Pro­posed changes to ‘pub­lic charge’ rule could dam­age pub­lic health ef­forts

Modern Healthcare - - Comment - By John Baackes

The Trump ad­min­is­tra­tion has pro­posed an im­mi­gra­tion pol­icy that could se­ri­ously harm pub­lic health ef­forts, po­ten­tially re­vers­ing gains made in health­care ac­cess and trust earned in our com­mu­ni­ties.

In fact, there are al­ready re­ports that le­gal im­mi­grants who are el­i­gi­ble for crit­i­cal pub­lic as­sis­tance pro­grams are dis­en­rolling or steer­ing clear out of fear and con­fu­sion.

The ad­min­is­tra­tion’s pro­posed changes to the “pub­lic charge” rule would make re­ceipt of cer­tain pub­lic as­sis­tance, like Med­i­caid, grounds for deny­ing a le­gal im­mi­grant a green card. For decades, such de­nials have ap­plied only to those likely to be­come pri­mar­ily de­pen­dent on the gov­ern­ment for sub­sis­tence. This new rule goes much fur­ther.

The Kaiser Fam­ily Foun­da­tion has es­ti­mated that the changes would lead to dis­en­roll­ment of as many as 4.9 mil­lion Med­i­caid/Chil­dren’s Health In­sur­ance Pro­gram en­rollees across the na­tion. CHIP is not in the pro­posed change, but the anal­y­sis pre­dicts that fear will cause par­ents of even U.S.-born chil­dren to steer clear of par­tic­i­pa­tion.

As the CEO of L.A. Care Health Plan, the largest pub­licly op­er­ated health plan in the coun­try, I can tell you that we have es­ti­mated that more than 170,000 of our 2.2 mil­lion mem­bers alone could be im­pacted by this sweep­ing ex­pan­sion of grounds for de­nial.

There is no doubt that the pro­posed changes would harm the health of im­mi­grants, their fam­i­lies and oth­ers. Many will likely drop out of Med­i­caid and SNAP, the nutri­tion as­sis­tance pro­gram formerly known as food stamps, to safe­guard their el­i­gi­bil­ity for per­ma­nent le­gal res­i­dency. With­out in­sur­ance, these peo­ple will likely have to forgo preven­tive health­care. What hap­pens then? How can we, as a na­tion, force fam­i­lies to choose be­tween nu­tri­tious food and nec­es­sary med­i­cal care or the op­por­tu­nity to be­come a cit­i­zen?

Im­mi­grant or not, peo­ple will in­evitably need health­care. With the cost of care be­yond the means of many af­fected by the rule change, they will wait and wait, un­til ul­ti­mately they re­quire emer­gency care—the costli­est of all care, of­ten re­quir­ing much more com­plex treat­ment. Costs go up for ev­ery­one when emer­gency de­part­ments are overused, and that means all tax­pay­ers pay more for health­care.

In Cal­i­for­nia, where half of all chil­dren have a for­eign-born par­ent, the rule would have an es­pe­cially big im­pact. The Amer­i­can Academy of Fam­ily Physi­cians in Septem­ber noted that if the pro­posed change is en­acted, it will “en­dan­ger pub­lic health,” not just im­mi­grant health. The physi­cians say that by avoid­ing nec­es­sary med­i­cal care le­gal im­mi­grants will in­crease the risk to their own health and the health of oth­ers. One spe­cific area of con­cern is im­mu­niza­tions. The Cen­ters for Disease Con­trol and Pre­ven­tion es­ti­mated that in­fluenza killed more than 80,000 peo­ple in the U.S. dur­ing the last flu sea­son. How many le­gal im­mi­grants and fam­i­lies will forgo a sim­ple flu shot this sea­son out of fear driven by this sense­less pol­icy pro­posal?

Fur­ther­more, U.S.-born chil­dren of many of these le­gal im­mi­grants will also suf­fer, es­pe­cially if those threat­ened by the changes de­cline food or hous­ing as­sis­tance out of fear. The Depart­ment of Home­land Se­cu­rity it­self ad­mits re­duced par­tic­i­pa­tion in such pro­grams could lead to worse health out­comes, in­clud­ing in­creased preva­lence of obe­sity and mal­nu­tri­tion; in­creased poverty and hous­ing in­sta­bil­ity; and re­duced pro­duc­tiv­ity and ed­u­ca­tional at­tain­ment. Echo­ing the AAFP, DHS says the new rule could in­crease the preva­lence of com­mu­ni­ca­ble dis­eases, in­clud­ing among U.S. cit­i­zens. It also rec­og­nizes the po­ten­tial eco­nomic cost as there will be an in­crease in un­com­pen­sated care for im­mi­grants who show up in the emer­gency room.

Poli­cies that would block le­gal im­mi­grant fam­i­lies from hav­ing a healthy, pro­duc­tive fu­ture in the U.S. do not rep­re­sent the val­ues on which this coun­try was built. The Whar­ton School in June 2016 re­leased a study ti­tled The Im­pact of Im­mi­gra­tion on the United States’ Econ­omy, which found im­mi­grants—whether doc­u­mented or un­doc­u­mented, high- or low-skilled—to be net pos­i­tive con­trib­u­tors to the U.S. econ­omy. With­out good health, that could change. ●

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John Baackes is CEO of L.A. Care Health Plan.

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