Public Charge: Bad for Seniors, Bad for the Economy, Bad for America

Proposed changes to the “public charge” rule by the Trump administration — the latest in a long list of actions designed to limit immigration to the United States by preventing permanent resident status for any individual here on a visa who accepts virtually any form of public assistance — go beyond the usual adjectives of cruel and xenophobic. They are short-sighted from both a health care and an economic perspective.

People here in the United States legally through a visa, but not yet holding a green card, are the people doing the hard labor in our economy today. They are particularly instrumental in our health care system.

They serve as personal care attendants to those with disabilities; home health aides to seniors who cannot live alone; certified nursing assistants helping groom, clothe and feed those in America’s nursing facilities; and aides in hospitals that serve as vital extenders to other more-skilled caregivers like nurses. They come from Africa, the Philippines, Central America and every other region of the world where people aspire to a better life in the United States.

If we impose significant new barriers for those people to come to our nation and begin the path to citizenship, then we are limiting our health care and service industry workforce and may soon find staffing in these fields at crisis levels. Our vibrant economy with record-low unemployment could change quickly if key positions go unfilled.

Look no further than the trucking industry. The nationwide shortage of drivers is seen as an economic headwind that will raise prices and inhibit economic growth. The same is true for our health care sector; only, a workforce shortage there can’t be fixed by paying a higher salary because these difficult and demanding jobs are just not taken by citizens. The people who truly suffer are the elders and those with disabilities, who will be forced to go without the PCAs and CNAs that create quality of life.

One could argue that the existing public charge rule has merit. It prevents abuse by limiting cash benefits to permanent residents and citizens. The expansion of this law, so that it applies to virtually every form of assistance — including the Supplemental Nutrition Assistance Program, Section 8 housing subsidies and Medicaid benefits — will remove every lifeline possible for those on the path to permanent residency.

How can low-wage employees here on a work visa afford a market-rate apartment in Boston, New York, Chicago, Los Angeles or wherever? How can they afford rent, groceries, heat and clothing at minimum wage?

Moreover, why should temporary assistance be a barrier to residency? Generations of immigrants have come to our country, gotten a helping hand and gone on to make America greater in the form of taxes paid, goods consumed and services provided.

The notion of people coming to our country just for the government benefits is largely a myth.  My organization helps eligible individuals and families apply for public health coverage. Many of the people we help are working two jobs to keep their head above water and need some assistance with health care. They want a little help — not a handout.

Just like my grandfather who came here with $17 in his pocket and made a good life as a laborer and stone mason, today’s immigrants want exactly the same thing. They have come here legally, contributed to our economy and waited their turn in the proverbial line for residency, and all they seek is a fair chance to succeed.

Let’s give our newcomers their fair chance, by striking down a proposal that is cruel on its face and dangerous both to the health of vulnerable citizens and to the broader economy.


Gerard A. Vitti is the president & CEO of Healthcare Financial Inc., a Boston-based firm that specializes in enrolling the uninsured into health programs.

Morning Consult welcomes op-ed submissions on policy, politics and business strategy in our coverage areas. Updated submission guidelines can be found here.

Morning Consult