A twenty-something mother cradled her five-month old baby in a doctor’s office as she wondered aloud whether she should un-enroll him from his health insurance and from the nutritional program she uses to keep him healthy. She’s too scared to make her situation known, so we’ll call her Rosa. Rosa is an immigrant who has lived in Detroit for over a decade and would love to eventually be a U.S. citizen like her son to ensure a more secure life for her and her family.
Rosa is one of many immigrant patients we have recently talked to that is agonizing over this decision due to the newly proposed ‘public charge’ rule by the Trump administration. This rule is forcing people to choose between the health of their family and maintaining their established life in the in the U.S.
The proposed rule states that immigrants who use government health care, nutritional programs, or housing programs could be ineligible to receive a visa or citizenship in the U.S. It expands the criteria the government can use to deem an immigrant inadmissible to the U.S. The rule would impact a broad range of immigrants with various immigration statuses and their U.S.-born children.
The public benefits that will newly be considered include SNAP, WIC, Medicaid, Medicare, and housing assistance programs. These are benefits that allow working families to afford nutritious food, preventive health care, and stable housing. As one example of the impact, a team of researchers estimated that 3 million U.S. citizen children could lose access to SNAP food assistance program if this rule goes into effect.
As a family medicine doctor and public health researcher, we know that these services are crucial for maintaining healthy families and avoiding complex and expensive health issues down the road. For example, one study showed that pre-natal enrollment in WIC resulted in women being more likely to have a healthy baby. Additionally, each dollar spent on WIC services saved $2.91 in newborn medical expenses. Unfortunately, the proposed rule discourages eligible people from using cost-saving and health-promoting services like WIC.
In our research with immigrant families in metro Detroit, we have already seen evidence that immigrant families are choosing to opt-out of public benefits that help keep children healthy and prevent diseases before they become costly. They un-enroll because they are afraid it will affect their chances of being able to keep their families together. One of the enrollment specialists we interviewed recently told us that immigrants clients “want nothing to do with WIC because of immigration….They were scared only because it was a government program.” We expect that as this proposed rule gets more attention, more eligible families will remove themselves from these health-promoting programs.
Some politicians and voices in the media believe immigrants should not receive any public benefits because they believe immigrants do not pay into these benefits. But, the data are clear that immigrants pay taxes and contribute to the growth of the economy beyond any cost of the public benefits they receive. Many immigrants are not even eligible to enroll for programs they are paying into through their taxes. For example, a report by Gov. Rick Snyder’s office showed that immigrants in Michigan paid more than $2.4 billion into Social Security and Medicare but many immigrants are ineligible for those programs. In metro Detroit’s 12th, 13th, and 14th congressional districts, immigrants paid over $2 billion in taxes. Earlier this year, the conservative Cato Institute published a comparative study of public benefit use among native-born and foreign-born and concluded that “immigrants consume 27 percent fewer benefits relative to natives with similar incomes and ages.”
Despite paying into this system through taxes, immigrant families face an enormous dilemma. The proposed public charge policy creates an impossible choice for parents like Rosa who only want the best for their children: health and wellness vs. keeping their family together. Sadly, Rosa’s child bears the potential health consequences of this new rule. No parent should be forced to make this decision and this ‘public charge’ rule should be abandoned.
Paul Fleming is an Assistant Professor at the University of Michigan School of Public Health. Richard Bryce is a family medicine doctor in Detroit. Monday is the last day for members of the public to comment on this proposed change.
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