The ‘Public Charge’ Rule Is Putting A Chilling Effect On Healthcare

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 not welcome in this country.

Not long after the 2016 election, the administration started rolling out proposals and policies designed to keep more people out of the U.S. Federal officials created a travel ban, added citizenship question to the Census, tried to overturn the Deferred Action for Childhood Arrivals program and reduced refugee admissions.

The courts have intervened in most of these cases, and they may do so again for the new “public charge” rule. But while we wait for that, our immigrant families are feeling threatened—which also impacts the larger community.

When someone applies to enter the country or become a permanent resident (green card holder), immigration officials use what they call a “public charge test” to determine if the person is likely to become primarily dependent on the government for subsistence. For more than 100 years, immigration officials only considered whether people had received public cash assistance and long-term institutional care when they made these decisions.

But starting Oct. 15, immigration officials will also consider whether people have enrolled in Medicaid, a low-income health program known as Medi-Cal in California; Supplemental Nutrition Assistance Program, known as CalFresh here; and housing assistance. All of these benefits impact the health and well-being of the recipients.

The new rule is doubly 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 reported 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 dissuaded from participating in programs.

Of course, for those who are directly impacted, the results could be devastating. The Kaiser Family Foundation reports that nationwide, 13.5 million Medicaid and Children’s Health Insurance Program 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 immigrants who have legal clearance to be here but are part of the working poor.

It is a cruel policy, and it threatens to harm the broader community. Health care costs will certainly rise for everyone 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.

As a health plan that is committed to providing access to healthcare for some of our most vulnerable populations, including immigrants, L.A. Care Health Plan has implemented an informational campaign to try to limit harm from the new rule. Our call center employees, staff at our Family Resource Centers and our member advisory committees have been armed with general information and a list of legal resources to pass on to any member who inquires about the new rule.

We also enlisted the National Immigration Law Center to conduct a webinar for our providers. About 300 providers participated, many of whom had witnessed their patients’ fear firsthand. They, too, received general information about the rule, a list of legal resources to pass along to anyone with questions about their status, and information about how to respond should immigration enforcement officials show up at their offices.

It’s disheartening to think that this informational campaign is necessary. We have to wonder, why would our government implement a policy that so clearly threatens the health of the country?

The new “public charge” rule has left some of our L.A. Care members with an agonizing choice to make—forgo public benefits, including health care, or risk their chance at permanent residency in the future. It is a personal choice. We can only help provide some of the information they need to make an informed choice.

Numerous lawsuits have been filed, and it’s possible that the new “public charge” rule will not take effect on Oct. 15 as scheduled. But it’s also clear that the Trump 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.

Healthcare leaders must lend their voice to the fight.

John Baackes is the CEO of L.A. Care Health Plan, the nation’s largest publicly operated health plan serving more than 2 million members. A version of this article was originally published by the California Health Report.