President Joe Biden’s Feb. 2 executive order directing federal departments to review Trump administration revisions to the Public Charge Rule – which were designed to deter legal immigrants from seeking Medicaid coverage and other benefits by potentially blocking permanent residency – will, if it leads to reversing the changes, help stabilize the nation’s health during a global pandemic while also shoring up our essential workforce.
Trump’s changes to the Public Charge Rule have been the subject of legal challenges since they were announced in 2018. While the stated intent was to protect America’s domestic interests and public benefits system, the expansion threatened to harm millions of immigrants and their families, many of whom are Black or brown.
The change created great harm to the health of our nation, specifically at a time when health care needed to be reinforced, not torn apart.
We know that COVID-19 has been devastating to immigrant communities. These communities have been virus red zones. Immigrant families that decided to forego Medicaid for fear – whether accurate or not – that accepting coverage would impede the immigration process have been placed in harm’s way.
But even aside from a pandemic, Medicaid should always cover those who are categorically eligible for the program, including legal immigrants who qualify. It makes all the sense in the world for these people to have health coverage: It allows us a healthier nation and prevents the needless spread of disease, it enables primary care that ensures illnesses get identified sooner – and thus are less devastating – and paves the way for better health outcomes and lower costs. It ensures that our essential workforce can meet society’s demands.
In studies published in 2019, 2020 and 2021, the Urban Institute found many immigrant families avoided using public benefits for fear of it negatively impacting their immigration status. This “chilling” effect took place even in the many months after the change had been announced but prior to the rule’s date of implementation.
Because so many health care, long-term care and home care workers are foreign-born people of color, the gravity of this issue cannot be overestimated. It could perpetuate a health care workforce crisis, too.
An immigrant labor shortage would impact every facet of our lives. Several industries, including health care, construction and agriculture, rely on a largely immigrant workforce. Ensuring the health of that workforce is central to the contribution it makes to these industries, as does proper nutrition, which can be assured through the Supplemental Nutrition Assistance Program, and the decent housing that can be afforded through Section 8 housing subsidies.
The Trump public charge rule counted each of these programs as a benefit that could potentially be used against a recipient’s eventual green card of permanent residency.
The Biden administration must ultimately not only review the Public Charge Rule changes — it must reverse them. This cannot be done with the simple stroke of a pen. It will in all likelihood require a regulation change, a process that can be drawn out due to notice and hearing requirements but that nevertheless should proceed now.
It will be incumbent upon the Biden administration to also launch an educational campaign focused on immigrant communities to rebuild their trust and assure them that utilizing Medicaid and these other benefits will not harm their path to permanent residency.
This is especially the case as we continue to fight the pandemic. Just like communicating the importance of the COVID-19 vaccine to immigrant and nonwhite communities, thoughtful messages that reassure them that seeking medical help when necessary won’t have unjust consequences is vital to our nation’s recovery and long-term well-being.
We are a nation built on hope. Our promise to immigrants is that their hard work and determination can lead to their citizenship — a chance to “join us in society,” as Thomas Jefferson said. The broadening of the public charge rule violated that promise. It sent a message to immigrants that they are a burden rather than a blessing.
We should want our nation to welcome all who seek a better life and are committed to the ideal of hard work and advancement. The expeditious overturn of the revised public charge rule will uphold the principles of our society, ensure our nation’s health and contribute to a reinvigorated post-pandemic economy.
Gerard A. Vitti is the founder and CEO of Healthcare Financial, Inc., a Boston area company that assists individuals in obtaining health care benefits.
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