What does the public charge rule mean for immigrant health? Experts share insights and story tips

The Trump administration’s new public charge rule, set to go into effect next month, could discourage immigrants from accessing everything from emergency services to free flu shots, health experts warn.  

The rule aims to make it far harder for low-income immigrants to obtain green cards if a government test deems them likely to use public benefits such as Medicaid, food stamps or housing assistance.

“We’re likely to see not only a chilling effect for those programs that are articulated in the final rule, but also chilling effects across a broad range of important programs that help serve our communities and protect the health of our communities,” said Tom K. Wong, the founding director of the U.S. Immigration Policy Center and an associate professor of political science at the University of California San Diego. 

Wong recently joined neurologist and health researcher Dr. Altaf Saadi and CalMatters’ health care and immigration reporter Elizabeth Aguilera in a Center for Health Journalism Health Matters webinar that explored the potential impacts of the new rule, what providers and health care organizations can do to allay immigrants’ fears, and how journalists can cover the story.  

A rule with far-reaching ripple effects 

The term public charge has been used for decades in immigration policy to refer to someone who primarily depends on government public benefits.

The new rule, slated to go into effect Oct. 15, specifically mentions benefit programs such as food stamps and public housing as well as some forms of Medicaid, the government health insurance for low-income individuals. It also defines a public charge as someone who receives these benefits for 12 months over a 36-month period.

Even though some health benefits (such as receiving Medicaid while pregnant) are excluded and others aren’t mentioned at all, experts like Wong expect that many immigrants will be less likely to use a broad range of government services regardless. 

That prediction is supported by new survey research from the U.S. Immigration Policy Center at UC San Diego, where Wong conducts social science research. 

The center surveyed more than 500 undocumented Mexican nationals in San Diego County about the existing rule as well as the rule plus the proposed changes, then being finalized (Wong predicts those responses would be amplified now that the rule is going into effect).

Under the change, respondents said they would be significantly less likely to access health services even if those benefits aren’t articulated in the rule. For example, under the proposed rule, participants reported about an 18%drop in their likelihood of using of preventative health services, a 15% decrease in utilization of emergency health care services and a 9% decrease in accessing free immunizations services such as the flu shot.

Also noteworthy: The survey found the trends held for families of mixed status with U.S. citizen children.

The idea that the impact could spread beyond the targeted group  isn’t a new one, Wong said.  

“What we know from previous policies like Alabama’s HB 56 is that the chilling effects likely extend beyond just those programs articulated in the policies,” he said.

How the health care system is responding

Dr. Altaf Saadi, a neurologist and physician-researcher at Massachusetts General Hospital and Harvard Medical School, further explored how the fear around the public charge rule could impact people’s health and what institutions and providers could do to combat this. 

Saadi said she has heard from people who say anti-immigration policies have left them scared to leave their houses to drive to medical appointments or to pick up medications. Others are fearful to go outside to exercise or be present in the community more broadly, changes that could lead to long-term negative health impacts, she said.  

“The flip side of that is that when community spaces are perceived to be safe, there continues to be active engagement,” Saadi said.

Drawing on  interviews with dozens of providers, administrators and executives in five states, Saadi discussed what institutions can do to allay fears and create safe spaces. One idea was to designate public and private waiting rooms, which could help people scared of having their names called out in a public setting. Some facilities have distributed “Know Your Rights” cards in waiting rooms and used community health workers to provide direct education on health care rights.  

Other health centers? have included deportation preparedness as part of their overall emergency preparedness discussions, encouraging people to identify legal guardians for their children. Some tk tk  set upvoter registration drives outside health care facilities, as well as information on how to tell their stories to legislators and the media. 

Covering the story

Before jumping into interviews on the rule’s impact, CalMatters reporter Elizabeth Aguilera urged journalists to educate themselves on the details and nuances of the new rule. 

One important clarification is that it will not impact U.S. citizens or those who already have a green card. Also, many of the programs mentioned aren’t even available to undocumented individuals or non-green card holders, she said. 

To find sources, Aguilera advised reaching out to community clinics, immigration attorneys, school parent groups and churches and charities in immigrant communities. These “community connectors” can serve as important liaisons, breaking the ice and offering a “sliver of the trust factor,” she said. They can also help reporters translate or reiterate a question in a different way since they know the person’s story. 

Aguilera stressed the importance of being clear and direct about the potential consequences of going on the record when you’re interviewing people. They could be understandably fearful of their names appearing in the public sphere. Sometimes, they might not understand exactly where their name might end up, or what might happen as a result.

“If they are very fearful and say no, I definitely wouldn’t push on that,”she said.

For story ideas, she suggested looking into what will happen in states such as California that provide their own state-level benefits separate from the federal government, such as Medicaid for undocumented young adults. Will utilizing those state benefits somehow be held against someone? Another angle: What do families plan to do if they opt out of benefits such as food stamps? And, what is the public health impact of people foregoing health services such as preventative care or immunizations? 

After the rule goes into effect, Wong also suggested reporters look into whether the government is basing their immigration decisions on an applicant’s actual use of these services or their potential to use them. And, reporters should see whether overall rate of green card denials increase as a result of the rule in the months and years to come. 

“One can imagine that if there is a sentiment at the top to use public charge to essentially close the door to immigration … then the implementation of this policy can quite literally do that,” Wong said.

Watch the full PUBLIC CHARGE presenation here: