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Migrant Clinicians Network Denounces Supreme Court Decision to Allow Public Charge Implementation

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A clinician checks someone's blood pressure

On Tuesday, the US Supreme Court temporarily removed an injunction that had prevented the implementation of the new public charge rule. This decision allows the public charge rule to go into effect nationwide, with the exception of Illinois, where a statewide injunction still stands. The Department of Homeland Security has yet to indicate how or when it will begin implementing the rule, but it could begin immediately.

Migrant Clinicians Network opposes the public charge rule, which has already had a startling effect on many of the patients of clinicians in our network. Under the new rule, the use of basic public assistance programs like Medicaid and SNAP (frequently referred to as “food stamps”), even when an immigrant is eligible for the program’s services, may be identified as a reason for rejection of a request to adjust status to permanent residency by an immigrant with authorization to live and work in the US.

This public charge rule discourages legally authorized immigrants from accessing even basic health services for which they are eligible, which ultimately may jeopardize the health of hundreds of thousands of legally authorized immigrants and their families. In 2019, many clinicians reported to MCN that they had legally authorized immigrant patients who had rejected Medicaid, even though the patients were legally eligible, out of fear that the utilization of government-sponsored insurance would jeopardize their future prospects at gaining legal permanent residency or, eventually, citizenship. This includes pregnant women who chose to give up prenatal care, which can jeopardize the health of both the baby and mother, and patients with chronic diseases who avoided care and abandoned treatment plans, which may leave them with dangerously worsened conditions that are harder and more expensive to treat.

With the new Supreme Court decision, more immigrants will avoid needed care. Additionally, the ruling may discourage mixed-status families from utilizing health care for their US citizen family members out of fear of potential repercussions, thus initiating a ripple effect of poor health care access across the US.

“People should not be punished for using government supported medical services for which they are eligible,” said Laszlo Madaras, MD, MPH, Chief Medical Officer for Migrant Clinicians Network. “With this new ruling, we anticipate a whole class of legally authorized immigrants who will be unable to access needed health insurance, who will end up much sicker in the emergency room instead of seeking their needed care earlier. Some may even decide, against their better judgement, to forgo prevention efforts such as immunizations, thus leaving a percentage of the American population unvaccinated or undervaccinated. This is an unacceptable and fiscally irresponsible decision on the part of our government that will have profound effects on America’s public health.”

Last year, Ken Cuccinelli, the acting director of US Citizenship and Immigration Services (USCIS) stated in a briefing that the policy will “have the long-term benefit of protecting taxpayers by ensuring people who are immigrating to this country don’t become public burdens, that they can stand on their own two feet, as immigrants in years past have done.” Dr. Madaras disputes this historical fallacy: “While I respect the idea of fiscal responsibility on the part of every American, none of us really stand on our own two feet. Any serious accident or needed medical procedure can bankrupt the average American, even those with some health insurance. Catastrophic accidents can happen to anyone. It makes sense to provide coverage to our neighbors and community members, and not disqualify them from living and working here when they use health services. We, as a nation, are not this poor, nor do we need to be this cruel.”

This new public charge rule does not directly affect the many patients who lack documentation status, who do not have access to federal public assistance programs, but we anticipate that the chilling effect that clinicians are already reporting will cause further confusion and fear among a large swath of immigrant patients, resulting in less utilization of needed health services among immigrant patients, regardless of documentation status.

“This rule is a step in the wrong direction. We should be extending our health programs to assure greater access,” Dr. Madaras noted. “Health care is a human right.”

Take Action

  • In The Health Center: Clinicians must provide accurate information for patients in the wake of this ruling. We recommend the following sites for resources, including signage, know your rights statements, and public benefits charts, in multiple languages.
  • In Your Community: As clinicians -- community health workers, physicians, social workers, nurse practitioners, psychologists, health educators, and more -- you work directly with immigrants whose health can be detrimentally affected by this public charge rule. We encourage you to speak up in your communities. Write letters to the editor, call your local representative, and post about this on social media. Your voice matters, your expertise is much needed, and your patients’ future health may depend on it.

Read More

Protecting Immigrant Families continues to provide regular updates on public charge:

Migrant Clinicians Network has repeatedly opposed the new public charge rule since its introduction, over a year ago. Read our previous statements and accounts on public charge:


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