The Trump administration on Monday finalized its “public charge” rule on immigration, and experts within the healthcare industry are warning about the potential negative impacts the regulation could have.
Under the final rule (PDF), the Department of Homeland Security could more easily reject green card or visa applications for people that the agency deems likely to use public assistance programs, such as Medicaid, in the future.
When the plan was proposed, healthcare experts warned that it could have a “chilling effect” on immigrant enrollment in these programs and could lead immigrant communities to avoid healthcare altogether.
Julie Linton, M.D., a pediatrician and a member of the American Academy of Pediatrics’ Council on Immigrant Child and Family Health, said on a call with reporters Monday that the industry is already seeing some of those effects. The rule received more than 260,000 comments, including from health industry experts.
“It is clear that the outcry from pediatricians and child health experts was ignored,” Linton said.
Research indicates that under these provisions many immigrants could drop out of federal health programs. Kaiser Family Foundation projects that between 2 million and 5 million people will leave Medicaid or Children’s Health Insurance Program enrollment in the wake of the changes.
Georgetown University researchers also noted an increase in the uninsured rate among children late last year and attributed that trend at least in part to the national rhetoric on immigration.
In a statement, Rick Pollack, president of the American Hospital Association, called on DHS to “immediately reconsider this misguided and harmful rule.”
“This rule is a step in the wrong direction when it comes to fairness with regard to the treatment of legal immigrants seeking a pathway to citizenship,” Pollack said. “And, it creates barriers to appropriately care for the sick and injured, and to keep people healthy.”
Linton said that the rule’s restrictions would force some immigrants to choose—or fear they must choose—between seeking needed healthcare or keeping their families together.
The healthcare industry could feel the rule’s impacts in finance, too. Margaret Murray, chief executive officer of the Association for Community Affiliated Plans, said the “ill-considered” rule could have outsized impacts on safety-net providers that treat high volumes of Medicaid patients.
“The increase in the uninsured would lead it to safety-net providers—community health centers, public hospitals, county health departments and others—to clean up the mess by forcing them to provide uncompensated care when the uninsured get sick,” Murray said.
Bruce Siegel, M.D., president of America’s Essential Hospitals, echoed the sentiment, saying the rule threatens the “sustainability of essential hospitals” and would drive up costs for taxpayers and the system.