Public Health

How AMA is fighting to stop “public charge” immigration rule

Tanya Albert Henry , Contributing News Writer

Editor’s note: The Department of Homeland Security announced in March 2021 that the government will no longer be defending the 2019 “public charge” rule. The U.S. Department of Justice also has dismissed its pending appeals in the Supreme Court and 7th U.S. Circuit and is in the process of dismissing is appeal in the 4th U.S. Circuit. Learn more.

As numerous legal challenges to a Trump administration rule that vastly expands which immigrants are considered a “public charge” wind their way through federal courts nationwide, physicians are letting judges know how the change puts immigrants’ health at risk—especially already vulnerable children, pregnant women and people with disabilities.

Advocating for immigrants

All patients deserve timely access to quality medical care. The AMA is fighting to secure this right for immigrants in the US. 

The change “dramatically increases the likelihood that lawfully present immigrants and their families will forego health and nutrition benefits to avoid negatively impacting their immigration status,” briefs from the Litigation Center of the American Medical Association and State Medical Societies tell the courts.

The AMA Litigation Center has joined state medical societies and medical specialty societies in filing briefs in a number of cases challenging the controversial new public charge rule and asking for preliminary injunctions to stop the change from going into effect while the courts consider whether the rule should be struck down permanently.

Find out more about the cases in which the AMA Litigation Center is providing assistance and learn about the Litigation Center’s case-selection criteria.

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Each of these briefs asks the respective court to put or keep a preliminary injunction in place to prevent further harm and damage to immigrants’ health. The cases include:

Casa de Maryland Inc. v. Trump. This case was on appeal to the 4th. U.S. Circuit Court of Appeals from the U.S. District Court for the District of Maryland.

City and County of San Francisco; County of Santa Clara v. U.S. Citizenship and Immigration Services. This case is on appeal to the 9th U.S. Circuit Court of Appeals from the U.S. District Court for the Northern District of California.

State of California v. U.S. Department of Homeland Security (DHS). This case is filed in the U.S. District Court for the Northern District of California. The case was joined with the City and County of San Francisco; County of Santa Clara case.

The AMA Litigation Center also joined the Washington State Medical Association and other physician organizations in filing a brief in State of Washington v. DHS that challenges the rule and asks for a preliminary injunction in the U.S. District Court for the Eastern District of Washington.

Learn more from the AMA about that case and how the new “public charge” rule will put immigrants’ health at risk.

The AMA Litigation Center partnered, too, in a brief in the case —DHS v. New York— in which the U.S. District Court in Manhattan issued a preliminary nationwide injunction that blocked the rule from being implemented.

In a 5–4 U.S. Supreme Court decision in late January, the nation’s highest court lifted a nationwide injunction on the rule that the Manhattan District Court had put in place in DHS v. New York.

The Supreme Court ruling applies to any cases in which a lower court granted a nationwide injunction, including the Casa de Maryland and State of Washington cases. The ruling allows the government to enforce the new public charge rule in those places. However, the underlying lawsuits challenging the rule itself will continue to move forward.

Meanwhile, the ruling does not affect preliminary injunctions that were more geographically specific. For example, the City and County of San Francisco; County of Santa Clara and the California v. DHS preliminary injunctions will remain in place, as will a ruling from a judge in Illinois who limited the preliminary injunction to that state.

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The Trump policy gives the government more leeway to deny visas or green cards for legal immigrants. DHS previously defined a public charge as someone who would likely become primarily dependent on the government, receiving cash assistance or become institutionalized in a government-funded long-term care facility.

The new rule expands the definition of “public benefits” to include health, nutrition and housing programs, including nonemergency Medicaid for nonpregnant adults and the Supplemental Nutritional Assistance Program known as SNAP. It also limits how many public benefits an immigrant can receive before being deemed a public charge.

While the Trump policy at issue in these lawsuits involves legal immigrants’ access to government benefits, the AMA has been, and continues to be, deeply committed to ensuring the health and safety of all individuals regardless of immigration status. That includes a focus on conditions at immigrant detention centers at the Southern border.

The AMA is urging the administration and Congress to work with the AMA and other medical and mental health care experts to develop policies that ensure the health of children and families is protected throughout the immigration process.