Trump ‘Public Charge’ Rule Would Prove Particularly Harsh for Pregnant Women and Children
In an accompanying paper(1), we explained that the
The new policy could affect a wide range of individuals of all ages, but its impact could be particularly harsh on pregnant and postpartum women and children. Their decision to forgo health care and nutrition assistance could have serious negative consequences for them in both the near and long term. In particular, the children may lose access to benefits that, in their later years, could mean better health, higher educational achievement, more work, and greater earnings.
Public Charge Rules Would Be Dramatically Changed
Under longstanding federal law, immigration authorities must determine whether an individual who is seeking lawful admission to
For decades under administrations of both parties, immigration authorities considered (among other factors) whether the individual received (or was likely to receive) cash assistance benefits and the part of Medicaid that pays for nursing homes and other forms of long-term care. Someone could be considered a public charge if she or he was primarily dependent (for more than half of his or her income) on cash assistance benefits or Medicaid long-term care benefits. (Cash assistance benefits include assistance from the Temporary Assistance for Needy Families program, the Supplemental Security Income program and state cash aid programs, which are now uncommon.)
The draft rule, which was leaked to the media, would dramatically change the benefit-related criteria used to make a public charge determination. The draft proposal would put someone at risk of being deemed a "public charge" if that person -- or anyone in the person's immediate family, including citizen children -- receive any of a far broader set of benefits. The criteria also would consider any receipt, not whether the individual was primarily dependent, so working families who receive benefits to supplement their low pay could receive an unfavorable public charge determination. The benefits and tax credits that would be considered include the Earned Income Tax Credit (EITC), the low-income component of the Child Tax Credit, Medicaid, the
Because undocumented immigrants are ineligible for nearly all of these forms of assistance -- and because cash assistance is already considered in public charge determinations -- the rule targets immigrants who are lawfully in
This extreme proposal would have two main effects. First, immigration authorities could use it to prevent some immigrants here lawfully who receive -- or whose close family members receive -- any of these benefits or tax credits from becoming permanent residents, and to prevent prospective immigrants who want to reunite with their families from entering
Second, the proposal almost certainly would convince large numbers of immigrants here lawfully and their children, many of them
This has happened previously. In the late 1990s, widespread confusion and fear about how public charge rules could impact families' ability to adjust their status among immigrants with children eligible for and in need of federal benefits such as SNAP and Medicaid resulted in many being deterred from applying for benefits. Partly as a result, the share of eligible individuals among these groups who were participating in benefits was low. For example, in 1999, just 40 percent of eligible citizen children living in households with immigrants participated in SNAP, compared to 70 percent of all eligible children.(4) Concerned that eligible individuals in immigrant households were unable to access federal benefits, the Clinton and George W. Bush Administrations took actions to clarify public charge rules and to ensure that benefit program applications and outreach were designed to address the fear and confusion. Participation rates subsequently improved significantly for eligible children in immigrant families.(5)
Finally, the draft rule indicates that the Administration is considering whether to change the rules governing when federal authorities can deport legal immigrants in ways that might make their receipt of benefits a consideration -- though we have no information about what, if any, changes the Administration may propose. If the Administration makes problematic changes in this area, that would heighten the risk that the rule would have a very large "chilling" effect on lawfully present immigrants receiving benefits for which they are eligible.
Especially Acute Impact on Pregnant Women and Children
The proposed rule could convince immigrants to forgo health coverage or nutrition assistance for themselves or for their infants, preschoolers, and school-age children and families to forgo tax credits like the EITC for which they are eligible. The results could include pregnant women who decline to enroll in Medicaid and thus lose access to pregnancy-related services, families that choose not to enroll babies and young children in Medicaid or CHIP, pregnant and postpartum women and young children who choose not to enroll in WIC, and school-age children who go to school without the health coverage and food assistance they need to succeed. In these cases, the result could be higher rates of poor birth outcomes -- including higher rates of infant and maternal mortality -- as well as poorer health, education, and financial outcomes for children of all ages.
The harm would be particularly acute for pregnant women and young children -- and the young children affected would typically be citizen children -- who may lose access to benefits that would lead to better long-term outcomes, including better health, greater educational attainment, and brighter future earnings prospects. The impacts for these children can start before birth, when the lack of prenatal care and nutrition assistance for their mothers could affect their birth and early health outcomes, and extend decades into the future, diminishing their opportunity to thrive in tangible and entirely preventable ways.
More specifically, under this rule:
* Women who qualify for Medicaid that would cover prenatal care and labor and delivery may feel that they face the impossible choice of (1) risking a public charge determination by signing up for this coverage, (2) finding a way to pay thousands of dollars for labor and delivery, as well as prenatal and postpartum care, or (3) going without needed care.
* A pregnant woman or mother of an infant (generally a citizen) might avoid enrolling herself and her child in WIC, which provides critical nutrition assistance to pregnant and breastfeeding women, infants, and preschoolers.(6) That's not a mere hypothetical possibility. In recent weeks, service providers reported that families said they were afraid to apply for WIC benefits. As
* Eligible children (including citizens) could miss out on Medicaid, which produces near and long-term benefits for children.(8) Children who are eligible for Medicaid do better in school, on average, and miss fewer school days due to illness or injury. They're also likelier to finish high school, attend college, and graduate from college.(9) And they earn more as adults and experience fewer emergency room visits and hospitalizations, research shows.
* Eligible children could miss out on SNAP, which also produces long-term benefits for children.(10) Research on the early days of the SNAP program shows that children who received food stamps (as SNAP was previously known) had greater rates of high school completion and a lower incidence of heart disease, stunted growth, and obesity as adults.
* In addition, eligible legal immigrant families with one or more adults working hard at low pay may forgo the Earned Income Tax Credit or Child Tax Credit for which they are otherwise eligible. Children in immigrant families that forgo these credits -- including citizen children -- would face more poverty and hardship immediately and weaker prospects in the labor market in the future. Without these tax credits, they would be less likely to do well in school, finish high school, and go on to college, research indicates.
The rule would likely have other adverse effects as well -- for example, on the financial health and viability of many hospitals, due to the significant increase it would produce in people who lack health insurance and come to emergency rooms for their medical care.
Footnotes:
(1)
(2) "Trump proposal would penalize immigrants who use tax credits and other benefits,"
(3) The term "lawful permanent resident" status is often referred to as having a "green card."
(4) "Trends in Food Stamp Program Participation Rates: 1999 to 2002,"
(5)
(6)
(7) "Spooked by
(8) See for example: "Medicaid Provides Needed Access to Care for Children and Families,"
(9)
(10)
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