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Experts: Trump's Public Charge Rule Will Hurt Us All

February 23, 2020 (3 min read)


"For over a year, millions of immigrant families in the United States have been living in fear. They have become targets of a confusing and malicious proposal by the Trump administration to change the “public charge” rule. This new change expands the factors that make otherwise legal immigrants ineligible for entry, legal permanent residency, or citizenship because they receive certain public benefits.

On Feb. 24, after surviving legal challenges, the Trump administration will finally implement its new public charge rule. The administration claims that the new rule will encourage self-sufficiency and limit costs. However, by constraining pathways to legal immigration, it punishes low-income families and jeopardizes public health.

The concept of “public charge” in the U.S. immigration system has existed since the 1880s. It has been used to deny entry and lawful permanent residency to those who would primarily depend on government assistance to survive. Until now, such benefits were limited to general cash assistance or long-term institutionalization at the government’s expense. Non-cash benefits like Medicaid, food stamps, and housing programs were available to immigrants for decades. Over 13.5 million legal immigrants use Medicaid and subsidized health insurance plans to remain healthy.

In this file photo, New York State Attorney General Letitia James holds a press conference at Foley Square to announce lawsuit against the Trump's Administration Public Charge Rule, a new rule that aims to deny Green Cards and Visas to immigrants that use or have used US Government assistance programs.

The new rule re-categorizes several non-cash health-related programs as “heavily weighted” negative factors. These include critical programs like Medicaid, the Children’s Health Insurance Program, subsidized health insurance through the Affordable Care Act, and the Supplemental Nutrition Assistance Program (the current name for food stamps). Immigrants who want to lawfully reside in the United States are being forced to choose between protecting their immigration status and ensuring they and their children have benefits essential to their health.

The administration proposed changing how it defines public charge in 2018. By 2019, the Kaiser Family Foundation found that nearly half of health centers nationwide reported significant numbers of immigrant families refusing or withdrawing from Medicaid, including steep declines among children. A May 2019 report from the Urban Institute estimates that 13% of adult immigrants or their family members started avoiding non-cash public benefits programs. This figure is even higher among low-income families (21%). Hispanic adults from immigrant families are twice as likely to avoid these programs compared to non-Hispanics (21% v. 9%). Even families who will be unaffected by the new public charge rule — those already with green cards or who are naturalized citizens — are avoiding public benefit programs to which they are entitled out of fear and confusion.

Furthermore, vulnerable groups like children, pregnant women, and patients with existing chronic diseases like diabetes or HIV are more likely to forgo or dangerously delay recommended medical care, including routine check-ups, health screenings and vaccinations. This compromise to healthcare access will lead to more avoidable complications, higher costs from emergency room visits and acute hospitalizations, and poorer health outcomes.

U.S. citizens will also be negatively affected. Fifty percent of Americans live in communities that have immigrant populations of at least 10%. Immigrants’ widespread disenrollment and impaired healthcare access are likely to decrease funding for local and regional health systems, affecting the health access of millions of Americans. Billions in revenue to hospitals and clinics will be lost, the cost of uncompensated care will increase, and safety-net providers will face more strain than ever.

In sum, the new public charge rule imposes significant costs on both citizens and noncitizens. It undermines the financial sustainability of our health systems, jeopardizes public health, and targets those most vulnerable among us.

There’s still much we can do to ameliorate the negative effects of the new public charge rule. Lawyers and healthcare providers can help guide immigrants through the confusing regulation. Citizens should vote for leaders who will champion sound public health and immigration policies."

Yale-Loehr is a professor of immigration practice at Cornell Law School. Shin is medical director of the Weill Cornell Center for Human Rights. Kingsbury is a student at Cornell Law School.