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Analysis

Advocates Rip Proposal to Penalize Immigrants Who Use Public Health Benefits

By John Commins  
   September 24, 2018

Critics say the 'draconian' proposed rule would prompt legal residents to forego medical care for fear of losing their green cards, with the higher costs of delayed care borne by taxpayers.

The Trump administration's proposal to expand public charge designations to Medicaid and Medicare Part D subsidies and other benefits will jeopardize the healthcare access of millions of legal residents, critics charge.

The 447-page proposed rule, which was unveiled Saturday by the Department of Homeland Security, would create "a strong disincentive to seek care," said Bruce Siegel, MD, president and CEO of America's Essential Hospitals.

"This rule would force people to forgo medical visits and medications until they are sicker and costlier to treat. It would drive higher levels of uncompensated hospital care and, ultimately, higher costs for insured patients and taxpayers," Siegel said in a media release.

Rick Pollack, president and CEO of the American Hospital Association, echoed Siegel concerns about delayed care, and urged DHS "to rethink this policy that could affect the health of millions."

"America's hospitals and health systems have serious concerns that those legally in the country could choose to forgo health care benefits—and therefore delay accessing care—out of fear of repercussions for themselves and their families," Pollack said.

In a statement on its website, DHS said it is "proposing to consider current and past receipt of designated public benefits above certain thresholds as a heavily weighed negative factor. The rule would also make nonimmigrants who receive or are likely to receive designated public benefits above the designated threshold generally ineligible for change of status and extension of stay."

DHS said it estimates that "about 382,264 aliens seeking adjustment of status annually would undergo review annually to determine whether they are ineligible on public charge grounds."  The rule would not apply to families making less than 15% of the federal poverty designation.

Homeland Security Secretary Kirstjen Nielsen noted that the "public charge" dates back to the Immigration Act of 1882, and is designed to ensure that new immigrants are not a financial burden for the United States. 

"Under long-standing federal law, those seeking to immigrate to the United States must show they can support themselves financially," Nielsen said. "This proposed rule will implement a law passed by Congress intended to promote immigrant self-sufficiency and protect finite resources by ensuring that they are not likely to become burdens on American taxpayers."

The proposed rule change does not require Congressional action, and DHS could impose the new rule after a 60-day public comment period is published in the Federal Registry, which is expected this week.

The Trump administration has made restrictions on immigration one of its top priorities, and the 60-day public comment period would extend through November's mid-term elections, likely making the proposed rule campaign fodder for Republicans and Democrats.

John Baackes, CEO of L.A. Care Health Plan, called the proposed changes politically motivated and said they could adversely affect more than 170,000 members of the nation's largest publicly operated health plan.

"The proposed change has already had a chilling effect, with anecdotal reports that people are choosing not to access benefits for which they currently qualify," Baackes says.

"The changes, once they become effective, are very likely to exacerbate serious problems that impact the health of the immigrant community," he says. "We are likely to see more hunger, child poverty, homelessness and a wide array of unmet health needs, as families may be unwilling to seek and maintain health care coverage, or enroll in other important programs, due to fear of the rule." 

Frederick Isasi, executive director of Families USA, said the proposal was "cruel, shortsighted, and violates our nation’s values."

"Families should never be forced to choose between being able access the healthcare and medicine they need and being together," Isasi said.

"Under the administration's draconian proposal, lawfully-present immigrants who access lifesaving programs like Medicaid,or Low-Income Subsidies for the Medicare Prescription Drug benefit would be in jeopardy of losing their current legal status or attain permanent resident status," he said.

John Commins is a senior editor at HealthLeaders.


KEY TAKEAWAYS

The Trump administration says the proposed rule would ensure that immigrants are not a burden on U.S. taxpayers.

Patient advocates say the rule would intimidate legal residents away from seeking heathcare.

Proposed rule will likely be a hot-button issue for November mid-term elections.


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