The Trump administration on Monday proposed restoring a rule that penalizes lawfully present immigrants who use Medicaid and other health insurance programs, arguing that “government benefits should not incentivize immigration” and that immigrants should be “self-reliant.”
It’s an updated version of the so-called public charge rule from Trump’s first administration, which the Biden administration stopped enforcing in 2021 and rescinded in 2022. The policy the government is seeking to bring back directs government officials to deny immigrants’ applications for permanent residency if they had received or were expected to receive food or housing assistance, Medicaid, or other public benefits.
While the U.S. has long imposed restrictions on immigrants considered a burden on taxpayers, the Trump administration was the first to designate public health insurance as a form of welfare.
The Department of Homeland Security will accept public comment on the rule over the next 30 days, and will review the feedback before issuing a final rule.
Some health policy experts and immigrant rights advocates are warning that the rule will cause both individual suffering and negative population-wide effects.
They say the policy could burden already overwhelmed hospitals if immigrants skip preventive care because they lack health insurance and end up in the emergency room. They also predict it will make it harder to control both outbreaks of infectious diseases and chronic health conditions.
“Immigrants don’t live in isolation. Many of them live in mixed-status families,” said Adriana Cadena, executive director of the advocacy group Protecting Immigrant Families. “So out of fear of jeopardizing their immigration status, they’re avoiding accessing public benefits. We are already seeing a drop in patients attending appointments.”
The Trump administration estimated that the government would save $8.97 billion annually because people would drop out of Medicaid and other benefit programs — including “aliens as well as U.S. citizens who are members of mixed-status households.”
The announcement also notes that the rule “might result in reduced revenues for healthcare providers, such as hospitals and nonprofits, participating in Medicaid” and hit the bottom line of “companies that manufacture medical supplies or pharmaceuticals.”
A 2021 study found that the rule led many low-income immigrants to avoid using health services, including more than a quarter of legal permanent residents, who were not subject to the rule. Another study that year by George Washington University researchers found that the rule made the racial disparities in illness and deaths during the Covid-19 pandemic worse by deterring immigrants from getting tested and treated for the virus.
