BCHC Voices Opposition to Proposed Changes to “Public Charge Rules”

December 7, 2018

Re: “Inadmissibility on Public Charge Grounds,” DHS Docket No. USCIS-2010-0012

The Big Cities Health Coalition (BCHC) appreciates the opportunity to provide comments on the Proposal to Revise section 212(a)(4) of the Immigration and Nationality Act (INA), Department of Homeland Security (DHS) Docket No. USCIS-2010-0012. BCHC is comprised of health officials leading 30 of the nation’s largest metropolitan public health departments, who together serve more than 55 million, or one-in-six, Americans. Our member health departments (HDs) work every day to keep their communities healthy and safe – and, importantly, they serve an incredibly diverse, and often vulnerable, population, including many immigrants.

BCHC opposes the proposed changes to the public charge definition and urges you to withdraw this proposed rule entirely. We believe it is detrimental to the health, security, and prosperity of the country as a whole, and our cities in particular. The proposal itself, not yet even implemented, has instigated yet another unnecessary crisis by forcing immigrants to choose between feeding or seeking health care for their children and the longterm security of their family. If this rule moves forward, it will increase sickness and poor nutrition, exacerbate homelessness, weaken our economy, and traumatize thousands of members of communities across the country whose inhabitants work hard and play by the rules.

Chilling Effect Several of our member jurisdictions report that just the proposed changes have led to a “chilling effect” on those seeking needed primary, and importantly, preventive, health care, as well as among those who are eligible for assistance programs designed to support low-income families. As noted in the proposed rule, the chilling effect is a welldocumented phenomenon.1 Researchers observed a steep decline in the use of public benefits by immigrants in the late 1990s in the wake of welfare reforms, including immigrant groups such as refugees who were exempt from the new rules.2 Further, findings from recent research published in Health Affairs highlights the same effect: “Advocates have started collecting early evidence of a ‘chilling effect’ due to the reports of the potential regulation, with immigrantfamilies disenrolling from these programs, not showing up for health care appointments, and otherwise being afraid to access vital services that can support the health and well-being of their families.”3

1 Batalova, Jeanne; Fix, Michael and Mark Greenberg. “Chilling Effect: The Expected Public Charge Rule and Its Impact on Legal Immigrant Families’ Public Benefit Use,” Migration Policy Institute, June 2018. 2 The U.S. Department of Agriculture published a study shortly after the welfare reform legislation took effect and found that the number of people receiving food stamps fell by over 5.9 million between summer 1994 and summer 1997. 3 Immigrant, US Values, and The Golden State, Health Affairs Blog, August 22, 2018. https:// www.healthaffairs.org/do/10.1377/hblog20180817.59208/full/