A New Threat to Immigrants' Health

August 8, 2018

RSF trustee Hirokazu Yoshikawa (New York University) and former visiting scholars Krista Perreira and Jonathan Oberlander (University of North Carolina, Chapel Hill) have authored a new report in the New England Journal of Medicine that examines the possible effects of a proposed change to the public-charge rule. Under the current guidelines, individuals who are dependent on the government for more than half of their personal income through cash-assistance benefits such as Supplemental Security Income or Temporary Assistance for Needy Families are classified as “public charges.” Immigrants that are labeled potential public charges can be denied entry to the U.S., and those already in the U.S. on visas can be prevented from obtaining legal permanent resident status, and in rare cases, even deported.

To date, non-cash benefits, such as SNAP, have been excluded from consideration in determining whether an individual meets the definition of a public charge. However, a new draft rule from the Department of Homeland Security proposes to expand the definition to include any individual who “uses or receives one or more public benefits.” These include programs such as nonemergency Medicaid, CHIP, housing assistance, SNAP, and the EITC, among others. The new draft rule also proposes to consider use of public benefits by dependents—including U.S.-born children and spouses—in determining whether an individual meets the criteria to be deemed a public charge. As Yoshikawa, Perreira, and Oberlander state, “The potential impact of these changes is enormous.” The graph below highlights how significantly the number of immigrants who could qualify as public charges would increase under the draft guidelines.

Figure 1. Percentage of persons for whom benefit use could be considered in a public-charge determination, 2014–2016.

If enacted, the new public-charge rule would disproportionately affect lawfully present immigrants and those living in mixed-status families. The authors note that the rule would likely deter many immigrants from using public benefits, and that this lack of access could lead to a number of negative health consequences. In addition to reducing immigrants’ enrollment in health insurance programs such as CHIP, the new public-charge rule would likely reduce enrollment in SNAP and WIC, increasing rates of food insecurity in immigrant communities. And reductions in the use of tax credits and housing assistance has the potential to push millions of adults and children into poverty, a primary determinant for risk of illness and death. The authors conclude, “We believe that the draft public-charge regulation represents a substantial threat to lawfully present immigrants’ access to public programs and health care services.”

Read their full report in the New England Journal of Medicine.


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