WASHINGTON — The Trump Administration’s new “public charge” rule released Monday could keep noncitizen immigrants from seeking necessary medical care, according to healthcare experts.
Under the rule (clocking in at 837 pages), immigrants’ financial status and past use of public assistance programs will be taken into account in deciding whether to approve applications for permanent residency (“green cards”) and visa renewals. Those with low incomes or little education, and who have used benefits such as Medicaid, food stamps, and housing vouchers, may be turned down because they’d be seen as more likely to need future government assistance.
The rule quickly came under attack.
“Today’s changes to how ‘public charges’ are classified will discourage noncitizen immigrants from seeking the care and other services they need and to which they are legally entitled,” said David Skorton, MD, president and CEO of the Association of American Medical Colleges in a press release.
The administration’s actions could worsen health disparities, Skorton said: “The consequences of this action will be to potentially exacerbate illnesses and increase the costs of care when their condition becomes too severe to ignore.”
“Along with the rule’s impact on food subsidies and housing support, this change will worsen existing health inequities and disparities, cause further harm to many underserved and vulnerable populations, and increase costs to the health care system overall, which will affect all patients,” he added.
The final rule expands the definition of “public charge” to include the use of non-cash programs that previously had been excluded, according to Samantha Artiga, director of the Disparities Policy Project for the Kaiser Family Foundation.
The rule also outlines certain characteristics that immigration officials would consider as “negative factors” when making a decision about an individual’s legal permanent status, Artiga told MedPage Today, and create “new barriers” for people to immigrate to the U.S. or to get a green card.
For instance, “having a health condition and not having resources or [private] health coverage to cover the cost of treatment for the condition would be a negative factor,” Artiga explained.
Even before the rule was finalized, Artiga said anecdotal reports came from providers that immigrant families were not enrolling in certain public programs, despite being eligible. Providers said they also noticed women dropping out from the Women Infants and Children (WIC) supplemental nutrition program, even though that program isn’t included under the rule, she noted.
According to Ken Cuccinelli, acting director of the U.S. Citizenship and Immigration Services (USCIS), the rule “does not consider many forms of government assistance that protect children and pregnant women’s health as public benefits … [including] emergency medical assistance, disaster relief, national school lunch programs, WIC, CHIP [the Children’s Health Insurance Program], Medicaid received by people under the age of 21, or pregnant women … foster care and adoption subsidies, student and mortgage loans, energy assistance, food pantries, homeless shelters, and Head Start.”
Immigrants and ‘Self-Reliance’
During a press briefing Monday, Cuccinelli said “self-reliance” has been a “core principle” of America for decades. He said his family came to the U.S. from Italy and “worked together to ensure that they could provide for their own needs and they never expected the government to do it for them.”
A “generations-old” law requires that certain immigrants must have a sponsor to bear financial responsibility for them, while a 1996 law stipulates that certain foreign nationals must leverage their family resources and those of private organizations in order to be successful in the U.S. But Congress never established the legal definition for the term “public charge,” and the term also has not been defined in regulation, he said.
“That is what changes today, with this rule,” Cuccinelli said. “Under the rule, ‘public charge’ is now defined as an individual who receives one or more designated public benefits for more than 12 months in the aggregate within any 36 month period.”
If a person receives two separate benefits within a month, that would count as 2 months of benefits, he added.
Using this rule as a litmus test, the USCIS can “objectively determine, whether an applicant [seeking legal status] is likely at any time in the future to receive public benefits above the designated threshold,” he said. The applicant’s age and health also will be taken into consideration. “No one factor alone will decide an applicant’s case,” he said. The rule does not set specific dollar amounts that would disqualify an applicant from U.S. residency.
Public benefits that are part of the rule would include “general assistance,” such as supplemental security income, Supplemental Nutrition Assistance Program (SNAP, a.k.a. food stamps), most forms of Medicaid, and certain subsidized housing programs.
He stressed that the final rule would not impact “humanitarian-based immigration programs for refugees and asylees” and that it included exemptions for trafficking victims and victims of domestic violence.
The rule will apply prospectively to applications and petitions received starting on Oct. 15, 2019 of this year, Cuccinelli noted.
‘An Impossible Choice’
Healthcare professional organizations panned the rule.
“Make no mistake — this rule is a threat to the health of immigrant children and families,” said Mark Del Monte, JD, CEO and interim executive vice president for the American Academy of Pediatrics.
“The rule considers the use of public programs like Medicaid, SNAP, and housing assistance in this definition, forcing immigrant families into an impossible choice: keep your family healthy but risk being separated, or forgo vital services so your family can remain together in this country. This is really not a choice at all,” Del Monte said.
“The public charge rule further intimidates these families and expands on the chilling effects pediatricians have seen across the country ever since the proposed rule was issued, with families disenrolling from or avoiding critical health programs and services they are eligible for,” Del Monte added.
“This rule also threatens the stability of essential hospitals, which will sustain higher uncompensated costs as immigrants put off care and seek treatment later, only as a last resort, when they’re sicker and more costly to treat,” said Bruce Siegel, MD, MPH, president and CEO of America’s Essential Hospitals.
“In turn, this will drive higher costs for taxpayers and the entire healthcare system,” he said.
Rick Pollack, president and CEO of the American Hospital Association, also attacked the rule. “Access to nutrition aid, housing support, and other programs that address the social determinants of health would also be jeopardized. No one should have to fear obtaining needed services and medical care,” he said.
AIDS United called the rule “a de facto ban on all immigrants living with HIV and other chronic health conditions from becoming U.S. citizens.”
The rule “poses a direct threat to the health of millions of immigrants — especially those in marginalized communities including LGBTQ people, people living with HIV, people of color, women, and youth,” the group said in a press release.
Source: MedicalNewsToday.com
