• AAFP Voices Concern About New 'Public Charge' Rule

    Group of Six Calls on Administration to Rescind Rule, Protect Public Health

    August 21, 2019 12:37 pm News Staff – The AAFP and its fellow frontline physician organizations this month called on the Trump administration to rescind a new regulation that could have negative effects on public health.

    The sweeping policy update from the Department of Homeland Security "puts a governmental barrier between physicians and patients and stands in stark contrast to the mission our organizations share: ensuring meaningful access to health care for patients in need," the organizations said in an Aug. 13 statement.

    The "public charge" rule redrafts the government's longstanding formula for gauging an immigrant's potential reliance on public assistance, widening the scope of programs considered in that determination. One example: Nonemergency Medicaid coverage for nonpregnant adults, which was not previously included, has been added. The new rule also adds complexity to the testing measures for immigrants -- including those who hold green cards and are already on a pathway to citizenship.

    "The regulation upends decades of settled policy with regard to public charge and makes it much more likely that lawfully present immigrants may not seek health care," members of the Group of Six said in their letter.

    Rather than risk denial of green cards or visas, or even deportation, the organizations warned, affected patients "almost certainly will avoid needed care from their trusted physicians, jeopardizing their own health and that of their communities."


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    "Many of our members have already witnessed this chilling effect among their own patient populations, with patients avoiding health services and programs out of fear," the statement continued.

    In addition to the Academy, the Group of Six is made up of the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Osteopathic Association, the American College of Physicians and the American Psychiatric Association.

    "The public charge final rule not only threatens our patients' health, but as this deferred care leads to more complex medical and public health challenges, it will also significantly increase costs to the health care system and U.S. taxpayers," the organizations added.

    That position is broadly supported by research.

    In a fact sheet published in the wake of the final rule's release, the Kaiser Family Foundation warned that the policy would have harsh implications.

    "Nationwide, over 13.5 million Medicaid and CHIP enrollees, including 7.6 million children, live in a household with at least one noncitizen or are noncitizens themselves and may be at risk for decreased enrollment a result of the rule," the fact sheet said. "Decreased participation in these programs would contribute to more uninsured individuals and negatively affect the health and financial stability of families and the growth and healthy development of their children."

    detailed analysis published in JAMA last fall also discussed sobering "follow-on effects" likely to result from aggressive public charge policy.

    Under such a new rule, the authors wrote, "it may be difficult for physicians and others to provide sound health care counsel."

    They went on: "For example, what will physicians advise the 50-year-old woman who has a limited visa, with two children born in the United States, who has hypertension and type 2 diabetes? Should she forgo her oral medications, a visit to the ophthalmologist to check for retinal disease, a mammogram and cervical cancer screening so that she can increase her chances of staying with her children? ... Can she even be advised about whether to remain enrolled in Medicaid without an immigration attorney in the room?"

    Whether immigrants have chronic conditions is a consideration under the final rule, as is whether they have private health insurance or are covered by the Patient Protection and Affordable Care Act -- adding up to a bureaucratic pitfall for immigrant patients.

    As an Aug. 13 Health Affairs blog post pointed out, "The final rule also treats the presence of a medical condition that is likely to require extensive medical treatment alongside the absence of private health insurance as a heavily weighted negative factor in the public charge determination. In contrast, having private health insurance (not including insurance that is subsidized by tax credits under the ACA) is a heavily weighted positive factor."

    Several lawsuits that seek to halt implementation of the rule, which is slated to go into effect Oct. 15, have been filed

    Related AAFP News Coverage
    Academy Objects to Harmful 'Public Charge' Rule Change
    Proposal Could Strip Critical Health Services From 10.7 Million Child Citizens


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


    Fresh Perspectives: Crackdown on Undocumented Immigrants Poses Broad Health Risks