In his most recent State of the Union address, President Donald Trump asked Congress to stand with him and “prohibit free government health care for illegal aliens.” He was referring to “Medicare for All” proposals that would provide government health benefits to all U.S. “residents,” including undocumented immigrants.
Whether our public health is better served by including or excluding the 11 million undocumented immigrants in this country is a debate worth having, and one that will surely take place should any Medicare for All legislation move forward.
But what the president didn’t mention is that increasingly his immigration policies are discouraging immigrants in the U.S. legally from applying for the existing public benefits that they legally can receive right now.
Last August, the administration dramatically expanded the federal “public charge rule” by denying green cards to immigrants already in the U.S. legally who have ever used — or are deemed likely to use — public benefits such as Medicaid, food stamps or housing assistance. As we wrote then, we view the new rule as an assault on legal immigration that attempts to skirt congressional authority.
On Jan. 27, the Supreme Court lifted a nationwide injunction against the rule while various legal challenges are heard in lower courts. We disagree with the high court’s decision and had hoped the injunction would remain in place.
Yes, immigrants, like the rest of us, are best served by a culture of personal responsibility, of hard work, and of self-reliance. But our society is better served if we also foster a culture of compassion that enables people to overcome the immediate obstacles in their midst. Sometimes that includes entitlement programs that address things such as hunger.
The problem with the administration’s approach in this case, however, is that rather than fostering compassion, it hardens views toward people if they are immigrants of meager means in need of even temporary assistance, and spreads fear and confusion among those who can legally receive benefits.
The term “public charge” was first codified in the Immigration Act of 1882, with its meaning evolving over time. For decades it’s been defined as someone who is or is likely to become ‘‘primarily dependent on the government for subsistence” through cash-assistance programs such as Supplemental Security Income and Temporary Assistance for Needy Families, or a person in need of long-term institutionalized care at the government’s expense.
The Trump administration has broadened that definition to include anyone who has or is deemed likely to receive any non-cash benefits such as Medicaid, food stamps, or housing assistance for more than 12 months in the aggregate in any 36-month period. This means that any two public benefits received in any given month would count as two months, etc. This new standard is so restrictive that an estimated one-third of all U.S.-born citizens would have trouble meeting it.
Sadly, the new rule and a growing climate of fear have discouraged many legal immigrants from seeking the government assistance they are eligible for and that might help them become self-supporting over the long term. Perhaps even more alarming, pediatricians and public health officials say they’ve seen a decline in immigrant families using preventive health care services for their children since the rule was introduced, even if those children are U.S. citizens.
Such uncertainties, along with the low unemployment rate, could be a factor in the recent drop in the number of children in Texas receiving public health insurance. As our Dianne Solis and Obed Manuel reported recently, “state statistics show that 234,000 fewer children over the past two years enrolled in public health care programs.” That number includes a drop of 170,000 children on Medicaid from December 2017 through November 2019 and 64,000 children enrolled in the Children’s Health Insurance Program, or CHIP, over that same period.
It’s important to point out here that under the new public-charge rule CHIP, as well as Medicaid for pregnant women, new mothers, and children under 21, will not count against green-card applicants. Nevertheless, the new rule is having a chilling effect that could threaten public health among the approximately 34 percent of Texas children with at least one foreign-born parent.
If the courts ultimately allow this administration’s broader public-charge definition to stand, one can expect more legal immigrants and their families to go without health care, housing and food assistance. That not only harms public health, it also harms the ability of immigrant families to overcome the obstacles that stand between them and the fulfillment of their American dream.
It’s times like this that we’d do well to remember, as former President George W. Bush reminded us here in Dallas last spring, that “America’s immigrant history made us who we are.” And, “Amid all the complications of policy, may we never forget that immigration is a blessing and a strength.”
— DALLAS MORNING NEWS