2. Is this as unprecedented as critics say?
Yes.
Public charge is an old idea. In the 1990s, lawmakers expanded it to consider explicitly whether people had received cash-based welfare.
But including programs like Medicaid and food stamps, which are much wider in scope, is a significant change. It would more likely hit working people – the majority of people on Medicaid are themselves employed, and almost 80% live in families with at least one working member, according to data compiled by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)
Children who are American citizens but whose parents are immigrants could be more likely to suffer repercussions, said some experts. When parents opt out of public assistance for fear of their own legal status, their kids are less likely to be enrolled in programs such as the Children’s Health Insurance Program, or CHIP, for which they would qualify.
To be clear, receiving public aid wouldn’t necessarily stop people from getting a green card. But it would tilt the odds against them.
“Another piece is the enormous discretion the administration will have under its proposal in making judgments about who gets admitted to the country and who gets a green card,” said the Migration Policy Institute’s Greenberg.
3. When will the policy shift take effect?
This is an early step in the complex federal rule-making process. And a lot could still change.
Once the proposed rule appears in the Federal Register, a 60-day countdown starts, during which anyone can weigh in with comments.
A final rule likely wouldn’t take effect until 2019.
And DHS is still seeking input on some details. For instance, it hasn’t decided whether CHIP would be counted as one of the “public charge” eligible programs.
In the interim, people who had received public benefits before the rule took effect would not be penalized for doing so.
4. Already, though, the proposal is having effects
DHS estimates that 2.5% of eligible immigrants would drop out of public benefits programs because of this change – which would tally about $1.5 billion worth of federal money per year. But others expect a much larger impact.
“The chilling effects will be vastly greater than the individuals directly affected,” Greenberg said. “There’s considerable reason to believe that [the White House estimate] may be a significant understatement.”
In the proposed rule, DHS notes that the changes could result in “worse health outcomes,” “increased use of emergency rooms,” “increased prevalence of communicable diseases,” “increased rates of poverty,” and other concerns.
Given the complexity of these programs and the proposed rule – and the high stakes at play – low-income immigrants would be much more likely to avoid public benefits altogether, immigration experts said. Millions of immigrants are likely to be affected directly or indirectly, according to the Center for Law and Social Policy, a D.C.-based nonprofit organization.
That could have stark health implications.
Take free vaccines, for which children are often eligible and which would not be subject to the public charge rule. Families afraid of jeopardizing a green card could still be more likely to opt out of that service, Whitener said.
Already, she added, there are reports of people declining federal assistance – even though nothing has yet happened.
“The fear factor cannot be underestimated,” she said.