The Public Charge Chilling Effect Threatens All

John Baackes, CEO, L.A. Care Health Plan

September 26, 2019

Immigrant rights groups are calling the new Public Charge rule another brick in the Trump Administration’s invisible wall which sends the message that some people are just not welcome in this country. Not long after the election, the Administration started rolling out proposals and policies designed to keep more people out of the U.S. – whether it was the travel ban, adding a citizenship question to the Census, trying to overturn DACA, reducing refugee admissions, etc. The courts have intervened in most of these cases, and they might do so again for this new Public Charge rule. But while we wait for that, the impacts are being felt. The health of legal immigrants and the larger population is threatened, as is the nation's economy.

Public Charge is the "test" used by immigration officials to determine whether someone applying to enter the country or to become a permanent resident (green card holder) is likely to become primarily dependent on the government for subsistence. For more than a hundred years, immigration officials only considered public cash assistance and long-term institutional care. Starting October 15, they will also consider Medicaid (Medi-Cal), Supplemental Nutrition Assistance Program (SNAP/CalFresh), and/or housing assistance – all things that impact the health and wellbeing of the recipients of those benefits.

The new rule is harmful because it is spreading fear to many who might not be impacted by the rule at all. It has already created a devastating chilling effect in certain communities. The Urban Institute reports that one in seven low-income immigrant families were afraid to access public benefits after the rule was first proposed last year. One legal analysis of the American Community Survey estimated that as many as 26 million people in families with immigrants might be chilled from participating in programs.

Of course, for those who are directly impacted, the results could be devastating. The Kaiser Family Foundation says nationwide, 13.5 million Medicaid/CHIP enrollees, including 7.6 million children, live in a household with a noncitizen or are noncitizens themselves and may be at risk for decreased enrollment as a result of the rule.

Remember, this rule is targeting people who are in this country legally. It is specifically targeting those legal immigrants who are part of the working poor. The Fiscal Policy Institute has looked at the economic impact of the new Public Charge rule and found that a middle-level estimate on disenrollment from the various benefits programs would mean $12.5 billion fewer dollars funneled into the economy. For example, if there’s no SNAP money, then there is less spending in grocery stores. The institute says the ripple effect could double the loss.

The rule will not only mean fewer dollars funneled into the economy, but it will result in more dollars being utilized. Healthcare costs will certainly rise if people drop off Medicaid rolls. People without health coverage will forgo regular health care and will end up with much costlier episodic care in the emergency room. Some will forgo vaccinations, which has the potential of creating outbreaks of preventable diseases.

What is especially troubling is the new rule will mean many legal immigrants won’t access temporary services that could actually help them get past a tough time and begin to climb up the economic ladder. The vast majority of these people want to contribute to the country that they now call home and indeed, the U.S. economy is dependent on them. In fact, the National Skills Coalition reports that immigrants account for one in six U.S. workers, and are essential to businesses that are already struggling to fill open positions, particularly for middle-skill jobs. But sick people can’t work.

Numerous lawsuits have been filed, and it’s possible that the new Public Charge rule will not take effect on October 15 as scheduled, but it's also clear that the Administration's efforts to curtail immigration will continue. Immigrant rights advocates vow to keep up the fight against all rules and policy proposals that unfairly target these vulnerable populations. Health care and business leaders must lend their voice to the fight because we will all be touched in some way by this decision – whether through higher healthcare costs or lost productivity from an unhealthy workforce.


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