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The revised rule puts health of immigrants at risk and interferes with the patient-physician relationship

Feb. 21, 2020 (ACP) – In the wake of a recent Supreme Court ruling, the �������ý continued its opposition to the proposed changes to the “public charge” rule because of the barriers they create for immigrants seeking health care. The court ruled that the proposed changes can take effect despite lawsuits challenging them.

“Immigration policy should not interfere with the patient-physician relationship, and health policy should not foster discrimination against any patient, regardless of immigration status,” said Dr. Robert McLean, president of ACP. “We are greatly concerned that this decision will jeopardize the health of children and their families and create barriers to care for legal immigrants. That's why we joined other major physician groups to file a legal brief with the Supreme Court that opposes the new rule and outlines the harms that it would cause if it went into effect.”

A divided Supreme Court agreed in late January to lift preliminary injunctions blocking the revised public charge rule, which “allows officials to deny permanent legal status … to immigrants who are likely to need public assistance,” such as Medicaid, food stamps and housing vouchers, The New York Times reported. Previously, officials could deny permanent legal status based only on the need for “substantial and sustained monetary help or long-term institutionalization,” according to the Times.

Renee Butkus, ACP's director of health policy, explained that the changes to the public charge rule were scheduled to take effect on Oct. 15, 2019, but several federal courts issued preliminary injunctions to stop the rule from going into effect while cases challenging it proceed through the courts. Three of the preliminary injunctions applied nationwide, and one applied only to the state of Illinois.

Now, she said, the Supreme Court ruling means that the new policy will go into effect across the nation as courts figure out the next steps. There is a sole exception: The policy is still on hold in Illinois.

“We were extremely disappointed,” Butkus said. “We will continue to urge the courts to issue a final ruling that the public charge rule is unlawful and unconstitutional.”

Critics say the change in policy will have a chilling effect on the use of medical services by immigrants. Sara Rosenbaum, a professor of health law and policy at George Washington University, told the Times that the policy has already hurt Medicaid enrollment. “We have documented evidence of people just disappearing off the rolls,” she said.

ACP shares her concerns. “We have been on record opposing the changes to greatly expand the scope of the public charge rule. We believe it would put the health of millions of children and families at risk,” Butkus said. “It also would undermine the patient-physician relationship and disrupt continuity of care. We are extremely concerned that many of the patients served by our members will avoid needed care rather than face the threat of deportation or family separation, jeopardizing their own health and the health of their communities.”

For now, Butkus said, the new policy will be in effect across the country – except in Illinois – for applications and petitions received after Feb. 24, 2020, that seek Medicaid, SNAP, HUD public housing, and “Section 8” housing benefits.

“We will continue to urge the courts to issue a final ruling that the public charge rule is unlawful and unconstitutional,” McLean said. “At the same time, we also urge Congress to act to block its implementation.”

Back to the February 21, 2020 issue of ACP Advocate