AAP, members speak out against ‘public charge’ proposal
DevinMiller, Washington Correspondent
After nearly a year of indicating it would do so, the Department of Homeland Security
(DHS) issued a proposed regulation in mid-October that could threaten the health and
well-being of immigrant families.
The proposal expands the “public charge” test, which is used to identify people who
may depend primarily on the government for subsistence. Someone who is found to be
a public charge could be denied a visa or green card. In short, the proposal makes
it harder for immigrants, especially those in low-income households with children,
to enter the country and advance through the immigration process.
The public has until Dec. 10 to submit comments on the proposal. After that deadline,
DHS must consider the comments. Eventually, it will publish a final rule, and the
changes will take effect.
While the public charge proposal threatens immigrant child health, it is technical
in nature and may not grab headlines like the issue of family separation. The Academy
is undertaking an extensive advocacy strategy to speak out against the proposed regulation
and is empowering members with tools to do the same.
Following is an explanation of what changes to public charge would mean for child
health, how the Academy is speaking out and how AAP members can add their voice to
the advocacy efforts.
The more than 400-page proposed regulation expands the public charge test to consider
whether an immigrant has used or is likely to use certain government programs, such
as Medicaid, the Supplemental Nutrition Assistance Program (SNAP) and housing assistance.
The proposal adopts an income threshold, under which households would be subject to
the public charge test; a family of four would need to earn nearly $63,000 annually
to be exempt from the test.
“The public charge proposal presents immigrant families with an impossible choice:
keep yourself or your children healthy but risk being separated, or forgo vital services
like preventive care and food assistance so your family can remain together in this
country,” AAP President Colleen A. Kraft, M.D., M.B.A., FAAP, said in a news release.
In addition, the proposal discriminates against those with pre-existing conditions.
For example, a low-income immigrant who is unable to cover the cost of an extensive
treatment needed for a medical condition could be denied permanent legal status.
Child health impact
Based on the numbers alone, the potential child health impact of the proposed regulation
is massive: one in every four children in the United States lives in an immigrant
family, meaning the child or at least one parent is foreign-born. A recent analysis
by the Fiscal Policy Institute finds that the effect of the proposal would extend
to 24 million people in the U.S., including 9 million children.
After the proposal was leaked, many pediatricians across the country witnessed a chilling
effect in their practices, with families disenrolling from programs or avoiding health
services for which they are eligible. Although there was no change in policy, parents
were afraid that by using the programs, they could jeopardize their ability to continue
through the immigration process and remain in the United States.
During a recent radio interview with PRI’s “The World,” Lanre Falusi, M.D., FAAP,
of Washington, D.C., explained how parents in her practice were asking if it is safe
to access programs such as SNAP and the Special Supplemental Nutrition Program for
Women, Infants, and Children (WIC).
“Parents are choosing to play it safe and remove themselves from programs that they
qualify for,” Dr. Falusi said in the interview. “It is a very confusing and scary
time for the families I see.”
As a result of this fear and confusion, children are not receiving the health care
and nutrition services they rely on and are missing out on lifelong benefits of these
programs. For example, children enrolled in Medicaid are twice as likely to have routine
checkups and vaccinations than uninsured children.
In addition, if parents disenroll from their health coverage or choose not to enroll
at all due to fear of being deemed a “public charge,” their children's health could
Recent studies looking at Medicaid expansion to low-income adults found that children
were more likely to have an annual well-child checkup if their parents were insured.
Ever since initial reports of the proposal surfaced, the Academy had been preparing
for its likely publication. In fact, the Academy was among the first to voice its
opposition to the harmful effects of the proposal at the White House Office of Management
and Budget when it was first under consideration last spring.
DHS finally announced its plan to issue the proposal over a weekend in September.
The following day, Dr. Kraft joined a press call with partners to respond to the news.
The Academy strongly opposed the proposal and called on the Trump administration to
rescind it immediately.
Since the policy is not final until after the administration publishes the final rule,
the Academy is ramping up efforts to submit comments on the proposed regulation and
is urging members to speak out against it.
The AAP recently created a Public Charge Advocacy Toolkit, which can be found at https://federaladvocacy.aap.org. The toolkit includes background information on the proposal and information on how
AAP members can oppose the rule by submitting comments, posting on social media and
writing letters to their local newspapers.
Over the past several months, pediatrician experts have been featured in local and
national news outlets, explaining the consequences of changes to public charge on
In addition to individual pediatrician advocacy, the AAP has joined with other leading
physician organizations to oppose the public charge proposal. Since last year, the
AAP has served as a health care sector lead for the Protecting Immigrant Families,
Advancing Our Future campaign, which brings together leading advocates for immigrants,
children, education, health, anti-hunger and anti-poverty groups, and faith leaders.
In advance of the December public comment deadline, the Academy will continue to emphasize
the proposal’s child health consequences and how families already are experiencing
its dangerous chilling effect.