The Department of Homeland Security recently proposed changes to the public charge rule for immigrants. Their changes threaten to take the health care system backward — especially in California. These changes would reverse many of the gains our state made in expanding access to care over the last five years. They would create tremendous challenges for families, including children, to get necessary care.

Health care is a basic human need. We are all better off when everyone has access to health care services. All of us who work in the health care arena have a stake in moving the system forward to ensure that everyone can get the care they rely on. We also have a responsibility to respond to a policy that clearly undermines those values.

The government is accepting public comments on the proposed rule until December 10, 2018. The California Health Care Foundation has just submitted comments, and I encourage you to read and share them. Here are the repercussions of the proposed rule that concern me most:

It Would Have an Enormous Impact on California’s Immigrant Families

The federal government uses public charge to determine whether immigrants can qualify for permanent residency or enter the country to reunite with families in the US. For California, which is home to the greatest number and percentage of immigrants of any state in the nation, the impact on the health, health care, and economy of the state could be enormous.

It Would Scare Families Away from Care

The proposed rule would — for the first time — penalize immigrant families who get care from Medicaid, known in California as Medi-Cal. Researchers from UCLA and UC Berkeley project that between 317,000 and 741,000 Californians would disenroll from Medi-Cal if the rule is adopted.

It Threatens Children’s Health and Well-Being

The proposed rule’s impact on children is especially troubling. Immigrant families already feel afraid and in jeopardy in the current environment, and the health and emotional well-being of immigrant children is suffering as a result. The new rule would exponentially worsen their circumstances. Especially vulnerable are children in low-income households known to need medical attention, including those with potentially life-threatening conditions such as asthma, diabetes, epilepsy, and cancer. Institute for Community Health researchers estimate that if the rule is finalized, 195,000 to 455,000 California children in need of medical attention could leave Medi-Cal.

It Would Harm Our Health Care System and Economy

The proposed rule would inflict significant damage on California’s health care system and economy. More uninsured patients means greater uncompensated care costs for safety-net health systems, leaving those institutions with fewer resources to invest in innovations and care for all.

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This ill-advised proposal will not change the fact that we have always been a nation of immigrants. What it would change is whether America is a healthy nation — and a compassionate one.

Sandra R. Hernández

Sandra R. Hernández, MD, is president and CEO of the California Health Care Foundation. Prior to joining CHCF, Sandra was CEO of The San Francisco Foundation. She previously served as director of public health for the City and County of San Francisco. Read More

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