The Biden administration is expected to scrap the Trump era rule that allows federal officials to consider immigrants' use of public programs in their residency applications.
Health and immigration advocates cheered the Biden administration's announcement Tuesday that it will review a Trump-era rule that allowed immigrants' use of Medicaid and other public programs to weigh against their residency applications.
The White House's instruction that agencies review the so-called public charge rule was tucked into a broader executive order the administration said is designed to restore faith in the country's legal immigration system and promote integration of new Americans.
"The prior administration enacted hundreds of policies that run counter to our history and undermine America's character as a land of opportunity that is open and welcoming to all who come here seeking protection and opportunity," the Biden-Harris administration said in a statement. "This Executive Order elevates the role of the White House in coordinating the federal government's strategy to promote immigrant integration and inclusion, including re-establishing a Task Force on New Americans, and ensuring that our legal immigration system operates fairly and efficiently."
The controversial rule allowed federal immigration officials to consider legal immigrants' use of government health, nutrition and housing programs against them in their applications for permanent legal residency. It has been the target of multiple lawsuits, including from Biden's pick for HHS secretary, since it was finalized in August 2019. The Trump administration said in September 2020 it would apply the public charge rule retroactively to all applications filed since Feb. 24, 2020 after a federal appeals court ended an injunction that had prevented it from taking effect due to the coronavirus pandemic.
Powerful healthcare groups have come out against the rule, including the American Hospital Association, which asked the Biden administration to rescind the rule in December. AHA General Counsel Melinda Hatton said in a statement that's because the rule has reduced access to care through Medicaid and other vital programs for legal immigrants and their families.
"Disparities in enrollment in health care coverage among Latino and other immigrant communities increased since the rule took effect and the rate of children's health coverage dropped for the first time in decades," she said. "We appreciate the administration's review of this misguided policy and look forward to its reversal."
Some research has shown the rule has already led to disenrollment in government programs or eligible individuals opting not to enroll. More than one in six adults in immigrant families in 2020 reported they or a family member avoided a noncash government benefit program—such as Medicaid, the Children's Health Insurance Program, the Supplemental Nutrition Assistance Program or housing assistance—out of fear over their immigration status or inability to get a green card, according to an Urban Institute report released this week. That grew to more than one in three among families where one or more members did not have a green card, the report found.
"If you're a mom and you're worrying about whether accessing Medicaid will affect your immigration status, your ability to stay and take care of your kids, you are going to forgo medical care," said Emily Stewart, executive director of the consumer advocacy group Community Catalyst.
Community Catalyst works with a number of partner organizations nationally that reported seeing those effects well before the public charge rule took effect, Stewart said. A Kaiser Family Foundation report in October 2019 found that, even though the public charge rule hadn't yet been implemented, nearly half of health centers surveyed said many or some immigrant patients declined to enroll in Medicaid in the past year. More than a third said many or some immigrant patients were declining to enroll their children in Medicaid over the past year.
In her work as a pediatrician in South Carolina, Dr. Julie Linton encountered a lot of fear and uncertainty while talking to patients about enrolling in Medicaid or the Children's Health Insurance Program.
"Many families are not eager to talk about their immigration status in the context of a health visit, particularly during a time of enhanced enforcement," said Linton, chair of the American Academy of Pediatrics' Council on Immigrant Child and Family Health.
Even if the rule is rolled back, it will be a lengthy process for building back peoples' comfort in enrolling in programs they're eligible for, Linton said. It'll require partnerships between healthcare providers, community health workers and social workers, she said.
While some advocates had demanded the public charge rule be scrapped outright, Stewart said the Biden administration has set a precedent of first reviewing rules before rescinding them. She's confident that's what will happen here, too.
"It's just one step in what has to be many steps," she said.
The administration's executive order on immigration also directs agencies to conduct "top-to-bottom" reviews of recent regulations, policies and guidance that have set up barriers to legal immigration. It also rescinds Trump's memorandum requiring family sponsors to repay the government if relatives receive public benefits.