Physicians Call for Administration to Rescind ‘Public Charge’ Proposal

Acoalition of frontline physicians, including APA, is urging the Trump administration to rescind a proposed rule to deem more immigrants who use Medicaid or other social safety net services “a public charge” and bar them from entering the United States or obtaining a green card.

The Department of Homeland Security’s (DHS) proposed rule would alter the long-held standards used to determine whether a person is likely to become dependent on the government for subsistence, known as “a public charge,” to newly include use of most noncash public benefits. Current rules penalize immigrants who receive cash welfare payments, but the proposal seeks to add use of other benefits such as Medicaid, public housing or Section 8 benefits, and food stamps. DHS is also “considering” adding the use of the Children’s Health Insurance Program (CHIP).

Immigration has dramatically increased over time (14 percent of the U.S. population were foreign born in 2015, compared with 5 percent in 1950), but the foreign-born population uses public benefits at virtually the same rate as native-born Americans: about 3 percent of noncitizens use public benefits versus 3 percent of U.S. citizens. Many see the proposal as the administration’s latest salvo against immigration, since its policy of separating families at the border and efforts to obtain funding for a border wall have failed.

The concern is that immigrants will forgo critical health care, such as immunizations or treatment of communicable diseases, or other needed services to avoid being removed from the country.

“The regulation upends decades of settled policy with regard to public charge and would make it much more likely that lawfully present immigrants could be denied green cards or U.S. visas, or even be deported, merely on the basis of seeking needed health services for them and their family, including those for which they are eligible,” the physician coalition wrote in a statement.

In addition to APA, the coalition includes the American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and American College of Physicians, representing more than 400,00 of America’s frontline physicians.

“Rather than face that threat, many of the patients served by our members almost certainly will avoid needed care from their trusted providers, jeopardizing their own health and that of their communities,” stated the coalition.

If finalized, the change would impact individuals who are applying for a green card to enter the United States as well as temporary visa holders seeking an extension or modification. The rule could extend beyond its intended recipients to affect existing green card holders or to family members of immigrants.

When federal welfare was reformed in the 1990s, even classes of immigrants and refugees not touched by changing policies abandoned their benefits in significant numbers out of concerns that it could jeopardize their citizenship status—or that of a loved one—because of a lack of understanding of who was targeted or which programs were affected, explained Michelle Mittelstadt, a spokesperson at Migration Policy Institute.

The DHS proposal would make current and past receipt of most public benefits “a heavily weighed negative factor” and would make nonimmigrants receiving such benefits “generally ineligible for change of status and extension of stay,” according to a DHS statement. Individuals needing disaster relief or emergency medical assistance would remain exempt from the rule, as would individuals seeking asylum or refugees.

“The proposed regulation not only threatens our patients’ health, but as this deferred care leads to more complex medical and public health challenges, it will also significantly increase costs to the health care system and U.S. taxpayers,” the physician coalition wrote.

Comments on the proposed rule must be posted by December 10 at www.regulations.gov. ■

 The coalition’s statement can be accessed here. The proposed rule is available here.