Goleen Samari is a demographer at Advancing New Standards in Reproductive Health at the University of California, San Francisco.
When my parents came to the United States 40 years ago, they were seeking higher education. Then, in 1979, the Iranian Revolution cut them off both financially and emotionally from their home country. Through perseverance and public support, they built their American life and became citizens. I am a beneficiary of those efforts: a U.S.-born child of immigrants and a university professor.
Today, people who have immigrated here, like my parents, are facing another targeted, xenophobic attack. The Trump administration, which has already implemented a travel ban against five majority-Muslim countries — including Iran — and locked immigrant children in cages, proposed a new rule this month that would punish legal immigrants for accessing basic needs programs. The Department of Homeland Security seeks to deny permanent residency for legal immigrants who have used social service programs, including health insurance, cash and nutrition benefits. These immigrants will not be able to build their lives as my parents did. They will be forced to choose between the programs that help them create a healthy life in a new country and their chance at becoming citizens.
Denying access to public needs programs for a significant segment of the population is a looming public-health crisis.
In the past, the “public charge” rule referred only to a narrow group of people, such as those who need cash assistance for more than half their income. The proposed regulation would extend the denials of green cards to immigrants who use a variety of programs, such as Medicaid and nutrition programs, or even those whose U.S.-citizen children use those programs. The Migration Policy Institute estimates that the proposed rule would expand the share of legal immigrants subject to denial from 3 percent to a staggering 47 percent.
Contrary to the belief that immigrants overuse public benefits, lower percentages of poor immigrants use public benefits than similarly poor U.S.-born natives. When immigrants do use public programs, they cost the government less per beneficiary, reducing costs in the long run.
Limiting access to social programs decimates the health and well-being of immigrant families. Health resources include health care and insurance, but also jobs, education, social capital and social services — all of which fundamentally support health.
DHS itself acknowledges the potential damaging effects, noting in the proposed rule that lack of enrollment in public programs could lead to worse health outcomes, especially for pregnant or breastfeeding women, infants and children. Outcomes include increased emergency room visits, delayed treatment and increased prevalence of diseases. That’s coupled with the chronic stress caused by anti-immigrant policies that contribute to declining heath. Studies have found that in states with more anti-immigrant laws, Latino Americans experience more barriers to accessing health care and higher rates of poor mental-health days.
DHS has also determined that the rule may increase poverty for certain families and children, including U.S. citizen children. The Kaiser Family Foundation estimates that there are 10.4 million citizen children with at least one noncitizen parent and that nearly 6 million children receive public-health benefits. These families could be separated if a parent is considered a public charge and not granted legal permanent residency.
Immigrants who legally migrated, pay taxes and contribute to society now risk deportation if they ever find themselves in an emergency situation in which they have to rely on their American community. And the chilling effect of this rule would go far beyond the already large number of legal immigrants receiving support.
More than 26 million people reside in families receiving benefits with at least one immigrant member. The fear of being denied legal permanent residency could cause millions of legal immigrants to withdraw from all public programs. In fact, scaring vulnerable populations off public assistance and blocking use of public programs could cost much more in the long run, because neglecting preventive health care and basic medical problems creates chronic and complex medical problems, making patients more expensive to treat down the road.
Public-health recognizes that anti-immigrant policies are forms of racism that are antithetical to valuing health for all. These policies endanger and lead to premature mortality among large portions of the population and do nothing to keep Americans safe. In the effort to eliminate health disparities, we must actively work against the Trump administration’s xenophobic policies. We are all Americans, and we must urge Congress to block this proposal so that we can promote the health of all Americans.