Providers Pan Trump Administration Final Rule on Public Charge

The 837-page expanded public charge rule limits who can get or keep a green card based on their use of government-sponsored programs.

The hospital lobby on Monday called on the Trump administration to rescind a newly expanded public charge definition that critics say would discourage legal immigrants from accessing Medicare, Medicaid and other government-sponsored healthcare. 

Rick Pollack, president and CEO of the American Hospital Association, called the Department of Homeland Security's Public Charge Rule "a step in the wrong direction when it comes to fairness with regard to the treatment of legal immigrants seeking a pathway to citizenship."

"It creates barriers to appropriately caring for the sick and injured, and to keeping people healthy. Failure to provide such services also has public health implications that could have widespread impact," he said.

The 837-page expanded public charge rule limits who can get or keep legal a green card based on their use of government-sponsored programs. The rule also treats applicants less favorably if they are poor, have health conditions, are either children or seniors, have large families, or lack education or English proficiency.

Pollack said the new rule would also worsen access for legal immigrants to nutrition aid, housing support and other programs that address social determinants of health.

By some estimates, as many as 26 million immigrants could be adversely affected by the expanded final rule. 

The White House issued a media release saying that the expanded rule was needed to "protect American taxpayers, preserve our social safety net for vulnerable Americans, and uphold the rule of law."

The Trump administration said the expanded rule is enforcing the existing Immigration and Nationality Act "which makes clear that those seeking to come to the United States cannot be a public charge."

"For many years, this clear legal requirement went largely unenforced, imposing vast burdens on American taxpayers. Now, public charge law will finally be utilized," the administration said.

Bruce Siegel, MD, president and CEO of America's Essential Hospitals, said the expanded definition "worsens the chilling effect that threatens the health of millions of people by making it more likely they forgo care for themselves and their families to avoid putting their legal immigration status at risk."

"This rule also threatens the stability of essential hospitals, which will sustain higher uncompensated costs as immigrants put off care and seek treatment later, only as a last resort, when they’re sicker and more costly to treat," Siegel said. "In turn, this will drive higher costs for taxpayers and the entire health care system."

Siegel said the expanded rule is "wholly unnecessary" because existing law already bars undocumented immigrants from Medicaid and other government assistance programs and requires legal residents to wait five years before enrolling in either Medicare or Medicaid.

Julie Linton, MD, chair of the American Academy of Pediatrics Council on Immigrant Child and Family Health called the final rule "an assault on my professional role."

"I am unsure how to guide families when I know that enrollment in bread and butter services that keep them healthy could jeopardize the family unity," she said. "This final rule serves to further intimidate and frighten families who seek needed services to keep them healthy and productive."

The National Immigration Law Center said it will file suit to block the final rule.

"This policy denies a permanent, secure future in this country to anyone who isn’t white and wealthy," NILC Executive Director Marielena Hincapié said. "We will not stand for it. The National Immigration Law Center is preparing to sue to fight back against this regulation and protect immigrant families."

California's Democratic Attorney General Xavier Becerra, a frequent and outspoken critic of the Trump administration, said the "vile" expanded rule "is the Trump Administration's latest attack on families and lower income communities of color."