“Have you EVER received, or are currently certified to receive in the future any of the following benefits?” United States Citizenship and Immigration Services (USCIS) now poses this question to all immigrants seeking legal permanent residence in the United States. These benefits include the Supplemental Nutrition Assistance Program, Medicaid, Public Housing, and cash assistance for income maintenance. If an immigrant answers yes to having received any of these health and social services, they risk being deemed a “public charge” and being barred from ever gaining legal permanent residence.
Under this brand new USCIS Public Charge Rule, since February 2020 immigrants to the United States must prove “self-sufficiency” when filing for permanent residency – also known as “green cards” – or even for temporary visas. Although the federal government has the legal mandate to regulate immigration, restricting access to health care, food, and other essential benefits on the basis of immigration status during a global pandemic is a dangerous and even lethal gamble to make.
“The U.S. government is forcing undocumented immigrants to choose between their health and a future path to U.S. citizenship, and many will choose the latter.”
This rule instills fear and confusion within the immigrant community, including amongst undocumented people and the large number of “mixed-status” households. Medical experts have already sounded the alarm on the “chilling effect” this rule has had on many immigrants, who are fearful of accessing benefits that may risk them being considered a “public charge” – such as Women, Infants, and Children (WIC) nutrition programs and Medicaid coverage during pregnancy. It is also likely to dissuade undocumented immigrants from obtaining potentially lifesaving testing and treatment for COVID-19. While the rule does not apply to refugees, asylum seekers, and applicants for other forms of humanitarian relief, this unpredictable policy environment creates fear and uncertainty in many immigrants across the board, not knowing what may come next.
I grew up in a predominantly immigrant community in the suburbs of Boston. My grade school classmates hailed from Brazil, El Salvador, Haiti, Morocco, and other parts of the world. My neighbors were from the Philippines, and the corner store was owned by a man who was deeply proud of his Italian heritage, as demonstrated by the countless Italian flags in his establishment. Many people in our community were either undocumented, on their path to U.S. citizenship (i.e. legal permanent residents) or newly minted U.S. citizens.
But the fear of deportation was ever-looming, and I witnessed many friends and family members forego medical care and refuse to enroll in public benefits for fear that their immigration status would be recorded, and that they would be deported as a result. The former federal agency that was charged with administering immigration and naturalization laws, the Immigration and Naturalization Service, was just as much a source of fear and anxiety for undocumented immigrants in the 1990s as Immigration and Customs Enforcement (ICE) is today. Today, however, the changes to the Public Charge Rule make those fears a reality.
“I witnessed many friends and family members forego medical care and refuse to enroll in public benefits for fear that their immigration status would be recorded, and that they would be deported as a result.”
I investigated the health impacts of this issue even before the COVID-19 pandemic heightened concerns. In September 2018, I traveled to Houston, Texas with Physicians for Human Rights and interviewed physicians to assess how recent immigration policies like family separation, increased Customs and Border Protection enforcement activities, and prolonged ICE detention affected the immigrant community in Houston. I spoke to one physician – a pediatrician who runs a free mobile clinic for low-income children in the area – about her experiences. She told me that the children she sees will often come to her asking about symptoms of various ailments that their parents are experiencing. When she asks why the parents do not seek medical care, the children reply that they are afraid of being deported and separated from their U.S. citizen children.
Policies that separate children from their parents, dissuade undocumented immigrants from enrolling in essential public benefits – including those NOT considered under the new rule – and allow community sweeps to deport individuals who may have lived in the United States for decades are meant to intimidate and create anxiety and confusion within immigrant communities like the one I grew up in. This is always wrong. But during a global pandemic, where undocumented immigrants are terrified to seek much-needed medical care, these policies may be deadly.
Although USCIS publicly stated that the Public Charge Rule does not restrict access to testing for or treatment of COVID-19, many immigrants already have and will undoubtedly continue to avoid hospitals and community clinics. They have heard the intended message loud and clear—you’re not safe here. The U.S. government is forcing undocumented immigrants to choose between their health and a future path to U.S. citizenship, and many will choose the latter. Three states have already asked the Supreme Court to suspend this rule and the U.S. government must heed this call. Only then will undocumented immigrants and others within the immigrant community feel comfortable seeking medical care and other essential benefits. The U.S. government must act now to save lives.