Health & Medicine

Why 150,000 doctors, others wrote to oppose Trump’s proposed change in immigration rule

More than 150,000 doctors, health care organizations and others have flooded the Federal Register with comments condemning a Trump Administration plan that would make it harder for immigrants to maintain their legal residency status if they seek federal assistance for food, health care or housing.
More than 150,000 doctors, health care organizations and others have flooded the Federal Register with comments condemning a Trump Administration plan that would make it harder for immigrants to maintain their legal residency status if they seek federal assistance for food, health care or housing. Getty Images

More than 150,000 doctors, health care organizations and others have flooded the Federal Register with comments condemning a Trump administration plan that would make it harder for immigrants to maintain their legal residency status if they seek federal assistance for food, health care or housing.

“Just the thought of this policy coming up was shocking to me,” said Dr. Lena Rothstein, a Sacramento pediatrician who first heard of the proposed policy at a national conference. “I didn’t think it would ever actually make it to fruition. Looking at immigrant families, I see parents in fear of enrolling in vital programs like Cal Fresh or food stamps or housing benefits or Medi-Cal. And, if the parents are affected, then downstream, the child is affected. So, it’s a pediatric issue.”

Rothstein submitted a letter opposing the proposed rule change, and she also wrote an op-ed column for the Davis Enterprise explaining how the policy changes will affect the health of one of the families in her care.

Sacramento-area organizations as diverse as Dignity Health, the California Pan-Ethnic Health Network and the Sacramento Breastfeeding Coalition signed onto an opposition statement. To be considered by federal officials, all public comments on the proposed change in federal rules must be submitted to the Federal Register by Monday.

The rule in question is known as a “public charge” test, and immigration authorities have long used it to determine whether immigration applicants might end up depending on government benefits as a primary source of financial support. These individuals can be refused permission to enter the U.S. and refused a green card.

The immigration policy has long held that only government-funded long-term institutional care and cash assistance programs such as Supplemental Security Income and Temporary Assistance for Needy Families may be weighed as part of the public charge test. The Trump Administration’s proposed rule would make radical changes:

It expands the type of benefits that can be considered, adding Cal-Fresh (formerly food stamps), Medicare Part D subsidies that help in purchasing medication, federal public housing assistance such as Section 8 vouchers, and Medi-Cal health coverage except emergency medical conditions and some disability services related to education.

Children, senior citizens, individuals with limited English proficiency, those with poor credit history or limited educations and people with large families will receive negative weights, as will any applicant whose income is below 250 percent of the federal poverty line, or about $63,000 for a family of 4.

Every state will feel the impact of this rule change, but none more so than California where roughly one in every in every four state residents are immigrants. The UCLA Center for Health Policy Research warned in a statement released Tuesday that California residents could lose $1.67 billion in federal dollars as a result of this policy change, and that large loss would have economic reverberations for not only health-care companies but also for farmers, landlords, financial services companies, grocers, food production companies and more.

“These are conservative estimates,” Ninez Ponce, director of the UCLA research center. “We think there will be a sizable population that will dis-enroll. When these immigrant families dis-enroll, then in the health care sector, that means you’re going to have some lost jobs.”

Those job losses and the corresponding drop in sales of food and other goods and services would result in a loss of $2.8 billion in spending. Like the changes to the U.S. tariff policy, this type of broad policy shift can have devastating consequences, Ponce said.

The new rules have a complexity to them that was absent from current policy, Ponce said, and that expands the possibility for misinterpretation and misinformation. That lack of understanding, she said, will have a “chilling effect” on many lawfully present immigrants, spurring them to forego federal benefits out of fear of losing the opportunity to maintain their legal residency.

“We’ve broken our social contract to provide basic means of health care, food and housing to this group who we know in many settings have contributed to the very robust economy in California,” Ponce said. These immigrants “contribute to the economy in terms of also providing labor to many of us. I mean, who takes care of our elderly parents at home? Who takes care of our children? A lot of immigrants are helping the general population to live their lives.”

Immigrants, both documented and undocumented, also help to sustain the financial balance in the nation’s health care insurance industry, according to research funded by the California Health Care Foundation. California immigrants were responsible for a net contribution of $27.7 billion in premiums to private insurers between 2008 and 2014. U.S. citizens, on the other hand, paid less in premiums during that period than what insurers paid for their care.

Researchers at Kaiser Family Foundation reviewed data on all noncitizens legally permitted to obtain residency in the United States in 2014, and it found that the new rule would leave few of them without a negative mark on their applications. Virtually all – 94 percent – had at least one characteristic that the U.S. Department of Homeland Security could cite as a negative determination.

Two out of five had factors that DHS could consider a heavily weighted negative factor, KFF researchers found, and more than a third had income below the new threshold.

Leaders of the California Association of Family Physicians say the rule change will deter immigrants from seeking preventive health care such as vaccines that help to keep the nation as a whole safe from epidemics.

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