America’s pediatric care system is in for a shock if the Trump administration moves forward with a long-awaited immigration proposal that could come out as early as next month.
The plan would intensify how federal authorities determine whether immigrants—or their children—are likely to be reliant on the federal government, counting public benefits such as Medicaid and supplemental nutrition as strikes against them for the first time. The Department of Homeland Security proposed rule (RIN 1615-AA22), not yet publicly released, has been under review at the White House Office of Management and Budget since March.
But the rule, called “Inadmissibility on Public Charge Grounds” on the OMB website, could soon become a reality, and health-care watchers are bracing for impact. Some providers expect a tidal wave of sicker children and fewer insured patients that they warn could have lasting effects on American health care. Under the plan the number of immigrants who could be found inadmissible due to public benefits could rise sharply, from 3 percent to 47 percent, according to an analysis from the Migration Policy Institute.
Medicaid covers almost 8.5 million immigrants, according to the 2016 Census Bureau Current Population Survey. And millions more—nearly 27 million people—belong to immigrant families that use public programs and would be subject to the changes. Those families could see applications for changes to their or their relative’s immigration status at risk of being rejected. It’s also unclear whether the move would lead to deportation of already-legal American residents.
The public charge rule is a Trump administration priority and an area where officials see the need to clamp down hard, according to Sara Rosenbaum, former chair of a congressional Medicaid policy advisory group and a health policy professor at George Washington University.
The Trump administration and GOP have taken a hard-line stance on immigration both legal and undocumented.
Officials will likely roll out the proposal after Labor Day, Rosenbaum told Bloomberg Law. “This is one they see as politically very powerful for them,” she said. “We may see it as the midterm elections draw closer.”
The efforts to release the rule could, however, be slowed by the logistics of determining the fiscal impact, as required for rule-making, she added.
Families are already choosing to opt out of benefits for their children, according to some providers.
Lanre Falusi, a Washington-area pediatrician with Children’s National Health System and a spokeswoman for the American Academy of Pediatrics, told Bloomberg Law the effects are already being seen.
Parents at her largely immigrant clinic have started skipping out on enrolling in or renewing their Women, Infants and Children nutrition benefits or the Supplemental Nutrition Assistance Program (formerly food stamps).
Falusi warned skipping out on healthy food and breastfeeding assistance, for example, could have serious affects down the line for the next generation. She’s especially worried about mothers of newborns.
“The health return on investment for a program like WIC is huge, especially for younger ages when there’s so much growth of the brain,” she said.
A few others are starting to question Medicaid participation, Falusi said. She cited the Latin American immigrant parents who decided not to renew coverage for their young son with sickle cell disease who’s a patient at her clinic. The illness is chronic, and he could wind back in the hospital.
The number of people potentially affected by the change could be drastic, according to immigration analysts.
In 1999, the Justice Department under the Clinton administration issued a public charge proposal amid a welfare reform debate. But that proposal never was made a final rule. However, the government did issue a guidance on deportation and inadmissibility on public charge grounds in 1999 that considered a public charge to be cash benefits, as opposed to health coverage like Medicaid.
The Migration Policy Institute expects a broader policy from Trump to result in anywhere from 5.4 million immigrants to 16.2 million forgoing their benefits.
“It’s part and parcel of the effort to cull the rolls of as many people as they can,” Rosenbaum said. Telling families that they can access benefits for themselves or even their citizen children but that it could place their presence in the U.S. at risk is an “efficient” way to “deter enrollment,” she said.
“In the long term I think what we’ll see then in the health-care system is kids who are sicker because they didn’t have that access to as many healthy foods if they were no longer on WIC and SNAP; we’ll see kids and families who wait longer to see doctors,” Falusi said. And the number of families disenrolling from Medicaid could increase several times over.
“They may not come to me as often for well visits, but then they show up in emergency rooms after things have festered,” she said.
That could take a toll on health-care costs and the system as a whole.
Rosenbaum noted the uninsured rate would likely increase and called the potential spill-over effects on clinics, hospitals, and pharmacies “incalculable.”
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