By Sasha Abramsky | Originally published on July 12, 2018 by Equal Voice News
In a little-watched issue, advocates for immigrants say the U.S. government might redefine “public charge,” which could deny citizenship status. Compounding concerns: Recent family separations and other detentions. Overlooked: The well-being of families.
When Mychi Nguyen was 5 years old, in the mid-1980s, her family arrived in the United States as refugees from Vietnam. “We relied on public assistance to make it through and survive. My sister went to Head Start. My mother worked very, very hard. Coming to a country with nothing, you create a new life for yourself—and there are tons of barriers: language, culture, food,” she recalls. “Getting some of your needs met is huge. Having that assistance in the beginning was a huge game-changer. I was…an immigrant, a refugee, and I needed help. And the U.S. government provided help. We’re very grateful for it.”
Similar to immigrants who’ve arrived in the U.S., the experience left her with an abiding sense of her good fortune, and a deep desire to pay it forward to improve the situation of other vulnerable people. “Years later, I’m still giving back to communities that need me.”
Nguyen used her opportunity well. She is now a primary care doctor in Oakland, California, working as the site director for the Frank Kiang Medical Center, a federally qualified health clinic. Most of her patients are impoverished immigrants. Many would be left without any access to health care were it not for her clinic’s work. They are treated regardless of their ability to pay. “We serve everyone, all nationalities, ethnicities, languages, levels of income.” Yet, today, her immigrant clients, and others like them around the country, are in a panic as to whether or not they will be able to continue to access health services and other vital assistance. They worry that using such services for them and their children will be counted against them when they apply for permanent residency or U.S. citizenship.
Since 1882, the U.S. government has used the likelihood of a person ending up a “public charge,” on the welfare system, as grounds to deny them entry into the country. “Public charge” was mainly taken to mean cash welfare programs. For public health reasons, it has always excluded usage of vital health and educational services. In the late 1990s, after more than a century on the books, the regulations were clarified by Congress. Congress reiterated what was taken for granted then. It explicitly excluded from the public charge definition access to critical services such as health care and nutritional programs.
The rationale was straightforward: The public, and government finances, ultimately do not benefit if immigrant children aren’t immunized, as occurred in Westchester County, New York, [which led to a rubella outbreak that spread into New York City]; or if immigrant communities lacking access to health services act as incubators for an array of infectious diseases; or if malnutrition means that those immigrants can’t perform their jobs effectively; or, if children are so hungry they cannot study in school and are stunted in their subsequent life prospects.
“This is all about policies that are common sense,” argues Tanya Broder, senior staff attorney with the National Immigration Law Center. “Investing in preventive care, so simple problems don’t become emergencies.”
Now, however, plans being floated by the Trump administration, using the argument that too many immigrants are a drain on the public purse, suggest they are seeking a catch-all expansion of the definition of “public charge.” If these plans come to fruition, would-be immigrants whose children are deemed likely to need free school lunches, for example, could be denied entry into the U.S. And the use of those services, even by U.S.-citizen children, who are legally entitled to them, would be used as grounds to deny their immigrant parents permanent residency or citizenship.
Masked as a “reform” of the welfare system, it is, in fact, as public interest attorneys and community leaders fear, an extraordinarily brazen way to limit the immigration of poor people into the U.S., or their continued stay in the country, if they are already here. It would be, in practice, a massive tightening of the immigration system, and one the Trump administration hopes to implement on the down-low, as a regulatory reform, without any Congressional oversight, grassroots observers say.
The devil is, of course, in the details: Technically, the government wouldn’t be denying immigrants and their U.S.-citizen children access to health care, food stamps, school lunches and other programs they now can access; such a move wouldn’t stand up to legal challenge. What they are doing, however, is saying something like, “Sure, you can use these services, but we reserve the right to hold that against you down the road.”
“They wouldn’t be denying them access,” Broder says. “But they would be penalizing the parents, terrorizing families, chilling access to services or reducing family immigration in a way that Congress hasn’t authorized. The potential scope of the rule is so sweeping it would affect a large swath of the U.S. population. It’s an abrupt departure from 100 years of law and practice.”
While the exact contours of these regulatory rule changes haven’t yet been published, a number of draft versions of the proposals have leaked over the past several months. “We’ve been tracking it for some time now,” says Carolina Gamero, of the California Immigrant Policy Center. “What’s happening at an administrative level does strike real fear in communities.”
The leaked versions, which suggest an eagerness to penalize immigrants for using not only federal mean-tested programs but also state ones, have deeply worried immigrant rights and anti-poverty advocates, and also have forced them to think far outside the box about how to respond.
It is, says Jessica Bartholow, policy advocate with the Western Center on Law and Poverty, a “potential game changer,” since accessing universal benefits would not be penalized, whereas accessing means-tested ones would be. It might, she says in a more hopeful moment, force states such as California to consider implementing universal health care, or universal child benefits or even the universal basic income, as a way around the Trump administration’s potential changes that would affect immigrant populations. But, in the meantime, she fears a vast, and negative, impact on immigrant communities: “It’s really cruel to allow people in your country to experience that kind of deprivation.”
Already, she says, simply based on rumors circulating in immigrant communities, her organization has watched in shock as more and more immigrants have stopped applying for vital nutritional and health benefits.
At some point over the summer, the draft regulations will likely be released after review by the Office of Management and Budget—advocates have, since May, believed the publication was imminent—followed by a public comment period of up to three months. Given the hardline, anti-immigrant policies favored by some lawmakers, as a central plank for their midterm strategy, it is likely this comment period will fill the months leading up to the November elections.
If so, that would push a debate on immigrants’ access to public benefits center stage. The Trump administration could seek to make the image of migrants using benefits serve as the same political lightning rod as did the “welfare queen” in the 1980s. Former President Ronald Reagan used that term, to powerful effect, a generation ago.
Hoping to reshape the narrative, immigrant rights organizations are gearing up for an enormous fight during this public comment period. But by the end of 2018, there is concern that some version of these new regulations will likely be on the books.
Organizers with the National Domestic Workers Alliance, which works with low-income workers, mainly women, in heavily immigrant communities, agree with Bartholow’s observation. Which is: That even if they are ultimately not adopted, simply sending out a drip of rumors about such rule changes will serve the purpose of discouraging large numbers of immigrants from accessing everything from food stamps and school lunches for their children to health care and the Earned Income Tax Credit.
“It really affects a lot of the domestic workers we work with,” says Natalia Jaramillo, of the NDWA’s immigration campaign. “Many are immigrants on temporary protected status, or they are undocumented, or they are [non-citizen] residents. They have children born here.”
And, since the funding for so many federal programs is based on a formula that takes into account usage, as the number of immigrants accessing vital programs such as school lunches declines, so the total moneys available to poor school districts for these services, and for related services based on overall poverty measures in a school district, also falls off. Hit access to these programs, and states like California and New York, Florida and Texas, with high numbers of immigrants, likely will see declining services to, and opportunities for, poor people across the board.
The result likely will be a further shredding of the safety net, and more low-income immigrants, and others, falling deeper into poverty. Already, as federal policies and bureaucracies “get-tough,” so immigrants are facing huge hurdles accessing benefits. Take, for example, the story of Lemka, a 46-year-old undocumented immigrant living in a small town in the western part of Virginia. Shortly after Trump was elected president, she had to renew Medicaid for her U.S.-citizen daughter.
When she went in to the office to fill in the paperwork, the official there interrogated Lemka about her immigration status, which was not relevant to the visit, and told her that if she didn’t provide all the information they requested she would refer her to federal immigration authorities. Lemka was only applying for benefits for her U.S.-citizen child. In a panic, Lemka left the office, and even though her daughter, who also qualifies for food stamps and school lunches, is legally eligible for Medicaid, she is no longer covered.
Lemka’s case speaks to a broader issue. Despite the view by some in the U.S. that immigrants, legal and otherwise, are “takers,” so many are either already excluded from or scared away from the social safety net that they contribute far more in taxes than they will ever receive in benefits. In 2017, says Robert Pollin, co-director of the Political Economy Research Institute at the University of Massachusetts at Amherst, “Undocumented immigrants contributed $13 billion to the Social Security Trust Fund and received only $1 billion in benefits – i.e. they were donating $12 billion to support everyone else’s Social Security.”
In the current anti-immigrant political climate, however, such inconvenient facts mean little to an administration intent on finding evermore creative ways to limit the ability of foreigners to migrate into, and remain within, the United States. “It’s all part of a huge plan to make our country as uncomfortable to immigrants as possible,” argues Amanda Baran, a consultant on immigration issues to the National Domestic Workers Alliance. As a result, some grassroots advocates fear, kids in immigrant families may well soon be excluded from even the most basic of health protections.
“It’s good health policy to make sure children are protected and healthy, not just for themselves but for the community at large,” Lemka says, speaking through an interpreter provided by the NDWA. “We’re talking about the safety and health of U.S.-citizen children. U.S.-citizen children that have rights. As a mom, I’m concerned about my kid. It’s hard to keep kids safe and healthy.”
Back in Oakland, California, Nguyen, the doctor, has seen firsthand what happens when her patients are scared off of using medical services. “They’re afraid, very, very scared about using services they need,” she says. “Food stamps, WIC [Women, Infants and Children program]. You’re providing food for babies, education. You’re preventing hunger, malnutrition, costs on society in the long term. I’ve had patients I’ve known for years. I tell them I’m worried they have cancer, and I’d like to do a workup. They’re afraid if they use a specialist or get a CAT scan, that’ll be seen as a public charge and hurt them. They’re risking their life. I had a patient, an old gentleman, he was having a stroke right in front of me. I told him he could die or be paralyzed if he doesn’t go to the ER right now. He told me he couldn’t take that risk. Now he’s paralyzed. The right side of his body doesn’t work.”
Nguyen worries constantly that, if the proposed “public charge” changes come into effect, such stories will become commonplace. “We will see patients not coming in,” she fears. “They won’t come in for their doctors’ visits. It will create a huge impact on the health care system. People will delay health care till they’re really in crisis. And then they’ll show up in the ERs very sick. From a public health policy standpoint, there’s no rationale to do this, to expand the ‘public charge’ definition. It’s very shortsighted. Economically, it doesn’t make sense.”
Sasha Abramsky is a freelance journalist and book author. The United Nations cited his 2013 book, “The American Way of Poverty: How the Other Half Still Lives,” in its 2018 report about extreme poverty and human rights in the U.S.
For more perspectives on this issue, see the following resources:
- “A New Threat to Immigrants’ Health: The Public-Charge Rule,” The New England Journal of Medicine
- “The Health 202: A White House proposal has legal immigrants forgoing health-care services out of fear,” Washington Post
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