Advocates see fallout from immigration rule change

CHICAGO — Diabetics skipping regular checkups. Young asthmatics not getting preventive care. A surge in expensive emergency room visits.

Doctors and public health experts warn of poor health and rising costs they say will come from sweeping Trump administration changes that would deny green cards to many immigrants who use Medicaid, as well as food stamps and other forms of public assistance. Some advocates say they’re already seeing the fallout even before the complex 837page rule takes effect in October.

President Donald Trump’s administration trumpeted its aggressive approach this past week as a way to keep only selfsufficient immigrants in the country, but health experts argue it could force potentially millions of lowincome migrants to choose between needed services and their bid to stay legally in the U.S.

“People are going to be sicker. They’re not going to go get health care, or not until they have to go to an emergency room,” said Lisa David, president and CEO of Public Health Solutions, New York’s largest public health organization. “It’s going to cost the system a lot of money.”

Immigrants who want permanent legal status, commonly called a green card, have long been required to prove they won’t be “a public charge.” The Trump administration announced Monday that would redefine the term to mean those who are “more likely than not” to receive public benefits over a certain period. U.S. Citizenship and Immigration Services will also now consider other factors, including income, education and English proficiency.

“We want to see people coming to this country who are selfsufficient,” said Ken Cuccinelli, the agency’s acting director. “That’s a core principle of the American dream. It’s deeply embedded in our history, and particularly our history related to legal immigration.”

Two California counties and attorneys general in 13 states sued, saying the changes will increase public health risks.

There are signs that is already happening in cities including Chicago, Detroit and New York, immigrant advocates say.

Within hours of the announcement, a Minnesota immigration attorney said she received a flurry of calls from worried clients about whether to leave Medicaid. A Detroit nonprofit helping Latinos and immigrants with social services said its usually jampacked lobby was empty the day after the rules were unveiled. New York’s largest public health organization, Public Health Solutions, which serves a large immigrant population, reported a 20 percent drop in food stamps enrollment since the rule was first proposed in the fall.

There is precedent for such a chilling effect. After 1996 welfare and immigration changes that limited public assistance for some immigrants, the use of benefits dropped steeply among U.S. citizen children and refugees, groups who were still eligible. Studies based on data following that change showed people disenrolled from Medicaid at rates ranging from 15 percent to 35 percent, according to Harvard University’s FrancoisBagnoud Center for Health and Human Rights. And, it found, this came at a high cost: Asthmarelated school absences in 1996 led to $719 million in lost parental productivity.