Skip to main content


Trump Wielding Health Insurance as Immigration Wedge

By Steven Porter  
   October 07, 2019

After finalizing its controversial 'public charge' rule, which penalizes immigrants who obtain coverage through a government-sponsored health plan, the administration plans to bar immigrants from entering the country if they cannot demonstrate an ability to pay for their healthcare.

Beginning early next month, immigrants seeking visas will be denied entry into the U.S. if they cannot demonstrate their ability to pay for healthcare, under a proclamation issued Friday by President Donald Trump.

Immigrants will have to show that they will be covered by an approved form of health insurance within 30 days of entering the country. The list of approved plan types includes employer-sponsored insurance, short-term limited-duration insurance, and an unsubsidized plan through the Affordable Care Act's individual market, but it doesn't include subsidized ACA plans or Medicaid, according to the proclamation.

"Immigrants who enter this country should not further saddle our healthcare system, and subsequently American taxpayers, with higher costs," the proclamation states.

This isn't the first time the Trump administration has used health insurance as an immigration wedge. The government issued a final rule in August that expanded the definition of "public charge" to penalize immigrants who obtain insurance through a government-sponsored health plan.

Healthcare provider organizations—including the American Hospital Association, America's Essential Hospitals, and the American Academy of Pediatrics Council on Immigrant Child and Family Health—panned the public charge rule, arguing that it could frighten immigrant families into delaying needed healthcare. A lawsuit is expected.

Friday's proclamation applies to immigrants abroad who are applying for visas to come to the U.S., not to those who are already here. It doesn't apply to children, asylum seekers, or refugees. And the U.S. Secretary of State may make case-by-case exceptions.

The proclamation could affect families who are trying to bring their parents to the U.S., as Colleen Long reported for the Associated Press. That aligns with the Trump administration's stated intention of moving from a family-based immigration system to a so-called "merit-based" system.

About 69% of the U.S.-born population had private health insurance in 2017, while about 57% of immigrants had such coverage, according to the nonpartisan Migration Policy Institute. Meanwhile, about 36% of the U.S.-born population had public health insurance in 2017, and about 30% of immigrants had such coverage.

Since the ACA's implementation in 2014, the uninsured rate among the U.S.-born population fell from 12% in 2013 to 7% in 2017, and the uninsured rate among immigrants fell from 32% in 2013 to 20% in 2017, according to the institute.

Related: Trump Speech Offers Dizzying Preview of His Healthcare Campaign Strategy

Related: Republicans' Drive to Tighten Immigration Overlooks Need for Doctors

Related: Immigrants Comprise More Than 18% of Healthcare Workers

Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.

Photo credit: President Donald Trump, speaks to the media in the Rose Garden at the White House after meeting with Democrats to discuss the ongoing partial government shutdown. (Michael Candelori /

Get the latest on healthcare leadership in your inbox.