This feature was written in partnership with Providence St. Joseph Health.
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In September, a peculiar thing started happening at the offices of the immigrant advocacy group, Make the Road New York. Dozens of immigrants began asking to cancel their benefits because they were nervous. Earlier that week, the Department of Homeland Security (DHS) had announced plans to treat certain public assistance programs, like Medicaid and food stamps, as “negative factors” on the visa and green card applications of legal immigrants. These men and women were prepared to give up their healthcare and other benefits, lest they risk being forced to leave the U.S.
Under the proposed regulation, the Trump administration aims to change “public charge” policies that determine how the use of public benefits would affect an immigrant’s ability to enter the U.S., obtain a green card or become a permanent resident. If the regulation is finalized, immigration officers could reject a visa application if they believed that person would be likely to enroll in non-emergency Medicaid, the Supplemental Nutrition Assistance Program (food stamps) and Section 8 housing vouchers and other programs.
The current proposal, which is open for public comment until Dec. 10, has engendered fear among immigrants around the country. Many have stopped signing up for — or have actively disenrolled from — benefits programs, according to the American Public Health Association. And the effects of this proposition are likely to have further consequences, according to a November analysis by policy advisory group Manatt Health.
Nearly 1 million children currently covered by Medicaid or the Children’s Health Insurance Program (CHIP) could lose their benefits under proposed changes to the current “public charge” policy.
CHIP was not included in the original proposal, but DHS has requested public comment on whether it should be added to the mix. Proposed federal regulations must go through a public comment period before they are enacted as policy.
Providence worries about a “chilling effect” in which immigrants fear retribution from the government for receiving benefits they’re entitled to under law. “We want to fight back against the culture of fear this is creating,” says Ali Santore, group vice president of government and public affairs for nonprofit Catholic health care system, Providence St. Joseph Health. “We’re seeing immigrants terrified to sign up or re-enroll [for benefits], and these are legal immigrants,” she says. Satore also worries the panic will cause immigrants to disenroll from public assistance programs that aren’t included in the proposition at all. This is already beginning to happen in some parts of the country. According to a recent Migration Policy Institute (MPI) report, some immigrants have stopped using public libraries.
An estimated 13.2 million legal immigrants now enrolled in Medicaid and CHIP in the U.S. would potentially be impacted by the move. In addition to the nearly 1 million children at risk of being disenrolled from Medicaid, there are 6.7 million children on those programs living in a household with a non-American citizen. They could possibly lose coverage as well.
The Trump administration says it’s merely providing clarity to immigration laws going back centuries. “Under long-standing federal law, those seeking to immigrate to the United States must show they can support themselves financially,” said Homeland Security Secretary Kirstjen Nielsen in announcing the proposal. Reihan Salam, executive editor of the conservative National Review magazine, argued in a column earlier this year that the current public charge rules are “too lax.” The waitlist for family-sponsored green cards is long, Salam points out, and if some immigrants do not meet the new public charge standards, there are likely to be others who can meet the standards and will take their place. “There are millions of potential migrants from outside Europe and Canada,” Salam writes, “who are capable of supporting themselves without relying on safety-net benefits and refundable tax credits.”
Still, Satore and Providence argue that when policies put barriers in place for healthcare access, the outcome is negative for everyone. “We believe that access to healthcare is not only the right thing to do, it’s also the most economically responsible thing to do,” Satore says. When people don’t have insurance, she says, they resort to the most expensive part of the healthcare system: the emergency room. But if they have Medicaid they are more likely to take care of their health up front.
While the rule’s final wording and its start date remain undetermined, its fate almost certainly will be decided in court. The City of Baltimore recently filed a federal lawsuit challenging a similar State Department regulation, laying out the legal lines of attack — though many anxious immigrants aren’t waiting to see the result.