Leah Zallman, M.D., M.P.H.: (917) 520-8918, firstname.lastname@example.org
Steffie Woolhandler, M.D., M.P.H.: (617) 312-2766, email@example.com
A proposal by the Trump administration to deny legal permanent residency status to immigrants who legally use public benefits like food assistance and Medicaid may prevent health care and nutrition aid from reaching millions of children, according to a new study by researchers from Harvard Medical School and the City University of New York at Hunter College that was published online today in JAMA Pediatrics. Currently, enrollment in public food, housing, and health insurance programs are not counted against immigrants applying for permanent residency, also known as “green cards.”
The study is the first to examine the impact of a proposed change in the U.S. Department of Homeland Security’s ‘public charge’ rule on children with significant medical needs. Researchers found that between 0.8 million and 1.9 million such children currently enrolled in public health insurance and the Supplemental Nutrition Assistance Program (food stamps), may lose these benefits, endangering their health. Most of these children are citizens living in households with a non-citizen immigrant parent or other family member.
Using data from the Medical Expenditure Panel Survey, the authors estimated the number of children who need medical care and who live in families that may disenroll from public benefits. They also estimated the number of children in need of medical care, e.g., kids with asthma, who may lose benefits due to the proposed rule change.
In 2015, 8.3 million children enrolled in Medicaid and the Children’s Health Insurance Program or who received Supplemental Nutrition Assistance Program benefits lived with adults who may disenroll their families from benefits due to fear or confusion caused by the proposed rule, even if the rule does not technically apply to them. Of these children, 5.5 million had medical needs, including 615,842 with asthma; 53,728 with epilepsy; 3,658 with cancer; and 583,700 with disabilities or functional limitations. The article concludes that this policy would threaten the health and wellbeing of millions of children, most of whom are U.S. citizens.
“Most children who lose Medicaid or CHIP due to this proposed rule will become uninsured, and are likely to skip needed care,” said lead author Dr. Leah Zallman, Director of Research at the Institute for Community Health at Cambridge Health Alliance/Harvard Medical School, where she is also an Assistant Professor of Medicine. “For many children, skipping care will lead to long-term medical problems, increased health care costs and school absenteeism. It also means that their parents — many of whom play vital roles as caregivers in nursing homes and home care — will be forced to skip work. The proposed public charge policy will threaten the health of millions of children and have negative repercussions for generations to come.”
The DHS proposal would affect both green card applications and applications for admission to the U. S. It would not apply to other immigrants, including: refugees; asylees; survivors of trafficking, domestic violence, or other serious crimes (T or U visa applicants/holders); VAWA self-petitioners; special immigrant juveniles; and certain people paroled into the U.S. Immigrants who already hold green cards are also exempt from public charge requirements when applying for U.S. citizenship.
The DHS proposal is one of several regulatory policy changes experts expect to dissuade lawfully-present immigrants and their families from using health and social services programs. Other Trump Administration regulatory proposals contributing to this “chilling effect” have been proposed by the U.S. Department of Housing and Urban Development, U.S. Department of Agriculture’s Food and Nutrition Service, U.S. Department of State (which processes visa applications abroad), the Social Security Administration, and a draft proposal by the U.S. Justice Department.
“Punishing children by denying them medical care and nourishment is a gross violation of medical ethics and common decency. But that’s what President Trump’s proposed immigration policy changes will do to millions of innocent children,” said Dr. Steffie Woolhandler, Distinguished Professor of Public Health at the City University of New York at Hunter College and Lecturer in Medicine at Harvard.
“Implications of changing public charge immigration rules on children who need medical care,” Leah Zallman, M.D., M.P.H., Karen Finnegan, P.h.D, David Himmelstein, M.D., Sharon Touw, M.P.H., Steffie Woolhandler, M.D., M.P.H., JAMA Pediatrics, July 2019.
Drs. Woolhandler and Himmelstein are co-founders of Physicians for a National Health Program (PNHP) which advocated single-payer health reform. PNHP had no role in the funding or designing the research, which was partially funded by a grant to Dr. Zallman from the California Health Care Foundation.