Public Charge Rule Change Threatens Coverage for Millions of Children

In October 2018, the Trump administration proposed rule changes to the criteria immigration officials use to determine whether an immigrant becomes a public charge and a recent study shows that these changes could result in over 8 million children becoming uninsured.

The proposed rule changes allow immigration officials to examine what public benefits an individual utilizes—including Medicaid, Supplemental Nutrition Assistance Program (SNAP), Children’s Health Insurance Program (CHIP), Medicare Part D low income subsidies, and housing assistance—a sharp departure from what the original rule allowed.

“In response to the proposed changes, many immigrant parents are expected to disenroll themselves and their children from safety-net benefits programs. Although no changes to the rule have taken effect thus far, reports indicate that disenrollment is already occurring. Leah Zallman, MD, MPH, Institute of Community Health, Malden, MA, and colleagues explained in the JAMA investigation. “A major contributor to disenrollment is the so-called chilling effect: fear and confusion about the rule, even among immigrant families to which the rule does not technically apply.”

Approximately 5.5 of the 8.3 million children enrolled in Medicaid, CHIP, or SNAP, have specific medical needs, and according to the study, 0.8 to 1.9 million children would be put at risk for further complications including disability or even death if benefits are lost. 

“Without coverage, they are likely to forego, or delay needed care, and some, such as children with epilepsy or asthma, as well as newborns who require immunizations, are likely to incur higher long-term health care costs,” explained Dr Zallman. “In addition, undertreatment of illness increases school absenteeism and parental work absence, which, in the case of asthma, led to a loss of parental productivity of $719.1 million in 1996 alone.”

“We believe that denial of needed health care and nutrition to anyone, but particularly to children, violates human rights. We call on the medical community to speak out against this unjust and unethical proposal to change the public charge rule.” Dr Zallman and colleagues concluded.—Edan Stanley