Trump bid to narrow benefit use by immigrants poses threat to health care system

In 1993, when I arrived in South Florida as an asylum seeker from Haiti, I had very little to my name. In my native country, I worked as a community organizer. But for those first few months in America, as I waited for my paperwork to get approved, I had no choice but to sign up for public assistance benefits so that I could buy groceries and see a doctor.

Still, I never wanted to take advantage. And as soon as I was legally able, I started working.

I started as a security guard. But as a single mom supporting two children, that paycheck alone wasn’t enough. Rather than go back on benefits, I got a second position as a home health aide.

I’d never worked in the health care industry, and I found the work to be extremely fulfilling. Our patients become like family. We talk to them, wash them, comb their hair, accompany them to doctor’s appointments, and tuck them in at night. And as I worked my way up the ranks of the industry, eventually becoming a certified nursing assistant and a vice president of the 1199 SEIU United Healthcare Workers East union, I noticed two things:

One, there are not enough workers to fill all of the available healthcare jobs in Florida; in 2014, there was one unemployed healthcare worker for every 4.7 available jobs listed online, according to data from New American Economy.

And two, a significant portion of the healthcare workers who are already working are immigrants like myself. In fact, one in four direct care workers—the nursing, home health, and personal care aides who do many of the day-to-day tasks caring for our seniors and disabled— is an immigrant.

Unfortunately, the Trump administration has put forth a “public charge” proposal that would threaten the ability of patients in Florida and nationwide to get adequate care.

Under the new rule, most immigrants who use more than 15 percent of the poverty line in public benefits—just $2.50 per person daily for a family of four—would be disqualified from gaining permanent residency here.

That puts immigrants who work in positions like home health aides, historically among the lowest-paid occupations in the country, at risk for deportation.

Often, their salaries are just not high enough to allow them to be fully selfsufficient, forcing both foreign- and U.S.born healthcare workers to support their families with some form of public benefits. So this isn’t an “immigrant” issue.

The problem here isn’t immigration; it’s wage stagnation in the economy.

Currently, nearly one out of every five Florida residents is elderly and, nationally, America’s elderly population is expected to more than double from 35 million to 71.5 million between 2000 and 2030.

In short, we cannot afford to lose even a single direct care aide. And yet, if the public charge proposal isn’t stopped, it could create a crisis with terrible ripple effects.

For example, PHI, a group that studies the industry, says that by 2020, America’s direct care workforce will be five million. That would make direct care workers the largest occupational group in the United States, just ahead of retail salespeople. If even a fourth of those workers are affected by the proposed public charge rule—again, one in four direct care workers are immigrants—it would have massive consequences for their employers, patients, and the economy.

And our healthcare industry won’t be the only casualty.

If implemented, the new rule could lead to the deportation of millions of people in industries from transportation to education and cost the United States economy up to $164.4 billion, according to NAE.

I was extremely lucky to be able to come to this country as an asylum seeker.

Now, I am a homeowner, a proud American citizen, and a registered voter.

And though the new public charge rule would not apply to asylum holders, the path that I have taken in this country is no different than millions of other immigrants who came here with very little and, with some public assistance, managed to accomplish greatness, not just for themselves but for their communities.