Healthcare groups blast proposed rule penalizing immigrants for using public benefits

A proposed rule issued by the Trump administration Wednesday would penalize legal immigrants for using government benefits like Medicaid, alarming a wide range of healthcare and public health organizations.

Leaders of many healthcare organizations, including the American Hospital Association, America's Essential Hospitals, the American Academy of Family Physicians, and the American Academy of Pediatrics, warn that the proposed rule would hurt public health efforts and reduce their ability to serve millions of low-income children and families. They have joined a broad coalition of advocacy groups seeking to block the rule.

The proposal, published in the Federal Register by the Department of Homeland Security, would allow federal immigration officials to consider legal immigrants' use of public health insurance, nutrition and other programs as a strongly negative factor in their applications for legal permanent residency.

Hundreds of thousands of children and other members of low-income legal immigrant families could drop out of public programs providing healthcare, nutrition and housing assistance due to the rule, experts said.

Following publication Wednesday, the public will have 60 days to comment on the plan.

The changes also would apply to citizens' and legal residents' requests to bring family members into the U.S., as well as to young people who have legal status under the Deferred Action for Childhood Arrivals program, known as Dreamers. They would not apply to people granted refugee status or political asylum.

The public benefits covered by the proposed rule include Medicaid, the Supplemental Nutrition Assistance Program and Section 8 housing vouchers. The agency is asking for public comment on whether the Children's Health Insurance Program also should be included.

Immigration officials currently are only allowed to consider families' use of public cash benefits and Medicaid long-term-care benefits in evaluating applications for legal permanent residency and legal entry into the United States. A 1999 rule clarification said non-cash benefits like Medicaid cannot be considered.

In a retreat from a leaked draft of the proposal earlier this year, the DHS proposal would not consider Medicaid or other benefits received by U.S. citizen children as a negative factor in their families' legal residency applications. Other changes from the leaked draft are that it would not consider Affordable Care Act premium subsidies, nutrition assistance under the Women, Infants, and Children program, use of earned-income tax credits, or participation in the Head Start educational program.

DHS Secretary Kirstjen Nielsen previously said the proposed "public charge" rule is consistent with long-standing U.S. policy requiring immigrants to show they can support themselves financially.

Healthcare leaders say the rule would drive up uncompensated care costs, increase use of emergency departments, endanger maternal and infant health and heighten the risk of infectious disease epidemics. It also could shift major costs from the federal government to state and local governments.

The American Hospital Association said "hospitals and health systems have serious concerns that those legally in the country could choose to forgo healthcare benefits—and therefore delay accessing care—out of fear of repercussions for themselves and their families. Forgoing care can exacerbate medical conditions leading to sicker patients and a higher reliance on hospital emergency departments. In turn, this could drive up costs for all purchasers of care."

The AAFP, the AAP, the American College of Obstetricians and Gynecologists, the American College of Physicians and the American Psychiatric Association said in a joint statement opposing the rule that it "upends decades of settled policy" and would make it much more likely that legal immigrants could be denied legal status or be deported merely on the basis of seeking needed health services.

More than 1,500 advocacy organizations, including the American Public Health Association and Families USA, have signed onto a joint statement opposing the proposed rule.

DHS estimated the regulation would affect about 382,000 people a year. But many experts said it would have a far broader impact.

That's because the families would worry that any member's use of those programs could jeopardize their legal status, whether or not they actually would be affected by the rule. Those concerns likely would spill over to citizen children of undocumented immigrants, who are not covered by the proposed rule.

In 2016, there were 10.4 million citizen children with at least one parent who isn't a citizen, and 56% had Medicaid or CHIP coverage. An estimated 27 million immigrants and their children are part of families with at least one member receiving public benefits, according to the Migration Policy Institute.

The proposed public charge rule is part of the administration's broader campaign to limit both legal and illegal immigration, including bigger border barriers and stepped-up detention and deportation of undocumented residents.

Critics pointed to the timing of the proposed rule's publication a few weeks before the hotly contested congressional and state elections, in which immigration is a major issue. They say the administration likely hopes the proposal will motivate anti-immigration Republicans to turn out to vote.

Groups opposed to the proposal have signaled they will consider litigation to block the rule, possible on the grounds that the Department of Homeland Security did not offer a reasonable justification for changing longstanding policy.