AAFP Joins Opposition to Sweeping 'Public Charge' Change

New Immigration Policy Would 'Endanger Public Health,' Academy Warns

September 24, 2018 04:20 pm News Staff

A proposed immigration policy change announced by the Trump administration(www.dhs.gov) on Sept. 22 would put a "governmental barrier" between physicians and their patients, the AAFP and four other physician organizations warned.

[mother trying to comfort crying infant]

The change would allow the government to deny permanent residency to immigrants who use Medicare Part D, Medicaid, the Supplemental Nutrition Assistance Program and certain other benefits. The proposal also noted that the administration is considering whether to add the Children's Health Insurance Program (CHIP) to this list.

"We are united in expressing our deep concern and opposition to the 'public charge' regulation announced yesterday by the administration," the organizations said in a joint statement(1 page PDF) issued shortly after the proposal was announced. It was signed by the AAFP, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians and the American Psychiatric Association.

In a separate statement issued Sept. 24, AAFP President Michael Munger, M.D., of Overland Park, Kan., said, "Family physicians' greatest concern about this proposed rule is that, regardless of their immigrant status, patients will risk their own health and safety -- and that of the community -- by avoiding needed health services from their trusted doctors.

"Not only does this scenario endanger public health, but it also lays the groundwork for higher health spending at the expense of U.S. taxpayers. Delaying necessary care can lead to worsening conditions and complications that require more complex and costly medical treatment."

The Department of Homeland Security estimates that more than 382,000 applicants would have been denied permanent residency if the proposed rules had been in place in 2016.

It's an alarming number -- and it might be low.

More than 8 million children with immigrant parents have health coverage through Medicaid or CHIP, according to an April report(www.kff.org) from the Kaiser Family Foundation on how changes to immigration policy could affect children. The report notes that children in immigrant families are predominantly U.S. citizens.

A commentary(www.nejm.org) published in The New England Journal of Medicine on Sept. 6, after media reports that the administration was considering changing the public charge rule came out, raises similar concerns.

"For health care providers such as federally qualified health centers and public hospitals, the expanded public-charge rule could lead to more patients lacking health coverage and higher costs from uncompensated care," the authors wrote. "It could also create confusion among patients from immigrant families and jeopardize progress that has been made in improving access to health care among language-minority populations."

The statement from the physician organizations was more pointed: "Many of the patients served by our members almost certainly will avoid needed care from their trusted providers, jeopardizing their own health and that of their communities," it warned. "As a result, the proposed regulation not only threatens our patients' health, but, as this deferred care leads to more complex medical and public health challenges, will also significantly increase costs to the health care system and U.S. taxpayers."

Munger urged the administration "to abandon this effort and to work with health care professionals to ensure broader access, improved quality and more affordable care to help build resilient communities with healthy families."

Once the rule is published in the Federal Register, it will be subject to a 60-day review period. The AAFP will make formal comments during that window.

Related AAFP News Coverage
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Students Focus on Protecting Vulnerable Patients, More Training

(8/10/2018)

Leader Voices Blog: Delaying Visa Approvals Would Harm Medical Training, Patients
(6/19/2018)