APA Joins in Protest of Trump’s New ‘Public Charge’ Rule

Physician groups are concerned that a Trump administration rule finalized in August will discourage immigrants from using public assistance such as Medicaid, public housing, and food stamps for fear of being denied legal permanent residence.

APA and its coalition partners of some 600,000 frontline physicians and medical students called for the administration to rescind the rule, saying it will cause patients to avoid needed medical care and jeopardize their own health and that of their communities.

“The public charge final rule not only threatens our patients’ health, but as this deferred care leads to more complex medical and public health challenges, will also significantly increase costs to the health care system and U.S. taxpayers,” the coalition wrote. “Most important, the order puts a governmental barrier between physicians and patients and stands in stark contrast to the mission our organizations share: ensuring meaningful access to health care for patients in need.”

The new rule, issued by the Department of Homeland Security (DHS) on August 14, amends longstanding practices governing when immigrants are deemed a “public charge,” a term that indicates an individual’s likelihood of dependence on the government for support. The rule expands the list of public programs that immigration officials consider when reviewing applications for entry into the United States or for a change in status, such as renewing a visa or issuing a green card.

In addition, the final rule expands on the list of what officials consider “heavily weighted factors.” These will now include an applicant’s receipt of public benefits for more than 12 months in total during the three years prior to an application. Using benefits from two different programs at the same time will count as two months of use.

Another heavily weighted negative factor related to health includes having a medical condition that is likely to require extensive treatment or institutionalization and being uninsured and lacking the financial resources to pay for the medical costs associated with the condition.

Prior to the new rule, no weight was given to an applicant’s receipt of noncash benefits, except for public institutionalization in a long-term-care facility. Under the new rule, immigrants who receive nutrition or food support, Section 8 housing, or Medicaid for nonpregnant adults may now be considered public charges. DHS stated that its goal in writing the new rule is to ensure approved immigrants are self-sufficient.

“This rule is designed to discourage people from seeking medical and/or psychiatric care that they may acutely need,” said APA President Bruce Schwartz, M.D. “It will almost certainly succeed in doing that—even among immigrants who are in the country legally—since use of public benefits for medical care could be used to deny green cards or U.S. visas, or even lead to deportations. APA and our partner health care organizations cannot be silent in the face of this unwarranted government action.

“As physician experts in mental health, we know that many immigrants face indescribable hardships and trauma before coming to this country, which leave them at risk for anxiety, depression, and posttraumatic stress disorder,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “This public charge rule threatens to get in the way of caring for patients who need our help. To keep our society healthy, government rules should encourage the use of mental health care and medical services by those who need it, including new immigrants.”

In practical terms, the new rule will create new barriers to getting a green card or immigrating to the United States, according to a report by the Kaiser Family Foundation (KFF). To get around these barriers, immigrants may avoid applying for and using government programs. “The rule is expected to reduce participation in critical safety-net programs broadly across immigrant families, including among their U.S.-born children who are not at risk of deportation,” due to lack of understanding of the complex rule. One-quarter of the children in the United States (19 million) have at least one immigrant parent.

The new rule is slated to take effect October 15; however, California is leading a multistate coalition that has filed a lawsuit against DHS and is seeking a temporary injunction to halt the rule. In addition to the California-led lawsuit, several other lawsuits were filed, including one by a coalition of 13 states and another by a coalition of immigrant advocacy groups.

California’s lawsuit, filed in the U.S. District Court for the Northern District of California, asserts the DHS rule targets working immigrants and their families by creating unnecessary new barriers to lawful admission to the United States. “The rule creates such a strict standard that, if it were applied to citizens across the country, a substantial portion would be considered likely to be a ‘public charge,’ ” California Attorney General Xavier Becerra said in a statement. The District of Columbia, Maine, Oregon, and Pennsylvania joined the complaint.

A separate lawsuit filed by a 13-state coalition asserted that the new rule would add unlawful barriers to legal immigration, in violation of the equal protection guarantees of the Fifth Amendment of the Constitution and interfere with states’ rights. The complaint was led by Washington and included Colorado, Delaware, Illinois, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, Rhode Island, and Virginia.

Meanwhile, a lawsuit filed by health care providers and other immigrant advocacy groups led by La Clinica de La Raza, a community health center in California, argues that the regulation was motivated by racial bias against nonwhite immigrants. The complaint cites Trump’s own racist statements, his administration’s acknowledgement that the policy will have a disparate impact on families of color, and his administration’s other racially biased policies as indicators of the motivating racial animus.

Not all noncitizens are subject to the new rule: Congress long ago exempted refugees, those being granted asylum, and certain vulnerable populations. In response to comments received by DHS, youth under the age of 21, pregnant women, and women who have given birth within the past 60 days will not be penalized for their use of Medicaid or the State Children’s Health Insurance Program, DHS wrote in the final rule. Still, misinformation about whom the rule impacts may prevent vulnerable patients from seeking care.

In addition to APA, America’s frontline physicians group includes the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American College of Obstetricians and Gynecologists, and the American Osteopathic Association. ■