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We Must Move from Public Charge to Public Trust

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In 2002, my parents nervously packed my brother and me into the car, and we drove silently to Indianapolis. We were providing emotional support to my father as he registered himself in the National Security Entry-Exit Registration System (NSEERS), a post-9/11 immigration policy, which required foreign nationals from 25 countries to register themselves in a governmental tracking program based on religion, ethnicity, and national origin.1 My parents came to the U.S. in 1992 to start a family in a place with more possibilities than were available in Lebanon. Harsh immigration policies like NSEERS brought immense fear to my family. My father did not return to see his family in Lebanon for six years because he was fearful that if he left the U.S., he would be banned from returning. This also sparked fear in my mother, brother, and me that our family could be separated at any moment. Eight years later, when my parents finally became citizens, a collective weight was lifted off of our shoulders. While NSEERS was removed in 2016 towards the end of President Obama’s second term, additional harsh and discriminatory immigration policies continue to be implemented.2 Fear is historically a key component of US  immigration policies.; the Trump Administration’s recent final rule amendment to the Public Charge Ground of Inadmissibility is only the most recent example. 

The public charge has been a component of immigration policy in the U.S. for over one hundred years, stating that noncitizens who receive welfare or depend on the government to fund institutionalized long-term care can be denied entry into the country or permanent residency, and even be deported.3 In 2019, the Department of Homeland Security published an amendment to widen the public charge definition to include government assistance programs, such as Medicaid, food stamps and subsidized housing.3 This is referred to as the final rule. Under this rule, 79% of noncitizens currently in the U.S. benefit from government assistance programs and are now at risk of deportation or denial of permanent residency status.4 Like NSEERS, this rule has spread fear throughout the immigrant community and has deterred eligible noncitizens from enrolling in government benefit programs for fear that it will impact their immigration status. A chilling effect has also been observed: immigrants and family members who are not affected by the final rule have been disenrolling in Medicaid and food stamp programs,5 with an estimation that between 2 and 4.7 million individuals could disenroll from public benefits as a result of this rule change.3 Individuals who are not impacted by the final rule are disenrolling because they are unaware that their immigration status will not be affected, or to protect the status of their family members. 

Supporters of the final rule believe that it enforces the long-standing principle of self-sufficiency in immigration policies and protects public benefit programs for current citizens. Kenneth T. Cuccinelli II, the director of the U.S. Citizenship and Immigration Services, stated that the final rule was implemented as a benefit to taxpayers by ensuring that immigrants can “stand on their own two feet”;6 however, this policy would result in the opposite. 

The final rule will drastically decrease immigrants’ use of social services and result in negative health outcomes and an increased financial burden on the healthcare system and economy. Government benefits address the social determinants of health, which are the social and economic factors that influence wellbeing and are fundamental to achieving good health outcomes. Reduced access to primary care services by uninsured noncitizens will increase the use of emergency departments (ED) since federal laws require EDs to serve all patients regardless of their ability to pay. ((Hernandez, N. (2020, June). Summary of Research at the Intersection of Public Charge and Health (Rep.). Retrieved January 6, 2021, from Protecting Immigrant Families website: https://protectingimmigrantfamilies.org/wp-content/uploads/2020/06/Public-Charge-and-Health-Literature-Review-2020-06-16.pdf)) A 2010 analysis of emergency room visits discovered that non-emergent use of EDs resulted in an excess cost of $4.4 billion annually. ((Weinick, R. M., Burns, R. M., & Mehrotra, A. (2010). Many emergency department visits could be managed at urgent care centers and retail clinics. Health affairs (Project Hope), 29(9), 1630–1636. https://doi.org/10.1377/hlthaff.2009.0748)) What’s more, it is estimated that if noncitizens were to leave the U.S., the economy would suffer an indirect financial loss of more than $33.9 billion. ((The New “Public Charge” Rule and Its Negative Impact on the U.S. Economy. (2019, October 14). Retrieved January 07, 2021, from https://research.newamericaneconomy.org/report/economic-impact-of-public-charge-rule/)) While not all immigrants may be forced to leave, any significant loss will cause economic strain.  

President Joe Biden can reverse the final rule now that he is in office, but the fear of jeopardizing their citizenship status for use of public benefits will leave an enduring scar on the immigrant community if nothing else is done. In addition to undoing the final rule, we must repeal public charge status as grounds for deportation altogether in an effort to repair the trust between noncitizens and the government and to ensure that immigrants feel protected enough to access health-promoting government benefits. Furthermore, immigrants must be reassured that their immigration status is secure in this country. 

The final rule contradicts the national ethos of the American Dream that individuals, regardless of their background, can create a better life for themselves and their families. It has already had harmful effects on the immigrant community and the economy and will continue to worsen if not addressed. For this reason, I implore you to reach out to your State Representatives to demand that they support H.R. 5814, which serves to repeal the public charge ground of deportability. ((Meng, G. (2020, July 2). H.R.5814 – 116th Congress (2019-2020): No Public Charge Deportation Act of 2019. Retrieved January 07, 2021, from https://www.congress.gov/bill/116th-congress/house-bill/5814?s=1&r=6)) We must shine a light on this legislative issue and bring awareness to the harmful impacts of current immigration policies both on the immigrants themselves and on the country as a whole. 

Stephanie Haddad
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  1. ACLU. (n.d.). National Security Entry-Exit Registration System. Retrieved January 19, 2021, from https://www.aclu.org/issues/immigrants-rights/immigrants-rights-and-detention/national-security-entry-exit-registration [↩]
  2. DHS. (2016, December 23). Removal of Regulations Relating to Special Registration Process for Certain Nonimmigrants. Retrieved January 19, 2021, from https://www.federalregister.gov/documents/2016/12/23/2016-30885/removal-of-regulations-relating-to-special-registration-process-for-certain-nonimmigrants [↩]
  3. Public Charge Provisions of Immigration Law: A Brief Historical Background. (2019, August 14). Retrieved January 06, 2021, from https://www.uscis.gov/about-us/our-history/history-office-and-library/our-history/public-charge-provisions-of-immigration-law-a-brief-historical-background [↩] [↩] [↩]
  4. Artiga, S., & Garfield, R. (2019, September 18). Estimated Impacts of Final Public Charge Inadmissibility Rule on Immigrants and Medicaid Coverage. Retrieved January 06, 2021, from https://www.kff.org/racial-equity-and-health-policy/issue-brief/estimated-impacts-of-final-public-charge-inadmissibility-rule-on-immigrants-and-medicaid-coverage/ [↩]
  5. Huang, P. (2020, February 11). DHS’ Final Rule: Impact of Public Charge on Health Care and Benefits (Rep.). Retrieved January 6, 2021, from National Health Law Program website: https://healthlaw.org/wp-content/uploads/2020/02/2020-02-11-Public-Charge-FAQ-post-SCOTUS-final.pdf [↩]
  6. Shear, M. D., & Sullivan, E. (2019, August 12). Trump Policy Favors Wealthier Immigrants for Green Cards. Retrieved January 06, 2021, from https://www.nytimes.com/2019/08/12/us/politics/trump-immigration-policy.html [↩]

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