Public Charge and Employee Health

A joint blog by L.A. Care Health Plan and Health Net

December 20, 2018

The term Public Charge has received quite a few headlines in the past few months, but many in the business community may not have fully absorbed what impact changes to the longstanding federal policy could have on the health of the workforce. Many health care experts fear adverse health outcomes for workers and their families if proposed changes are implemented.

On October 10, the Department of Homeland Security (DHS) published proposed changes to the Public Charge rule which has been in place for more than a century. Public Charge is a term used by U.S. immigration officials to refer to a person who is primarily dependent on the government for subsistence. Historically, one was considered a public charge if they received cash benefits or long-term care. But DHS has proposed changes that will greatly expand the set of benefits in determining public charge status. The changes would primarily affect people lawfully present in the United States who are working, in several key industries, and applying for a green card.

Under the proposed changes, immigration officials will still consider cash assistance and long-term care in determining whether an individual is a Public Charge. However, they will also be able to consider use of Medicaid, food stamps, Medicare Part D subsidies, and housing assistance such as Section 8 vouchers as grounds for denying a green card. These changes could leave many in the position of choosing between important support programs and a chance at permanent residency.

The Kaiser Family Foundation estimates the changes would lead as many as 4.9 million Medicaid/Children’s Health Insurance Program (CHIP) enrollees across the nation to disenroll. Although CHIP is not in the proposed changes, analysts predict fear will cause parents of even U.S.-born children to pull out.

Here in California, where one in every two children has a foreign-born parent, the rule change could have a dramatic impact. The American Academy of Family Physicians says if the proposed change is enacted, it will “endanger public health,” not just immigrant health. One specific area of concern is immunizations. The CDC estimates that influenza killed more than 80,000 people in the U.S. during the last flu season. In October, the board president of the California Academy of Family Physicians told the Sacramento Bee that its member physicians were already “having difficulty getting our immigrant children and adults in for flu shot.” Flu and other illnesses do not discriminate based on immigrant status.

Spread of communicable diseases is just one area that the DHS itself admits could be impacted by the changes to the Public Charge rule. DHS says other potential consequences are increased obesity and malnutrition, and increased rates of poverty, housing instability, and access to our education system, including early childhood education all of which can lead to reduced productivity and educational attainment.

Although DHS indicates cost savings to the government under the proposed regulation, the agency also points out that the rule changes could result in an increase in uncompensated health care not paid for by an insurer or the patient. Immigrants who are lawfully in this country- many of whom with employment visas- may delay medical treatment; thus, resulting in increased use of emergency rooms and overburdening the public health system.

A public comment period on the proposed changes to the Public Charge rule ended on December 10. Once DHS has completed a review of all comments, it will publish a final rule in the Federal Register. The new rule will take effect 60 days later. 

 

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