A Systemic Attack on Health: Why the New Public Charge Rule Endangers California

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At the California Health Care Foundation, we operate on a simple foundational belief: health care is a human right. A healthy society depends on a system where everyone — regardless of income, ZIP code, or immigration status — can seek care without fear. However, a recent US Department of Homeland Security proposal to rescind the clear, fair 2022 Public Charge rule is a direct assault on this principle. By reintroducing ambiguity into immigration policy, the administration is manufacturing a climate of fear that threatens the well-being of all Californians.

An Impossible Choice for Immigrant Families

The proposed rule would force immigrant families to make an impossible choice between their health and their future in this country. We know from experience that when immigration rules become punitive or unclear, families disenroll from safety-net programs to avoid perceived risk to their status, even when they remain legally eligible.

No other state has as much at stake in this proposal, with nearly one-quarter of the nation’s immigrants calling California home.

The human cost of the proposal’s chilling effect is staggering. Analysis of the proposed rule indicates that the resulting fear could lead to a 10.3% disenrollment rate among Medicaid and Children’s Health Insurance Program enrollees living in mixed-status households. That translates to more than 422,000 people losing health coverage — not because they are ineligible, but because they are terrified.

An Array of Harmful Policies

We should not view this rule in isolation. It is part of a constellation of detrimental policies and punitive tactics being used against immigrant communities by the current federal administration. Beyond the proposed Public Charge rule, we see efforts to share sensitive Medicaid data with Homeland Security and reports of US Immigration and Customs Enforcement (ICE) conducting raids at and around places where people seek care.

These actions are intended to weaponize the health care system. When hospitals and clinics — places that should be sanctuaries of healing — are transformed into sites of surveillance and intimidation, trust will be eroded. Patients will delay seeking help for manageable conditions until they become life-threatening emergencies. Pregnant women will skip prenatal care. Parents will be afraid to get well visits for their children.

Immigrant Health Policy Affects All Californians

These policies do not harm only immigrant families; they put everyone’s health at risk. Public health is inherently collective. We cannot effectively manage communicable diseases or respond to community health crises if a significant portion of our population is driven into the shadows.

When families are pushed out of primary care, they are forced to rely on hospital emergency rooms, increasing wait times and costs for all of us.

We Must Find a Way Forward

This new public charge rule must not go unchallenged. It represents a fundamental misunderstanding of public health and a repudiation of the values that keep our communities strong. California has long recognized that we all are safer and healthier when our neighbors can get care when they need it. CHCF stands with the families, providers, and advocates navigating these challenges, and we urge all stakeholders to submit comments opposing this harmful rule.

Even as the federal landscape shifts and new barriers emerge, our commitment to that principle remains firm. We must continue to ensure that all residents have access to timely and appropriate care. The health of our state depends on it.

Looking for ways to stay informed about the Public Charge regulation? Protecting Immigrant Families provides regular updates and tools to engage on the issue.