President Trump’s October proclamation required that prospective immigrants demonstrate they could obtain health insurance within 30 days of arriving in the United States — a demand that immigration and health experts said would be particularly onerous for low-income immigrants who may not already have lined up jobs with health insurance or may be unable to pay for “reasonably foreseeable medical costs,” as the rule states. Experts warned that the policy would favor the wealthy and prevent many U.S. citizens from bringing family members into the country.
The proclamation also required that even those who qualified for a federal tax subsidy to help them buy health insurance on the Obamacare individual market would have to reject that option, although there is not a mechanism on the federal health exchange website, healthcare.gov, to do so.
The proclamation came shortly after a wave of legal challenges sought to block Trump’s “public charge” rule, which would have made it more difficult for immigrants to get green cards if they needed federal assistance, such as food stamps or Medicaid. That rule was put on hold last month before it went into effect.
Yet the temporary blocks on the two policies — both of which experts said appeared designed to favor wealthy immigrants and prevent many low-income immigrants from coming to the United States — have done little to assuage fear among immigrants already living here. Some have sought to give up federal health insurance to which they are legally entitled, including Medicaid, health officials said, while others fear that their relatives will not be able to immigrate.
The proclamation sparked particular confusion among some American citizens who planned to apply for visas for their parents and other relatives, said Jesse Bless, director of litigation at the American Immigration Lawyers Association. Other immigrants expressed concern that if they leave the country to apply for their visas from consulates in their home countries they would be denied reentry, according to Bless.
“People are confused and terrified they will lose the ability to live in the U.S. with their loved ones,” Bless said.
The Migration Policy Institute estimated that the presidential proclamation could prohibit the entry of about 375,000 people annually, mainly those coming into the country on a family immigration program, who make up the majority of green-card holders. About one in four legal immigrants lack health insurance, compared to about one in 10 citizens, according to the Kaiser Family Foundation.
Seven U.S. citizens and the nonprofit Latino Network brought the lawsuit against the new policy.
The proclamation had also sparked concern among federal officials tasked with implementing it. During a conference call in October, officials within the Centers for Medicare & Medicaid Services (CMS) raised practical and legal questions about implementing the proclamation, according to two government officials who were on the call, speaking on the condition of anonymity to share details of a private conversation.
Among the concerns raised on the call were whether enforcing the proclamation was legal, the two people said. At least one official raised concerns about how the order would affect immigrants currently on the health care exchanges set up by the Affordable Care Act.
One attorney on the call said that, “I’m really thinking that in many ways, sticking to the letter of the proclamation will cause us to run afoul of current laws on the book,” the two government officials said.
Politico also reported that CMS officials had legal concerns about implementing the order, but details from the call had not been previously reported.
A spokesman for CMS denied that the agency had legal concerns about the president’s proclamation. “The Department has no concerns with implementing the President’s proclamation. Any alleged comments to the contrary are inaccurate,” spokesman Johnathan Monroe said in a statement.
State officials were also left in the lurch, uncertain how or whether the new rules would affect state-run health care programs open to immigrants because they had not yet received federal guidance. More than a dozen members of state health exchanges held a call on Friday to try to resolve confusion over how to comply, according to an official on the call who spoke on the condition of anonymity because they were not authorized to speak about it. Several state health officials submitted comments warning of dire consequences for immigrants if the proclamation went into effect.
The block will remain in place for 28 days, during which the plaintiffs and the government will try to gather and present evidence to the court.
The White House criticized the restraining order on Sunday and asserted the president’s right to make such changes to immigration policy.
“It is wrong and unfair for a single district court judge to thwart the policies that the president determined would best protect the United States healthcare system,” press secretary Stephanie Grisham said in a statement.
The organizations involved in the case — the Justice Action Center, the American Immigration Lawyers Association and the Innovation Law Lab, with pro bono assistance from the law firm Sidley Austin — celebrated the decision on Saturday but said their case was far from over.
“Today’s decision highlights the urgency of blocking this health care ban before it causes irreparable damage to our community and those we serve,” Carmen Rubio, executive director of Latino Network, said in a statement.