The Department of Homeland Security recently proposed changes to the public chargerule 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.
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 low-income children 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.
* * *
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, MD, is president and CEO of the California Health Care Foundation. Prior to joining CHCF, Sandra was CEO of The San Francisco Foundation, which she led for 16 years. She previously served as director of public health for the City and County of San Francisco. She also cochaired San Francisco’s Universal Healthcare Council, which designed Healthy San Francisco. It was the first time a local government in the US attempted to provide health care for all of its constituents.
In February 2018, Sandra was appointed by Governor Jerry Brown to the Covered California board of directors. She also serves on the Betty Irene Moore School of Nursing Advisory Council at UC Davis and on the UC Regents Health Services Committee. Sandra is an assistant clinical professor at the UCSF School of Medicine. She practiced at San Francisco General Hospital in the HIV/AIDS Clinic from 1984 to 2016.
Sandra is a graduate of Yale University, the Tufts School of Medicine, and the certificate program for senior executives in state and local government at Harvard University’s John F. Kennedy School of Government.