Health & Medicine

43,000 California doctors weigh in on Trump’s proposed change in immigration rule

As public comment came to a close Monday on a controversial Trump administration immigration proposal, the California Medical Association wielded the clout of its 43,000 members to oppose a measure that has drawn criticism from food banks, community colleges, domestic abuse advocates and immigrant rights groups.

“This proposed rule is a step in the wrong direction, one that could lead thousands of Californians to avoid needed health care,” wrote Dr. David H. Aizuss, CMA president “We are particularly concerned about the chilling effect it could have on children’s health, if parents are fearful that utilizing health care services could jeopardize their immigration status.”

The rule in question applies to immigrants who apply to lawfully enter the United States or to get a green card once they are here. It is known as a “public charge” test, and immigration authorities have long used it to determine whether immigrants might end up depending on government benefits as a primary source of financial support. If immigrants fail the test, they can be refused permission to enter the country or be denied permanent legal residency.

The public charge test 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. The Trump administration’s proposed rule would make radical changes:

Expanding the type of benefits that can be considered to 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.

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

Not all immigrants are subject to the public charge test. It does not apply to refugees, asylum seekers, children asking for special immigrant juvenile status, visa seekers who are victims of crime or human trafficking, people seeking a green card because of abuse or battery by a U.S. citizen spouse or a permanent resident spouse, and those renewing Deferred Action for Childhood Renewals or temporary protected status.

If the Trump standards were applied to the current U.S. citizenry, immigration experts say, many likely would not be eligible for permanent residence. The Center on Budget Policy and Priorities looked at just one year’s worth of data on public assistance recipients and discovered that a third of the U.S.-born citizens received one of the benefits named in that year. If more years had been studied, research analysts said, it is likely that a much higher percentage of citizens would meet the criteria.

Public assistance benefits Americans of all races. In the case of Medicaid (Medi-Cal in California), government data showed in 2016 that 43 percent of recipients were white; 18 percent black; and 30 percent Hispanic. When it comes to food stamps, 36.2 percent of 2016 recipients were white, 25.6 percent black, 17.2 percent Hispanic and 15.5 percent unknown.

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

Roughly 190,000 comments had poured into the portal as of 5 p.m. Monday, and many of them are from organization leaders like Aizuss speaking on behalf of hundreds or tens of thousands of members.

“This rule will have a particularly harmful impact on the state of California, which has 10.4 million non-citizens and family members, over a quarter of the state population,” Aizuss wrote. “Discouraging participation in Medi-Cal (Medicaid) could result in coverage losses throughout California, decreased access to care, and worse health outcomes for entire families, including children, many of whom are U.S. citizens.“

While every state will feel the impact of this rule change, none will feel it more so than California, where roughly one in every in every four state residents are immigrants, said researchers at the UCLA Center for Health Policy Research. They warned in a statement released last week 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 not only for health care companies but also for farmers, landlords, financial services companies, grocers, food production companies and more.

“These are conservative estimates,” said 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 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 forgo federal benefits out of fear of losing the opportunity to maintain their legal residency.

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. Golden State 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.

Sacramento-area organizations as diverse as the California Association of Family Physicians, Dignity Health, Sutter Health, the California Pan-Ethnic Health Network and the Sacramento Breastfeeding Coalition voiced opposition to to the rule change.

Jonathan Williams, Sutter’s vice president of government affairs, wrote on Monday that the proposed rule would deter immigrants from using the programs that their tax dollars support and make them avoid accessing much-needed health services.

“Sutter Health has serious concerns with any change in immigration policy that will create a barrier to individuals accessing needed health care services and other programs that are essential to our collective well-being,” Williams said. “In addition to increasing the uncompensated care costs borne by California hospitals, the proposed rule would significantly increase administrative costs, as hospitals would need to devote considerable time and resources to educating their frontline staff about the various ways patients would be impacted by the rule’s provisions.”

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