Doctors Call New Trump Rule a Threat to Public Health

Dr. Jasmine Saavedra, a pediatrician at Esperanza Health Centers in Chicago, hands newborn Alondra Marquez to her mother, Esthela Nuñez. Doctors and public health experts warn of poor health outcomes and rising costs from sweeping changes that would deny green cards to immigrants who use Medicaid, food stamps or other forms of public assistance. (AP photo/Amr Alfiky)

CHICAGO (AP) — Diabetics skipping regular checkups. Young asthmatics not getting preventive care. A surge in expensive emergency room visits. Doctors and public health experts warn of poor health and rising costs they say will come from sweeping Trump administration changes that would deny green cards to immigrants who use Medicaid, food stamps or other forms of public assistance.


President Donald Trump’s administration trumpeted its aggressive approach last week as a way to keep only self-sufficient immigrants in the country, but health experts say it could force millions of low-income people to choose between needed services and their bid to stay legally in the United States.


Immigrants who want permanent legal status, commonly called a green card, have long been required to prove they won’t be “a public charge.” The Trump administration redefined the term to mean those who are “more likely than not” to receive public benefits over a certain period. U.S. Citizenship and Immigration Services now will also consider other factors, including income, education and English proficiency.



There are signs that is already happening in cities including Chicago, Detroit and New York, doctors and attorneys say.



New York’s Public Health Solutions, which serves a large immigrant population, reported a 20% drop in food stamps enrollment since the rule was proposed.

There is precedent for such a chilling effect.


Federico Mason, who emigrated from Mexico more than two decades ago, said he is worried about the new criteria because he is low-income and doesn’t speak English well. The Chicago resident said he has no immediate plans to remove his 8- and 15-year-old sons, who are U.S. citizens, from Medicaid, but the new rule has made him fearful about providing for his family and about applying for a green card.


Noncitizen low-income immigrants use public benefits at a much lower rate than low-income U.S.-born citizens, but millions of people could drop benefits out of fear or confusion. Estimates vary. It could be as high as 24 million people, according to the nonpartisan Fiscal Policy Institute, which includes in its count anyone in a family that has received food, health or housing support and where at least one person is a noncitizen.


She said noncitizen parents might hesitate to apply for their children who are U.S. citizens, mistakenly fearing that if their children get benefits it will destroy their own chances of getting a green card, and tear their families apart. That will lead to people being unable to afford care for chronic diseases like asthma and diabetes, as well as preventative measures. Instead, they’ll rely on far more costly emergency rooms.



Esperanza Health Centers, which runs four Chicago-based clinics that serve low-income and largely immigrant populations, has seen an increase in the number of uninsured children. Since a draft of the new rule was released last fall, the clinics report having 600 children without insurance, including those who have disenrolled from Medicaid. Typically, it’s about 200, according to Jessica Boland, director of behavioral health.







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