Population Care

New “public charge” rule will put immigrants’ health at risk

If the government is allowed to go forward with a sweeping expansion of the criteria that determine which immigrants are considered a “public charge,” the new definition will wreak havoc on the health of already vulnerable immigrant children, pregnant women and the disabled, physicians told a federal court. 

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The Litigation Center of the American Medical Association and State Medical Societies has joined the Washington State Medical Association and several other physician organizations in filing an amicus brief in the U.S. District Court for the Eastern District of Washington. They are urging the court to issue the preliminary injunction that is being sought by the state of Washington officials to stop the new regulation. 

“Immediate and irreparable harm … will impact millions of vulnerable individuals” if the court does not issue the injunction to halt the Department of Homeland Security (DHS) regulation’s enforcement, says the brief, filed in the case of State of Washington v. United States Department of Homeland Security

Without an injunction against the regulation, there is a bigger likelihood that lawful immigrants and their families will not seek health and nutrition benefits they are entitled to because of fear that doing so would hurt their immigration status, the brief says. 

“Though DHS claims the regulation is intended to promote self-sufficiency, there is no evidence that chilling the use of health and nutrition benefits will result in an increase in income, employment or educational status of immigrants,” the brief says. “These sweeping and detrimental changes will ultimately result in far greater costs to the public’s health than any purported benefit offered by DHS.” 

The case is one of a dozen lawsuits regarding the controversial rule. In October, Judge George Daniels of the U.S. District Court in Manhattan issued a preliminary nationwide injunction blocking implementation of the rule. Read the judge’s opinion in the case, for which the AMA also filed an amicus brief. 

What changed? 

DHS in August promulgated a regulation that dramatically altered what immigration officials consider when evaluating whether a person seeking to immigrate will be deemed a “public charge.” The new definition also could lead to the government adjusting an immigrant’s status. If an immigration officer concludes an immigrant is a public charge, the government can deem the immigrant inadmissible to the country. 

Previously, a public charge was someone who would likely become primarily dependent on the government. For example, someone who received cash assistance or someone institutionalized in a government-funded long-term care facility. 

Now, DHS defines a public charge as an immigrant “who receives one or more public benefits … for more than 12 months in the aggregate within any 36-month period.” If someone receives two benefits in one month, that counts as two months. The regulation also expanded “public benefits” to include health, nutrition and housing programs such as nonemergency Medicaid for nonpregnant adults and the Supplemental Nutritional Assistance Program (SNAP). 

Related Coverage

How can physicians care, and advocate for, undocumented immigrants?

How will it hurt immigrants? 

A May 2019 study from the Urban Institute—issued before the DHS rule had been made final—found that one in seven adults in immigrant families already reported avoiding noncash public benefits over the past year because they feared that doing so would harm their legal immigration status.  

Survey results included in the study, “One in Seven Adults in Immigrant Families Reporting Avoiding Public Benefit Programs in 2018,” showed that low-income members of immigrant families reported even higher avoidance rates:  

  • 46% reported opted against SNAP benefits. 
  • 42% decided not to seek medical benefits such as Medicaid and the Children’s Health Insurance Program (CHIP). 
  • 33% avoided public housing subsidies. 

“It is expected that the rates of avoidance will be markedly higher” once the new DHS rule is enforced, the AMA Litigation Center brief tells the court.  

That will result in children losing health insurance coverage, likely contributing to deaths and future disabilities. And the brief notes that access to health insurance increases a child’s likelihood of graduating high school and attending college. 

With fewer people seeking SNAP assistance, children will not have access to nutritional food that “is fundamental to the health development of all children,” the brief tells the court. That matters because “children in immigrant families that receive SNAP benefits are more likely to be in good or excellent health, be food secure and reside in stable housing.” 

The regulation will have similar damaging effects on pregnant women, as well as the disabled. Prenatal care results in fewer low birth weight babies and newborn deaths. For the disabled, access to Medicaid is critical to helping ensure they can attend school and work, the AMA Litigation Center brief tells the court.