Deep within the fine print of a newly proposed federal rule change is an admission of its disastrous health consequences. The Department of Homeland Security’s plan would deny legal immigrants permanent residency status if they accept government assistance to which they are entitled, allegedly an effort to “promote immigrant self-sufficiency” and ensure “they are not likely to become burdens on American taxpayers” or “public charges.”
But the certain collateral damage of this misguided policy, which greatly expands an existing principle to make its application downright punitive, reveals it’s not about promoting self-sufficiency at all.
In describing the impact of this effort, the Department of Homeland Security states, “Disenrollment or foregoing enrollment…by aliens otherwise eligible for these programs could lead to:
- “Worse health outcomes, including prevalence of obesity and malnutrition, especially for pregnant or breastfeeding women, infants or children…
- “Increased use of emergency rooms and emergency care as a method of primary health care due to delayed treatment
- “Increased prevalence of communicable diseases, including among members of the U.S. citizen population who are not vaccinated.”
This acknowledgement is right there, on page 370 of a 447-page rule change that may soon become federal policy. Only a one-word substitution is needed for complete accuracy: “would” instead of “could.”
The rule change, if implemented, will cause legal immigrants, their spouses and children, including U.S. citizens, to withdraw from government assistance programs out of fear that it would endanger the chances for a family member to obtain a green card and become a legal permanent resident. Washington will, in effect, force individuals to choose between their welfare and a family member’s legal residency status.
As the CEO of a health system that works to maintain the good health of hundreds of thousands of first-generation Americans, I am extremely concerned about the consequences.
The Mount Sinai Health System cares, on an ongoing basis, for over 110,000 children. One out of every two receives assistance through Medicaid and other government aid programs to help cover the cost of their care. What will happen to those children who suddenly could go without regular primary care and sick visits because of concerns of family members that accessing the assistance might disqualify them from receiving a green card?
Some children will not receive necessary vaccines, making them susceptible to preventable diseases, such as measles, mumps, Hepatitis A and B, and polio. Illnesses will not be addressed when they are easily treatable. Without proper prenatal and perinatal care, there will be an increase in birth complications.
What inevitably happens when someone goes without proper care is that minor health issues are ignored until they become so serious that the patient shows up at the emergency department with a severe condition that is costly to treat. We see it happen every day at our hospitals.
Nationwide, more than eight million U.S.-citizen children who have an immigrant parent receive government-supported health care. The administration’s tough talk on immigration has already driven some of these struggling families to drop federal and state health benefits. If the DHS “public charge” rule change were to go into effect, far more immigrants would follow suit.
DHS estimates the annual cost savings to Washington and the states resulting from immigrant families bypassing public benefit programs would be $2.3 billion. That’s a small sum compared to the proposal’s long-term costs, all measured in damage done to broader public health. Sicker children will have more chronic disease, more health complications, and, over time, will cost the country multiples of any short-term savings in government benefits.
Washington policymakers have not given adequate thought to the fine print in their own proposal. It is bad policy, financially and morally costly, that should not be implemented.