It’s Getting Chilly in Here

When my youngest daughter came home from her first day of preschool nearly seven years ago, she told me about her new best friend. Every day, she would come home with a new story about how she and her friend played tag, made fairy houses in the playground, or how her new friend shared the most delicious dumplings ever.

It wasn’t long before she was asking me to initiate a play date. About a month after her first day at preschool, I had to awkwardly introduce myself to her new friend’s mother. We exchanged numbers and before long, had a playdate scheduled. This was the beginning of a beautiful friendship for me as well. It involved long play dates, conversations about family and marriage, and many dinners as our families grew closer. In this time, their family added another beautiful daughter and we were honored to be invited to her rice feeding ceremony.

In our many conversations, I also came to learn that although my daughter’s friend and her little sister were American citizens born in the United States, their parents were here on temporary visas and in the process of applying for legal permanent resident (LPR) status. The process is long and expensive, but they were hopeful that citizenship was not out of reach.

That is until late 2018, when the Trump administration announced a proposed change to a little-known rule known as the public charge rule. This proposed change, if implemented, has the potential to end those dreams of citizenship and uproot this family to a country that has now been their home for over a decade.

What is the public charge?

In its determinations of who is eligible for admission into the United States, U.S. Citizenship and Immigration Services (USCIS) uses the phrase “public charge” to refer to an individual who is likely to become primarily dependent on the government for support. The current rule used by USCIS defines public benefits as cash assistance programs, including Temporary Assistance for Needy Families (TANF), and Supplemental Security Income (SSI), as well as long-term institutional care paid by the government.

On October 10, 2018, the Department of Homeland Security (DHS) posted a proposed change to public charge regulations in the Federal Register. The proposed rule would expand the types of services considered to be public benefits to include the Supplemental Nutrition Assistance Program (SNAP), Medicaid, the Medicare Part D Low-Income Subsidy Program, and several housing programs.

Under current law, a public charge assessment is made when a person applies to enter the U.S. or adjust their status to obtain a green card. Under the proposed rule, a public charge assessment would be made in two additional circumstances: when a person applies to extend a current visa or change visa types. Overall, more legal immigrants will be subject to the public charge test.

For the family I know, this means that when they apply for LPR, they may fear that their children’s use of Medicaid benefits could be used to deny their application.

And in May, Reuters reported that a draft regulation from the U.S. Department of Justice would make it easier to deport people because they use such benefits. Reuters described the plan as one of the Trump administration’s efforts to restrict legal immigration to the U.S.

The chilling effect

In the months after the proposed DHS rule change was made public in October, researchers have reported a “chilling effect” among U.S.-born children of immigrant parents and/or naturalized citizens that are not subject to the rule. This is because the proposed rule changes are complicated, and, rather than risk their status, many mixed immigration households are choosing to forgo benefits altogether. Chilling effects, by definition, end up affecting people whom the laws aren’t designed to target. 

Researchers predict that many children will end up paying the price as they are disenrolled from benefits such as Medicaid and Children’s Health Insurance Program (CHIP) out of fear that use of these benefits could jeopardize their parents’ citizenship status. Currently, CHIP is not one of the benefits included in the expanded list of programs that are considered in determining whether a person is a likely public charge. However, researchers are observing that this fact does not dispel fears among immigrant communities that utilization of this benefit might hurt their citizenship status and increase their chances of deportation.

A May 2019 Urban Institute study found that adults in immigrant families living with children under age 19 were more likely to report chilling effects (17.4 percent) than adults without children in the household (8.9 percent). 

What this means for public health

The proposed rule could substantially deter families from using public benefits because the list of public benefits considered is much longer than the current list, the proposed rules are highly complex, and the ultimate outcome of the public charge test is difficult to predict. This fear will extend beyond the individual immigrant subject to the public charge test and impact the entire family and community.

According to a Kaiser Family Foundation analysis, the proposed rule could lead to between 2.1 and 4.9 million Medicaid/CHIP beneficiaries disenrolling nationwide, including immigrant children and parents and the citizen children of immigrant parents, due to increased fear and confusion. This change would have a lasting impact on society, as many studies have shown that children with health coverage are more likely to become healthy adults.

In September 2018, the Colorado Health Institute released an analysis of how this proposed rule change could impact Colorado. The analysis estimates 75,000 Coloradans — three-quarters of them U.S. citizens — will lose health insurance coverage because of the chilling effect, with children making up two-thirds of those losing coverage.

Additionally, families with an uninsured member may be at increased risk of financial hardship from expensive medical events that must be paid out-of-pocket.

In an analysis released by the Department of Homeland Security (DHS), the agency estimates that 2.5 percent of eligible immigrants would drop out of public benefits programs because of the public charge change. DHS also notes that the changes could result in “worse health outcomes,” “increased use of emergency rooms,” “increased prevalence of communicable diseases,” “increased rates of poverty” and other concerns.

A chilly landscape, but the paint isn't yet dry  

While the proposed changes to the public charge rule have the potential to affect many families nationwide, the fact is that the rule has not yet been finalized. If the Trump administration does decide to implement the changes, it is likely to face legal challenges, further delaying the official effects.

Due to the chilling effect researchers have already observed, however, it is reasonable to expect that if the rule does take effect, thousands more families are likely to disenroll from public benefits out of fear of loss of citizenship status and deportation.

Most importantly, if the rule does take effect, the United States stands to lose families that enrich the fabric of our nation, families like the one my daughter’s best friend belongs to, families that were created in the United States.

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