Public charge provisions hurt citizen children too

This week, The Urban Institute released a powerful new report showing that one-fifth of all children on Medicaid or CHIP (the Children’s Health Insurance Program) are citizens but have noncitizen parents. A recent proposal from the Trump administration to strengthen the “public charge” rule would harm such citizen children and strain health care budgets.

For example, a student at a university in Oregon recently discovered she needs emergency heart surgery only after experiencing extreme dizziness and fatigue during exam week. Why? She has an undiagnosed chronic illness and has never seen a doctor before—all because her immigrant parents were too afraid to enroll her in the state public health program.

{mosads}This student is the casualty of the public charge rule—a lesser-known provision in immigration law that makes immigrants ineligible for adjustment of legal status if they are deemed likely to become dependent upon the state. If the administration adopts the proposed public charge rule change, there are likely to be many more casualties like her.

“Public charge” doctrine governs whom the Department of Homeland Security deems “primarily dependent upon the government for assistance” and therefore ineligible for legal status in the United States. Confusion has long surrounded which forms of public assistance the federal government would penalize. In 1999, the Clinton administration clarified that the receipt of Medicaid and food stamps do not apply towards public charge determinations.

The Trump administration’s proposed policy would overturn this guidance. For the first time in the nation’s history, the administration would make the use of Medicaid, food stamps, and Section 8 housing vouchers as grounds for labeling an immigrant a public charge.

Since 1999, the federal government had maintained that if an immigrant parent’s citizen child receives public assistance, this will not jeopardize the parent’s immigration status. Nevertheless, immigrant parents have been leery of accepting public assistance for their citizen children. The proposed policy change will only intensify this reluctance, leading to further preventable illness and greater overall health care costs.

Public charge rules depress the use of social services and render the children of immigrants second-class citizens. They teach immigrants and their children that being a “good citizen” means avoiding health care—a lesson that has long-term costs for immigrants and for society.

The university student whose case opened this piece likely could have avoided emergency heart surgery had she had preventive care—a service to which she was entitled. According to the Urban Institute, there are 6.8 million children on Medicaid or CHIP who are citizens but have noncitizen parents—children whom public charge doctrine may similarly deprive of public benefits.

Studies already show that having an immigrant parent makes a U.S.-born child less likely to have health insurance. Twenty-five percent of U.S.-born children born to undocumented immigrants lack health insurance even though they are likely to qualify for public insurance through Medicaid or state Children’s Health Insurance Programs. By contrast, only eight percent of U.S.-born children with U.S.-born parents lack health insurance.

Such low rates of insurance, despite eligibility, can translate into more acute health emergencies and higher health care costs. One study found that even as foreign-born children had fewer visits to the Emergency Room than US-born children, their emergency department expenditures were more than three times higher. The authors conclude that “immigrant children may be sicker when they arrive at the emergency department” precisely because of their poor access to primary care.

Public charge rules contaminate all forms of assistance with suspicion. Some immigrants are afraid of receiving discounted medical care on hospitals’ charity care program—a program open to all low-income residents. Others are suspicious of receiving food assistance for their families from charities such as the Salvation Army. After Hurricanes Harvey and Florence, reports surfaced that immigrants were reticent to use emergency services offered by FEMA, only further jeopardizing the safety of families and communities.

What, then, can we do to prevent this rule change? Post your opinion about the rule change in the Federal Register before 11:59pm on Monday, Dec. 10, at which point the public comment period closes.

Taking action to stop the proposed change from taking place is incumbent. The proposed regulation change has the potential to exert a “chilling effect” on citizens’ use of public benefits, worsen immigrant families’ health, and lead to unnecessary health care costs. Citizens should not be penalized for being children of immigrants. To ensure all children an equal start, the proposed change must be halted.

Sarah Horton is an Associate Professor of Anthropology at the University of Colorado, Denver and author of “They Leave Their Kidneys in the Fields: Illness, Injury, and ‘Illegality’ among U.S. Farmworkers (University of California Press, 2016). Whitney Duncan is an Associate Professor of Anthropology at the University of Northern Colorado and author of “Transforming Therapy: Mental Health Practice and Cultural Change in Mexico” (Vanderbilt University Press, 2018). Kristin Yarris is an Associate Professor of International Studies at the University of Oregon, where she also co-Directs the Center for Global Health and is a Steering Committee member of the Dreamers Working Group. She is author of “Care across Generations: Solidarity and Sacrifice in Transnational Families (Stanford University Press, 2017).


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