the health of others. One specific area of concern is immunizations. The Centers for Disease Control and Prevention estimated that influenza killed more than 80,000 people in the U.S. during the last flu season. How many legal immigrants and families will forgo a simple flu shot this season out of fear driven by this senseless policy proposal?

Furthermore, U.S.-born children of many of these legal immigrants will also suffer, especially if those threatened by the changes decline food or housing assistance out of fear. The Department of Homeland Security itself admits reduced participation in such programs could lead to worse health outcomes, including increased prevalence of obesity and malnutrition; increased poverty and housing instability; and reduced productivity and educational attainment. Echoing the AAFP, DHS says the new rule could increase the prevalence of communicable diseases, including among U.S. citizens. It also recognizes the potential economic cost as there will be an increase in uncompensated care for immigrants who show up in the emergency room.

Policies that would block legal immigrant families from having a healthy, productive future in the U.S. do not represent the values on which this country was built. The Wharton School in June 2016 released a study titled The Impact of Immigration on the United States’ Economy, which found immigrants—whether documented or undocumented, high- or low-skilled—to be net positive contributors to the U.S. economy. Without good health, that could change.

Interested in submitting a Guest Expert op-ed? Send drafts to Assistant Managing Editor David May at [email protected]


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