Say Ahhh! Healthcare Impacts of Anti-Immigrant Policies
It’s hard to keep up these days on the policies pushed by this Administration that unfairly target immigrant families, but it’s important to be aware and to hold those who are in power accountable. Over the last two years, we’ve tracked harmful policies such as “zero tolerance” at the border and changes to public charge rules that promote wealth above all else. These policies have been challenged in the courts and thankfully, the plaintiffs have had some successes worth celebrating.
In September, a judge blocked implementation of new rules that would have gutted the Flores settlement agreement. SayAhhh! readers will remember that Flores requires immigrant children to be released from custody without delay, preferably to a parent or family member. These protections ensure that children are safe and healthy while immigration proceedings take place. When the “zero tolerance” policy went into effect and the Administration started separating families at the border and detaining children in cages, human rights lawyers challenged the new policies and procedures as a violation of Flores. The human rights lawyers won, but DHS and the Department of Health and Human Services (HHS) proceeded anyway, issuing a final rule that gutted Flores while purporting to implement it. Thankfully, the human rights lawyers went back to the courts and won again when the judge stopped the new rules from going forward.
More recently, three judges issued preliminary, nationwide injunctions in four cases challenging the Department of Homeland Security’s (DHS) final rule on public charge. This means that DHS cannot implement changes to the public charge grounds of inadmissibility that would make it harder for legal immigrants to gain permanent status until after the various cases have been resolved. (Two other judges issued more limited preliminary injunctions in four other cases challenging the DHS rule.) It is incredible that five different judges reached essentially the same conclusion – the public charge rule is on such shaky legal ground that it cannot move forward without a full review by the judiciary branch.
As health and human rights advocates applaud these decisions, a reasonable Administration might pause and rethink their approach. Instead, the Department of State (DOS) and the Department of Justice (DOJ) are moving forward with similar public charge rules.
DOS issued an interim final rule that would make it harder to get a green card from abroad, prioritizing only wealthy applicants (like the DHS rule tried to do for those applying from within the US). An “interim final rule” means that DOS can implement the rule changes without first seeking public comment. Instead, they can implement the new rules while taking comments from the public at the same time. Even those who are unfamiliar with the ins and outs of administrative procedure can see why it is irresponsible to move forward with yet another public charge rule while the first rule has been blocked and without letting the public weigh in first. (Comments on the DOS rule are due on November 12, 2019 and can be submitted here.)
The proposed DOJ rule is still under review by the Office of Management and Budget, but would apply new public charge rules related to deportation. It’s likely coming this Fall.
And in case three different public charge rules aren’t enough to make it clear that this Administration wants to shift our immigration system to one based on wealth above all else by administrative fiat, President Trump issued a “Presidential Proclamation” requiring immigrants to have health insurance before they can even get a visa. Under the proclamation, immigrants applying to come to the US from abroad would have to prove that they either will have private, unsubsidized insurance within 30 days of arrival or that they have the “financial resources to pay for reasonably foreseeable medical costs.” The proclamation is slated to go into effect on November 3, though at this point it is unclear if that is even possible given the reported lack of coordination and preparation within the Administration and concerns from Administration officials that the proclamation is unworkable and illegal.
The purported justification for this rule change is two part: “health care providers and taxpayers bear substantial costs in paying for medical expenses incurred by people who lack health insurance” and “immigrants who enter this country should not further saddle our health care system.” Let’s take each of these in turn.
There is widespread agreement that insuring more people decreases uncompensated care costs for providers and taxpayers. In fact, the relationship between insurance rates and uncompensated care costs was one of the driving factors behind the coverage expansions in the Affordable Care Act. And it worked – uncompensated care costs fell as people gained coverage, with more dramatic declines in states that fully embraced the Act by expanding Medicaid. If this Administration truly cared about increasing coverage and decreasing uncompensated care, it would stop sabotaging the ACA, stop approving waivers requiring Medicaid beneficiaries to report work hours to stay covered, and start paying attention the troubling decline in Medicaid and CHIP enrollment. Instead, this Administration has overseen two years of increases in the uninsured rate for children and done nothing about it.
There is also widespread agreement about who is “saddling” our health care system and, news flash, it’s not immigrants. The proclamation rightly notes that noncitizens are more likely to be uninsured than citizens, but ignores the fact that citizens account for the majority of the uninsured. In 2017, citizens accounted for three-quarters of the total 27.4 million uninsured. Moreover, the higher uninsured rate among noncitizens is because noncitizens are more likely to work in low-wage jobs and in industries that are less likely to offer employer-sponsored insurance, and noncitizens are also less likely to be eligible for programs such as Medicaid and CHIP that offer affordable coverage options to low-income citizens.
The truth is easy to see. This Administration is willing to do whatever it takes – even if illegal – to send a loud and clear message that only white and wealthy immigrants are welcome in the US. Even if the courts continue to block these rules and policy changes before they take effect, the damage has already begun. The lasting and harmful consequences of family separation are only beginning to be understood, with a recent HHS Office of Inspector General report finding that traumatized children were often unable to access needed treatment. One of the medical directors interviewed explained that physical symptoms felt by separated children are often manifestations of their psychological pain.
“You get a lot of ‘my chest hurts,’ even though everything is fine [medically]. Children describe symptoms, ‘Every heartbeat hurts,’ ‘I can’t feel my heart,’ of emotional pain.”
And even before the first public charge rule was finalized, one in seven adults in immigrant families reported avoiding public benefits last year out of fear. When children are uninsured, they are less likely to get the health care they need to grow, thrive, and learn. Not to mention the harmful effects of inadequate nutrition and housing in childhood.
All of these policies are taking a toll on the health and well-being of children and families. We will continue to track these policies through the administrative process and the courts and make our best effort to provide our readers with the facts. Families impacted by these policies can find more resources at PIF.
This was originally posted at the blog of Georgetown University Health Policy Institute's Center for Children and Families.