Supreme Court will hear challenge to Trump Administration's 'public charge' rule

On Monday, the Supreme Court announced it would take up a case challenging a Trump-era rule that makes it more difficult for immigrants to achieve legal status if they use public benefits such as Medicaid or food stamps. The case was brought by state and local officials, as well as various advocacy groups.

Enacted in 2019, Trump's "public charge" rule requires legal immigrants to submit to a public charge determination if they use public health, nutrition and housing benefits for which they are eligible. 

The rule, finalized by the U.S. Department of Homeland Security in August 2019, allows immigration officials to designate immigrants as a "public charge" if they use certain public benefits, including many forms of Medicaid, certain types of federal housing assistance or Supplemental Nutrition Assistance Program benefits. The rule is still in effect in most states, but was met with opposition when it was proposed.

Some of that opposition came in the form of an amicus brief signed by the American Public Health Association, American Academy of Nursing, and more than 60 deans and scholars from 27 schools of public health, public policy, nursing and medicine.

WHAT'S THE IMPACT?

Immigrants can be labeled as a public charge if they have medical conditions requiring "extensive" healthcare, a term that opponents said the rule doesn't clearly define. Being designated as a public charge can disqualify immigrants from permission to enter the country or to achieve green card status as permanent legal residents.

The amicus brief argued that the rule threatens the health of immigrants, their families, the healthcare safety net and entire communities in which they live. Half the U.S. population lives in communities where at least one in 10 residents is an immigrant. 

Supporters of the public charge rule say it will require aliens to prove they will strengthen American society rather than burdening it. They point to support from President Bill Clinton in 1996, when he argued that aliens be self-reliant in accordance with federal immigration policy.

President Barack Obama also voiced support for a public charge rule before a joint session of Congress, promising that the Affordable Care Act would not cover illegal immigrants, although some of them eventually utilized ACA programs.

Scholars said at the time that the administration ignored or dismissed more than 266,000 comments from public health officials and others who warned that the rule jeopardized healthcare, with immigrants and their families opting to forgo critical benefits related to basic health needs, including immunizations that can keep an entire community healthy.

The scholars state the rule would cause a substantial drop in enrollment in Medicaid and other essential health programs, leading to poor health outcomes and an increase in death rates.

THE LARGER TREND

This month, President Biden signed an executive order requiring a "top-to-bottom review" of the public charge rule, garnering praise from groups such as the American Hospital Association and America's Essential Hospitals. 

Rescinding the public charge rule has been a priority for the AHA in particular. In its outline of priority policies for the Biden administration, the organization included the rule in what it considers "ongoing critical challenges."

A drop in Medicaid enrollment would likely result in falling Medicaid revenue, which could affect the ability of healthcare safety net providers, such as community health centers, to serve all residents of their communities.

An analysis prepared by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative concludes that as a result of declining Medicaid revenue, health centers across the nation could serve between 136,000 and 407,000 fewer patients annually.

The brief also says that patients may simply cease to obtain care they need, insured or otherwise, since having a medical condition that requires care can jeopardize the ability to remain in the U.S. Immigrants simply may forgo care for themselves and their families entirely, fearing the consequences.

A Kaiser Family Foundation report projected that as many as 4.7 million individuals could disenroll from Medicaid and CHIP because of the rule.

Decreased rates of participation in safety net programs increase uninsured rates among immigrant families, ultimately reducing their access to care and contributing to worse health outcomes, KFF said in a separate report about the public charge rule.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com