In his State of the Union address last week, President Trump asked Congress to stand with him and “prohibit free government healthcare for illegal aliens.” He was referring to “Medicare for All” proposals that would provide government health benefits to all US “residents,” including undocumented immigrants.
Whether America’s public health is better served by including or excluding the 11mn undocumented immigrants in the 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 legal immigrants 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 legal immigrants already in the US who have ever used _ or are deemed likely to use – public benefits such as Medicaid, food stamps or housing assistance. The new rule is an assault on legal immigration that attempts to skirt Congressional authority.
On January 27, the Supreme Court lifted a nationwide injunction against the rule while various legal challenges are heard in lower courts.
Yes, immigrants, like the rest of Americans, are best served by a culture of personal responsibility, of hard work, and of self reliance. But the society is better served if the citizens 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 meagre 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 institutionalised 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 noncash 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 US-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 healthcare services for their children since the rule was introduced, even if those children are US 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.
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