If You Care About Immigrant Health, Now’s the Time to Act.

In September, the U.S. Department of Homeland Security (DHS) published a proposed change to longstanding immigration policy regarding the “public charge” rule.

Under the current policy, the federal government can deny individuals entry to the US or deny a Green Card if they are determined likely to become a “public charge,” or someone who is primarily dependent on government assistance to meet their basic needs. This includes any immigrant who is likely to receive public cash assistance, such as Temporary Assistance for Needy Families (TANF), Supplemental Security Income (SSI), or government assistance for long-term care.

Under the proposed revision, immigration officials would also consider the use of certain non-cash programs in determining “public charge” status. This includes Medicaid, the Supplemental Nutrition Assistance Program (SNAP), the Medicare Part D low-income subsidy program, Section 8 housing, and several other essential social support programs. In 2016, an estimated 19% of non-citizen adults and 38% of non-citizen children were enrolled in Medicaid or CHIP in 2016. This is reflected at Boston Medical Center (BMC), where we serve a diverse and often vulnerable population. One-third of our patients do not speak English as their primary language and over half of our patients receive care funded through Medicaid, Children’s Health Insurance Program (CHIP), or free care (i.e. uninsured). If the proposal is implemented, millions of lawfully-present immigrants – including many BMC patients – will be forced to choose between health insurance and seeking legal permanent resident (LPR) status.

Research shows  that individuals who lack health insurance  receive less preventive care and are more likely to forgo needed care., For chronic diseases such as diabetes, cardiovascular disease, end-stage renal disease, and mental illness, population-based studies have shown that uninsured patients have worse clinical outcomes than insured patients. Furthermore, food assistance, such as SNAP, and housing supports have been shown to improve health for Americans of all ages., Loss of these supports would likely lead to poorer health outcomes and further health care disparities.

As residents at Boston Medical Center and primary care physicians to immigrant patients in the Boston area, we are speaking out against this proposed rule change. We see firsthand how programs like Medicaid and SNAP help our patients care for themselves and their families as they build a life in this country. We also see the significant anxiety this proposed change is causing among our patients, even before it has been implemented.

Now that the proposed rule has been published in the Federal Register, a public comment period is open – during which time, we can submit written comments to the administration regarding our perspectives. The comment period will end on December 10th.

As part of a nationwide strategy, immigration advocates are pursuing a goal to submit 100,000 unique public comments to the Federal Register. Any type of comment is welcome, from personal stories to evidence-based explanations of how this rule would hurt immigrants. The administration is required to respond to each comment and address all issues that are raised. Your comments also become part of the public record and can be used to argue against the rule if it is challenged in court.

Please consider submitting a comment by Dec 10, 2018. You can contact Leah Harvey (leah.harvey@bmc.org) if you have any questions.

Krupa Patel, Muna Sheikh, and Leah Harvey are senior Internal Medicine residents at Boston Medical Center.