Let’s talk about immigration policy changes and how they impact public health

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I was recently asked to talk about immigrant health policy on Boston Public Radio. The hosts of the show were interested in learning about my research on the potential impacts of a proposed immigration rule known as the ‘public charge’ rule.

What is the public charge rule?

When an immigrant applies for a visa to enter the country or for legal permanent residency status (a ‘green card’), an immigration official can review the application and determine if the immigrant may be reliant on government

benefits in the future. For the last century, our government has looked at two things: whether a person was on cash assistance or institutionalized in a government-funded facility. The proposed rule would drastically change this policy and instruct immigration officials to take into account a much wider variety of factors including age, medical conditions, and whether the person has used non-cash benefits like non-emergency Medicaid, food stamps, housing assistance such as Section 8 housing vouchers and Medicare Part D low-income subsidies.

What does this mean for children’s health?

According to our research, the rule is expected to cause millions of children who need medical care to be disenrolled from Medicaid and the Children’s Health Insurance Program (CHIP), mostly out of fear or confusion. Essentially, in an effort to keep their families together and be eligible for green cards, immigrants are likely to disenroll themselves and their family members from these benefits even when the rule does not apply to them. For example, in our study, nearly 90% of the children who are likely to be disenrolled from benefits are United States citizens – these are citizen children living with non-citizen adults who are likely to disenroll their families from benefits out of fear and confusion. For children in need of medical care, loss of health insurance benefits could have severe impacts on health outcomes, in the short term and into the future.

And recent research from the Urban Institute shows that 1 in 10 citizen immigrants are already avoiding government benefits even though the proposed rule is not yet approved and not in effect – confirming that 1) people to whom this rule does not apply are avoiding benefits due to fear and confusion, and 2) citizens of our country are avoiding benefits to which they are legally entitled.

What can we do about this?

  1. Know your rights and educate yourself and others. There are many exclusions to the rule, and it does not apply to all immigrants. Protecting Immigrant Families has some great information.
  2. Keep your benefits and encourage others to do the same. The rule is not approved, is not in effect, and will not be retroactive so there is no reason to disenroll from benefits now!
  3. Speak out! Talk to your representatives in congress and tell them that this rule, and the many anti-immigrant rules that are being proposed are bad for our country. Here are some talking points to use:
    • These rules are dangerous – they weaponize basic needs, which is not consistent with our country’s values.
    • These rules discourage immigration, which our country and our healthcare system rely on. We at the Institute for Community Health have shown that immigrants subsidize Medicare and private health insurance for others, and that immigrants disproportionately provide care to our elderly and disabled – a population that is growing and already is experiencing severe workforce shortages.
    • These rules have many other spillover effects – that is, effects on the health and wellbeing of others. If the proposed rule goes into effect, it will result in roughly $340-620 million dollars less in funding to community health centers and will cost roughly 3,400-6,100 healthcare jobs.

This is a dangerous and scary time for vulnerable populations in our country. We at ICH are striving to make the invisible visible – highlighting the critical role vulnerable populations play in the United States and building evidence about the potential implications of dangerous policies. The message is clear – these policies are dangerous to our public’s health, and we need to fight back!

Leah Zallman, MD, MPH

Director of Research