• Academy Objects to Harmful 'Public Charge' Rule Change

    Proposal Could Strip Critical Health Services From 10.7 Million Child Citizens

    December 06, 2018 03:42 pm News Staff – U.S. public health -- particularly that of children -- is jeopardized by the administration's proposed Inadmissibility on Public Charge Grounds rule, the AAFP told the Department of Homeland Security (DHS) in a Dec. 3 letter.(2 page PDF)

    As written, the regulation "not only threatens our patients' health but will also significantly increase uncompensated costs to the health care system and U.S. taxpayers as deferred care leads to more complex medical and public health challenges," the Academy told DHS Secretary Kirstjen Nielsen in the letter, which was signed by Board Chair Michael Munger, M.D., of Overland Park, Kan.

    The proposed rule, announced by the Trump administration in September and published Oct. 10 in the Federal Register, would put "a governmental barrier between health care providers and patients, and does not ensure meaningful access to health care for patients in need," the AAFP said. And the proposal's dramatic expansion of the government's ability to refuse admission or deny green cards or U.S. visas to individuals would likely lead to patients failing to seek vital care from family physicians because of fear they may be deported, which would risk the health of whole communities.

    "Widespread confusion about which benefits are and are not included in a public charge determination will also lead to families avoiding programs that are not clearly part of this proposed rule," the letter warned. "This ambiguity will harm the health of millions of families."

    Among those most at risk under such a rule change are the U.S. citizen children of immigrants. According to a Manatt Health analysis, as many as 41.1 million noncitizens and their family members could be affected by the revised rule; Manatt estimates that 10.7 million of these individuals are children who are U.S. citizens with noncitizen family members and could lose critical health care services.

    The proposed rule also considers factoring Children's Health Insurance Program (CHIP) enrollment into determination of public charge status. Because CHIP provides health care for 9.4 million children, the AAFP strongly objects to CHIP's inclusion in the proposed rule.

    "Even if CHIP is not included," the Academy cautioned, "many states use CHIP funding to finance care for children enrolled in Medicaid, as well as some pregnant women. In fact, nearly 330,000 mothers are covered by states' decision to trigger the 'unborn child' option, extending prenatal coverage for the health of the fetus."

    According to a new study issued by the nonpartisan Urban Institute, Medicaid and CHIP participation increased by 15.5 percentage points among citizen children with noncitizen parents from 2008 to 2016. The study posits that a policy change such as the public charge rule could have "broad chilling effects that lead to immigrant families opting out of public benefits and avoiding interactions with government authorities."

    Meanwhile, the number of U.S. children without health insurance rose last year, according to a report issued in November by the Georgetown University Health Policy Institute's Center for Children and Families. Noting that the administration indicated possible changes to the public charge rule in early 2017, the report attributes the increase -- the first uptick since comparable data were first collected in 2008 -- to an anti-immigration political climate.

    "We strongly urge the administration to abandon this effort and to work to ensure broader access, improved quality and more affordable care for our patients," the Academy's letter concluded.

    Related AAFP News Coverage
    AAFP Joins Opposition to Sweeping 'Public Charge' Change
    New Immigration Policy Would 'Endanger Public Health,' Academy Warns


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