BY NUSHEEN AMEEDNUDIN
For over a century, the Statue of Liberty stood as a powerful symbol of the United States’ promise to welcome immigrants to a new land of safety and opportunity. However, a recent Department of Homeland Security (DHS) proposal to expand the definition of the “public charge” rule threatens to tarnish that legacy. The proposed changes would harm immigrant families and betray the promise of a better life in America.
Proposed public charge expansion would penalize legal immigrants in the United States who use specific public benefits, even in the short term. It would classify them as being “at risk” of becoming dependent on the government for subsistence, which could further complicate their applications for US residency and citizenship. This change would create additional unnecessary obstacles to legal immigration, punish immigrant families for accessing services to which they are entitled, and ultimately force a choice between crucial support services and an unfettered path to a permanent home in the United States.
History of Public Charge
The term “public charge” historically referred to individuals in the United States who relied predominantly on cash-based government assistance, such as Supplemental Security Income (SSI) and Temporary Assistance for Needy Families (TANF). This classification was used to filter out prospective immigrant applicants for US visas, permanent residency, and citizenship who were deemed likely to become primarily dependent on public assistance. The rationale for public charge centered around the idea that potential and current immigrants who sought US residency should function as productive citizens who could contribute financially to their new home country without depending on the government for help.
The current definition of public charge originated from field guidance prepared in 1999 by the Department of Immigration and Naturalization Service. The field guidance responded to concerns that the 1996 passage of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) greatly expanded the bases to deny legal immigrants’ petitions for permanent residency or naturalization and allowed states to deny welfare benefits to undocumented immigrants. In addition, PRWORA established a five-year waiting period for legal immigrants to apply for federal benefits including SSI, Medicaid, Medicare, and the Supplemental Nutrition Assistance Program (SNAP, also known as food stamps). The field guidance sought to reassure immigrant communities that, even after PRWORA, any history of non-cash benefit use like health insurance (except for long-term hospitalization) or food stamps would not negatively impact residency or citizenship applications.
Effects of Expanding Public Charge
On 10 October 2018, DHS proposed wide expansions to the definition of public charge, raising concerns about implications for immigrant families among advocates for immigration, child health, and social justice. The proposed rule would expand the definition of “is likely at any time to become a public charge” to include immigrants with a history of even short-term use of cash (SSI, TANF) or non-cash (Medicaid, SNAP, housing vouchers) benefits. The expanded definition would categorize these benefits as negative factors in visa and green card applications. In other words, even legal, working, tax-paying immigrants could be penalized for accessing non-cash benefits to which they were legally entitled. If the rule were finalized, it would create an additional hurdle to naturalization.
Cutting off access to necessary benefits by forcing families to choose between feeding their children and pursuing a path to citizenship is cruel, stigmatizing, and counterproductive. It can be particularly damaging to children, who perform better academically with adequate nutrition and access to health insurance and whose development can be hindered without these supports. Low-income children who have health insurance through Medicaid miss fewer school days due to illness; grow up to be healthier adults; and are more likely to graduate from high school, attend college, and earn higher wages than their uninsured counterparts. Immigrants have also contributed more in taxes to the US health care system than they use, according to the conservative Cato Institute. Downstream effects of not being able to access primary and preventive health care could lead to higher, unreimbursed costs from more advanced disease that requires emergency or specialty care, which would ultimately result in a higher cost to the community.
Early leaked versions of the expanded rule indicated that successful anti-poverty programs that served vulnerable populations, such as the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), would be included under the public charge designation. Due to massive outcry over the inclusion of WIC even prior to the official comment period, it was removed from the final draft of the proposal that was made formally available for public review and comment. However, health care providers still reported hesitation among immigrant families to enroll in WIC and similar programs due to worry over the impact on future citizenship applications. Voluntary disenrollment from essential services by eligible immigrants, even from programs excluded from public charge definitions, occurred in the past to the detriment of these families and society. In the wake of PRWORA, refugees, asylees, and other groups exempt from public charge designation disenrolled from programs at rates as high as 54 percent, greatly outstripping DHS predictions that did not account for disenrollment based on fear.
Dr. Omolara Uwemedimo, the daughter of Nigerian immigrants, discussed the public charge issue from two different perspectives. During pregnancy, Dr. Uwemedimo’s mother temporarily stopped working as a nurse after she was placed on bed rest by her physician. Dr. Uwemedimo’s father, who was pursuing engineering studies at the time, faced the dilemma of quitting school to work in order to compensate for the lost income. But thanks to short-term use of SNAP and WIC, the family was able to make ends meet without derailing their American dream. They welcomed a healthy baby, Omolara, who thrived to become a New York–based pediatrician whose patients include immigrant children. The American Academy of Pediatrics and members like Dr. Uwemedimo have been vocal and active in organizing against public charge rule expansion. They brought to the fore the perspective of frontline physicians whose patients depend on services like Medicaid. Dr. Uwemedimo noted that the effects of public charge expansion would be “highly traumatic, not only to children and families, but also to our health care system and our economy.”
“A Pattern of Attack”
In addition to its detrimental effects on health and well-being, public charge expansion would damage the fairness and integrity of the American immigration system. The Protecting Immigrant Families campaign (PIF), co-chaired by the Center for Law and Social Policy and the National Immigration Law Center, classified the new public charge rule as part of a series of legislation and executive orders that comprised a “pattern of attack on low-income immigrant families.” Within the larger crackdown on both legal and illegal immigration through the administration’s actions and rhetoric surrounding the Deferred Action on Childhood Arrivals program and the “Muslim ban,” public charge expansion would make it even harder for immigrants to obtain permanent legal status in the United States.
Households with mixed-immigration status would face complex decisions with no easy solution. A legally employed immigrant mother of American-born children might not sign up for SNAP benefits for fear of jeopardizing her pending permanent residency application. Conversely, parents who accessed public services to help their families might face the prospect of rejected residency or citizenship applications that could force them to leave the United States. However, for families with safety concerns in their countries of origin, leaving the United States with their children might not be a viable option. Out of desperation, these parents might opt for separation, leaving their children with relatives or friends in the United States. Alternatively, in order to keep the family together, the parents may choose to allow their legal status to lapse and become undocumented.
Drivers of Proposed Expansion
The motivation for public charge expansion was unclear but purportedly rooted in the administration’s expressed economic concerns and fear of immigrant crime. However, these concerns diverge from facts. According to the Migration Policy Institute, immigrants comprised only 14 percent of SSI, Medicaid, CHIP (Children’s Health Insurance Program), SNAP, or TANF recipients from 2014 to 2016. In addition, immigrants were less likely to access public benefits than native-born Americans, and when they did, they used lower dollar amounts. They were also less likely to commit serious crimes compared to native-born US citizens, according to a 2015 report by the American Immigration Council. The same report examining crime trends for over 100 years showed that high rates of immigration were associated with lower rates of violent crime.
Justin Lowe, legal director of Health Law Advocates in Boston, stated that “at its core, public charge dehumanizes immigrants.” Lowe noted that the proposed public charge rule would cause families to forego health care and other public benefits in the hope of obtaining legal status. It would also be the first time that English proficiency would be evaluated as part of the green card determination. In estimating indirect impacts of this rule, also called the “chilling effect,” Lowe cited data that immigrants of color and non-wealthy immigrants would be disproportionately affected by this rule.
Defenders of the public charge expansion pointed to the need for immigrants to prove self-sufficiency before earning permanent status as new Americans or at least secure financial sponsorship to ensure they would not become a public charge. However, temporary use of non-cash benefits has helped many working immigrant families bridge needed gaps in services, decreasing food and housing insecurity, especially during early stages of adjustment in a new country. Due to factors such as upheaval in home countries and even country-specific laws that prevent international transfer of income, many immigrants, including educated, skilled, and previously self-sufficient workers, arrive in the United States with limited resources. As a result, they might briefly need public benefits to stabilize themselves until they can secure more permanent means of subsistence. By limiting access to these services, immigrants’ ability to eventually attain self-sufficiency could be impeded, which runs counter to the intent of the expanded rule.
Current Status of Public Charge
The future of the public charge proposal is uncertain; it is proceeding through the administrative rule-making process but has encountered significant opposition at the public-comment stage. Because public charge expansion is a rule that allows an existing law to be reinterpreted, it would not require an act of Congress or an executive order to come into full effect. It would require only that DHS finalize the rule following the mandatory 60-day public review and comment stage. As of February 2019, DHS was still reviewing over 200,000 individual comments by the public in addition to formal analyses by organizations that could sway the interpretation and implementation of the expanded public charge rule. Until the review is complete and the final rule is issued, the fate of immigrants is unclear. Immigrants and advocates expressed fear that, despite prior assurances outlined in the draft, the final policy could revoke exemption of certain groups and services from being classified under public charge. They also worry that the law could be applied retroactively to include any history of benefit use as a blemish on future applications.
Public-benefit programs like Medicaid and SNAP are anti-poverty investments proven to help children and vulnerable populations thrive. Withholding access to these programs by bartering immigrants’ hope for permanent legal US residency or citizenship would cripple the American Dream by limiting newcomers’ ability to succeed. The proposed public charge expansion would discriminate against the poor. By limiting access to programs that bridge economic gaps, it would risk perpetuating a cycle of poverty rather than assisting immigrants toward self-sufficiency. It would force families to make cruel choices between health and security in a new homeland. Ultimately, public charge would inhibit America’s success, growth, and reputation.
Nusheen Ameenuddin, MD, MPH, FAAP, is a master in public administration student at the John F. Kennedy School of Government at Harvard University and a Commonwealth Fund fellow in minority health policy at Harvard Medical School. She is a pediatrician at the Mayo Clinic and chair-elect of the American Academy of Pediatrics Council on Communications and Media. All opinions are her own and do not necessarily reflect the official positions of the institutions of which she is a part.
Edited by: Jaylia Yan
Photo by: Wikimedia
Author’s note: Special thanks to Madeline Curtis of the American Academy of Pediatrics Department of Federal Affairs for providing legislative expertise on public charge and the rule-making process.
 Justin Lowe (legal director, Health Law Advocates, Boston), interview with author, 11 February 2019.
 James R. Edwards Jr., “Public Charge Doctrine: A Fundamental Principle of American Immigration Policy,” Center for Immigration Studies, 1 May 2001, https://cis.org/Report/Public-Charge-Doctrine-Fundamental-Principle-American-Immigration-Policy.
 Lowe, interview.
 Department of Homeland Security, “Inadmissibility on Public Charge Grounds,” Federal Register, 10 October 2018, https://www.federalregister.gov/documents/2018/10/10/2018-21106/inadmissibility-on-public-charge-grounds.
 Diana F. Jyoti, Edward A. Frongillo, and Sonya J. Jones, “Food Insecurity Affects School Children’s Academic Performance, Weight Gain, and Social Skills,” The Journal of Nutrition 135, no. 12 (2005): 2831–9.
 “CCF-AAP State Snapshots Data Sources,” Center For Children and Families, Health Policy Institute, Georgetown Unviersity, 19 April 2017, https://ccf.georgetown.edu/2017/04/19/snapshot-source-2/.
 David Bier, “New Rule to Deny Status to Immigrants Up to 95% Self-Sufficient,” Cato Institute, 24 September 2018, https://www.cato.org/blog/new-rule-deny-status-immigrants-95-self-sufficient.
 Helena Bottemiller Evich, “Immigrants, fearing Trump crackdown, drop out of nutrition programs,” Politico, 3 September 2018, updated 4 September 2018, https://www.politico.com/story/2018/09/03/immigrants-nutrition-food-trump-crackdown-806292.
 Samantha Artiga, Rachel Garfield, and Anthony Damico, “Estimated Impacts of the Proposed Public Charge Rule on Immigrants and Medicaid,” Henry J. Kaiser Family Foundation (blog), 11 October 2018, https://www.kff.org/disparities-policy/issue-brief/estimated-impacts-of-the-proposed-public-charge-rule-on-immigrants-and-medicaid/.
 Omolara Uwemedimo (MD, MPH), interview with author, 1 February 2019.
 “About Us,” Protecting Immigrant Families, n.d., accessed 31 January 2019, https://protectingimmigrantfamilies.org/about-us/.
 Jeanne Batalova, Michael Fix, and Mark Greenberg, Chilling Effects: The Expected Public Charge Rule and Its Impact on Legal Immigrant Families’ Public Benefits Use, Migration Policy Institute, 8 June 2018, https://www.migrationpolicy.org/research/chilling-effects-expected-public-charge-rule-impact-legal-immigrant-families.
 Alex Nowrasteh and Robert Orr, “Immigration and the Welfare State: Immigrant and Native Use Rates and Benefit Levels for Means-Tested Welfare and Entitlement Programs,” immigration research and policy brief 6, Cato Institute, 10 May 2018, https://www.cato.org/publications/immigration-research-policy-brief/immigration-welfare-state-immigrant-native-use-rates.
 Walter Ewing, Daniel E. Martínez, and Rubén G. Rumbaut, “The Criminalization of Immigration in the United States,” American Immigration Council, 13 July 2016, https://www.americanimmigrationcouncil.org/research/criminalization-immigration-united-states.
 “Public Charge Proposed Rule: Potentially Chilled Population Data Dashboard,” Manatt, 11 October 2018, https://manatt.com/insights/articles/2018/public-charge-rule-potentially-chilled-population.
 Bier, “New Rule to Deny Status to Immigrants Up to 95% Self-Sufficient.”
 Madeline Curtis (policy associate, American Academy of Pediatrics), interview with author, 13 February 2019.