Illi­nois doc­tors: Trump im­mi­gra­tion pro­posal is scar­ing away pa­tients

Change would al­low of­fi­cials to con­sider like­li­hood of us­ing Med­i­caid in de­cid­ing green card el­i­gi­bil­ity

Chicago Tribune (Sunday) - - BUSINESS - By Lisa Schencker

Within days of ar­riv­ing in Chicago from Hon­duras, the 12-year-old boy sat in Dr. Sue Haverkamp’s of­fice, get­ting a phys­i­cal. Haverkamp learned the boy had a his­tory of chest pain and heart pal­pi­ta­tions. She told his mother that she’d re­fer him to a car­di­ol­o­gist once he was on Med­i­caid.

“She looked at me and said, ‘I’m not ap­ply­ing for in­sur­ance. I don’t want to risk his sta­tus,’” re­called Haverkamp, a pe­di­a­tri­cian at Erie Help­ing Hands Health Cen­ter in Chicago’s Al­bany Park neigh­bor­hood.

Cur­rently, par­tic­i­pa­tion in Med­i­caid doesn’t af­fect a per­son’s abil­ity to get a green card — but un­der a new Trump ad­min­is­tra­tion pro­posal, it might. A pro­posed change to the “pub­lic charge” rule would al­low im­mi­gra­tion of­fi­cials to con­sider some im­mi­grants’ like­li­hood of us­ing Med­i­caid, food stamps and hous­ing pro­grams, among other things, when de­cid­ing whether they should be able to be­come le­gal per­ma­nent res­i­dents — also known as get­ting a green card. The use of those pro­grams could also weigh against peo­ple look­ing to ex­tend their visas to stay in the U.S. and those seek­ing to change the types of visas they’re us­ing.

The rules now al­low im­mi­gra­tion of­fi­cials to con­sider po­ten­tial use of cash as­sis­tance pro­grams, such as Sup­ple­men­tal Se­cu­rity In­come, when de­cid­ing whether to al­low some­one to be­come a le­gal per­ma­nent res­i­dent, but not food stamps, hous­ing as­sis­tance or the Med­i­caid health care pro­gram for low-in­come fam­i­lies and oth­ers.

The Trump ad­min­is­tra­tion has said the pro­posal is meant to pro­mote self-suf­fi­ciency and save tax­payer money by not al­low­ing im­mi­grants to stay in the U.S. if they’re likely to be­come fi­nan­cial bur­dens on the coun­try. Com­ments on the pro­posal are be­ing ac­cepted through Dec. 10, af­ter which the ad­min­is­tra­tion may fi­nal­ize it.

But lo­cal ad­vo­cates for im­mi­grants say the pro­posal goes too far and will re­sult in fam­i­lies, par­tic­u­larly those that in­clude both cit­i­zens and nonci­t­i­zens, skimp­ing on health care and other ne­ces­si­ties out of fear

that us­ing those pub­lic ben­e­fits could jeop­ar­dize their chances of legally stay­ing in the U.S. That will ul­ti­mately cost tax­pay­ers more in the long run, they say.

Many ad­vo­cates say the pro­posed change al­ready is hav­ing a chill­ing ef­fect on im­mi­grants, even those who wouldn’t be putting them­selves or their fam­ily mem­bers at risk by ac­cept­ing Med­i­caid or food stamps.

As many as 1.7 mil­lion peo­ple in Illi­nois and 41.1 mil­lion peo­ple across the coun­try might drop out of pub­lic ben­e­fit pro­grams or not ap­ply for them be­cause of the pro­posed rule and fear sur­round­ing it, ac­cord­ing to es­ti­mates from pro­fes­sional ser­vices firm Manatt, Phelps & Phillips.

For ex­am­ple, a child’s use of gov­ern­ment pro­grams such as Med­i­caid won’t be held against a par­ent’s at­tempts to get a green card, the pro­posed rule says. Still, some fam­i­lies are steer­ing clear of Med­i­caid, food stamps and other pro­grams out of con­fu­sion or just to be safe, ad­vo­cates say.

Adult im­mi­grants who are in the coun­try with­out le­gal per­mis­sion are not al­lowed to en­roll in Med­i­caid, and im­mi­grants here il­le­gally can­not get food stamps.

“It’s forc­ing fam­i­lies who are el­i­gi­ble for th­ese fed­eral ben­e­fits to have to make this im­pos­si­ble choice be­tween stay­ing with their loved ones and stay­ing on the path of im­mi­gra­tion sta­tus, or for­go­ing th­ese es­sen­tial pro­grams,” said An­drea Ko­vach, a se­nior at­tor­ney at the Sergeant Shriver Na­tional Cen­ter on Poverty Law in Chicago.

Ad­vo­cates are hear­ing that’s the case among mem­bers of Latino, Korean, Arab and Chi­nese im­mi­grant com­mu­ni­ties, said Lu­via Quinones, health pol­icy di­rec­tor for the Illi­nois Coali­tion for Im­mi­grant and Refugee Rights.

“There are a lot of mixed-sta­tus fam­i­lies where the kids are cit­i­zens but then the par­ents hear about this, and they’re like, ‘Oh, well, I don’t want to get pe­nal­ized for my kid be­ing on Med­i­caid,’” said Dr. Mi­nal Giri, chair of the Illi­nois chap­ter of the Amer­i­can Academy of Pe­di­atrics’ Refugee Im­mi­grant Child Rights Ini­tia­tive. “They’re scared.”

One preg­nant woman told Giri, who is med­i­cal di­rec­tor at Mel­rose Park Pe­di­atrics, that she wouldn’t get health in­sur­ance for her baby be­cause she didn’t want it to af­fect her ap­pli­ca­tion for a green card, Giri said.

At Un­der the Rain­bow, Si­nai Health Sys­tem’s out­pa­tient be­hav­ioral health clinic for chil­dren and fam­i­lies, many of the ther­a­pists have been field­ing ques­tions about the pub­lic charge rule from ner­vous par­ents, said Mirna Ballestas, pro­gram di­rec­tor. The pro­gram’s busy Span­ish-speak­ing ther­a­pists have started ex­pe­ri­enc­ing no-shows — peo­ple who make ap­point­ments and then don’t show up — some­thing that was rare un­til now, Ballestas said.

“If peo­ple don’t get the ser­vices they need, it’s go­ing to come out in some way,” Ballestas said. “It’s go­ing to come out in vi­o­lence, un­nec­es­sary hos­pi­tal vis­its.”

Si­nai’s Women, In­fants and Chil­dren pro­gram, a fed­er­ally funded pro­gram that pro­vides nu­tri­tion ed­u­ca­tion and food to women and young chil­dren, has seen dozens of peo­ple stop par­tic­i­pat­ing in the pro­gram in re­cent months be­cause of the pro­posal, said Steven Fo­ley, di­rec­tor of fam­ily ser­vices at the Si­nai Com­mu­nity In­sti­tute.

The WIC pro­gram isn’t among those listed in the pro­posed pub­lic charge rule, but it was re­port­edly un­der con­sid­er­a­tion to be in­cluded in the rule at one point. WIC is funded by the same fed­eral agency as food stamps. That’s been enough to scare many peo­ple away from it, Fo­ley said. Peo­ple don’t have to be le­gal U.S. res­i­dents to par­tic­i­pate in WIC.

Im­mi­gra­tion ad­vo­cates say the rule will hurt not only those peo­ple, but also cost tax­pay­ers more in the long run by forc­ing them to pay for med­i­cal treat­ment that po­ten­tially could have been avoided with reg­u­lar care. Fewer peo­ple with health cov­er­age could also mean less money for doc­tors and hos­pi­tals, which will end up ab­sorb­ing the costs of treat­ing those peo­ple, ac­cord­ing to a Manatt re­port writ­ten on be­half of hos­pi­tal in­dus­try groups.

The num­ber of unin­sured chil­dren in Illi­nois in­creased from 82,000 to 89,000 be­tween 2016 and 2017, ac­cord­ing to a new re­port by the Ge­orge­town Univer­sity Health Pol­icy

“What’s hap­pened is fam­i­lies are get­ting more con­fused be­cause they don’t un­der­stand specif­i­cally what kinds of im­mi­grants are the ones af­fected by the rule. They as­sume ev­ery­one is af­fected or will be af­fected.” — Ale­jan­dra Va­len­cia, di­rec­tor of the Heart­land Al­liance’s Oral Health Fo­rum

In­sti­tute. Na­tion­ally, that num­ber in­creased for the first time in a decade be­tween 2016 and 2017.

Still, some say the rule is a good step to­ward en­sur­ing that im­mi­grants ac­cepted by the U.S. won’t be­come pub­lic charges.

“The idea be­hind the pro­gram, to deal with this long-term prob­lem of heavy im­mi­grant wel­fare use, makes sense,” said Steven Ca­marota, di­rec­tor of re­search at the Cen­ter for Im­mi­gra­tion Stud­ies in Wash­ing­ton, D.C., a think tank that sup­ports the pro­posal. “I think most of us would say, ‘Look, if the per­son needs to use wel­fare, it doesn’t make sense to give them a green card.’”

He also pointed out that the pro­posed rule doesn’t pe­nal­ize par­ents for their chil­dren’s use of pro­grams. If cit­i­zen chil­dren are drop­ping out of the pro­grams, it’s be­cause their par­ents are mis­un­der­stand­ing the pro­posal, he said.

Chicago-area providers agree that mis­in­for­ma­tion abounds.

“What’s hap­pened is fam­i­lies are get­ting more con­fused be­cause they don’t un­der­stand specif­i­cally what kinds of im­mi­grants are the ones af­fected by the rule,” said Ale­jan­dra Va­len­cia, di­rec­tor of the Heart­land Al­liance’s Oral Health Fo­rum. “They as­sume ev­ery­one is af­fected or will be af­fected.”

Haverkamp, the Al­bany Park pe­di­a­tri­cian, said part of the prob­lem is that be­cause a rule has not been fi­nal­ized, im­mi­grants are be­ing extra cau­tious.

Since Haverkamp saw the 12-year-old Hon­duran boy a few months ago, she’s said she’s seen sev­eral more chil­dren whose fam­i­lies don’t plan to sign them up for Med­i­caid be­cause of the pro­posal.

“I think the lack of trust in the sys­tem is growing,” she said.

NUCCIO DINUZZO/CHICAGO TRI­BUNE

Dr. Sue Haverkamp treats a young pa­tient at Erie Help­ing Hands Health Cen­ter in Chicago on Wed­nes­day.

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