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Friday, September 7, 2018

Looming Public Charge Draft Threatens Coverage for Millions

The Trump White House is reportedly poised to release a major change to immigration policy that would penalize lawful immigrants. As we described when a draft of this regulation leaked in April, “the proposed regulation targets families who have immigrated lawfully, as well as their U.S. citizen relatives, by undermining their access to basic needs, including food, shelter, and health care.”  We have now learned that low-income immigrant parents are rapidly disenrolling from a basic food support program for infants and preschool children, putting their babies at serious risk of malnutrition in order to avoid deportation. 
If this policy change moves forward, then we are asking these parents to choose between food and medical care for their infant children and legal residency. This is destructive, dangerous and foolish. America should not be forcing parents to choose between the health of their babies and deportation. 

Public Charge

Most immigrants who are either entering this country or applying for lawful permanent residency must show that they are not likely to become a “public charge” – that is, they will not be dependent on the U.S. government for their financial support. This law has been in place for a long time, and over its history the test for public charge has focused on whether applicants ever received cash assistance, such as Temporary Assistance for Needy Families (TANF) or Supplemental Security Income (SSI), and whether they are likely to need that cash assistance in the future. (The test also examines whether immigrants are likely to need long-term nursing home care paid for by the government.) 
The Trump Administration is about to release a regulation to dramatically expand the list of benefits that would be considered in a public charge determination to include (among others) whether the applicant or his/her dependents ever received food assistance, or purchased health insurance through the marketplace with federal premium tax credits, or enrolled in Medicaid or the Children’s Health Insurance Program (CHIP). Furthermore, proposed regulations may increase the authority of federal immigration agencies to not only deny applications for permanent residency but to deport immigrants based on nothing more than their use of health care services or other assistance for which they fully qualify. 

Dramatic Declines in Enrollment

We are starting to learn of what will likely become a drumbeat of qualitative and quantitative evidence that immigrants are abandoning basic—and unquestionably appropriate and necessary—public services for their young children, many of whom are American citizens. The WIC program (more fully the Supplemental Nutrition Program for Women, Infants and Children) prevents hunger and malnutrition for millions of pregnant women, infants and children under 5. There are few if any programs that are less politically controversial or more fundamental to who we are as a society. The program provides low-cost targeted food assistance at the most critical time for nutrition. 
On September 3rd, Politico reported that “Agencies in at least 18 states say they’ve seen drops of up to 20 percent in enrollment, and they attribute the change largely to fears about the immigration policy.” Given that immigrants are a limited minority of WIC enrollees, this indicates catastrophic levels of disenrollment among immigrants. Victoria Pelham of Bloomberg Law/BNA reports  numerous indications of a beginning to drops in Medicaid enrollment for immigrant children, quoting a pediatrician at a clinic in Washington DC that “Latin American immigrant parents who decided not to renew [health] coverage for their young son with sickle cell disease who’s a patient at her clinic. The illness is chronic, and he could wind back in the hospital.” 
These program disenrollments are the tip of the iceberg--merely in anticipation of a regulation which is likely to be formally proposed this fall and then potentially finalized in late 2018.
A policy of making lawful immigrants choose between staying in the United States and buying medicine or feeding their infant children is not only inhumane. It is not only un-American. It is foolish. We all will pay the costs of children growing up malnourished and with untreated medical conditions.