Immigrants Should Not Have to Choose Between Health and a Green Card

As medical students at Johns Hopkins University from immigrant backgrounds, both health and immigration are very personal to us.

We are deeply disturbed by the rule, “Inadmissibility on Public Charge Grounds,” proposed by the U.S. Department of Homeland Security on September 22, 2018. This expansion of “public charge” determinations would deny permanent residency (a green card) to immigrants who legally use Medicaid, Medicare Part D, Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), Section 8 housing vouchers, and potentially even the Children’s Health Insurance Program (CHIP).

In addition to the use of public benefits, the proposed rule also deems certain medical conditions — like mental disorders, heart disease, and cancer — to be among the heavily weighed factors for use in determining eligibility for being  issued a green card. Ultimately, this proposed rule puts millions of immigrants and children at risk for a lack of health services, food insecurity, and homelessness, out of fear that using these federal programs puts their green card application in jeopardy.

We have seen firsthand the pivotal role that services like SNAP, Medicaid, and CHIP play both in helping immigrant families get on their feet and in ensuring healthy outcomes for patients: for the 6 year old Nepali patient whose family’s access to SNAP has prevented diseases related to malnutrition and improved her performance in school; for the young Indian mother we see at the temple who depends on Medicaid to ensure a healthy pregnancy while her husband completes graduate school; and for the Nigerian boy at the pediatric emergency department whose family relies on Medicaid for the treatment of his sickle cell disease.

It is heartbreaking to think about a future where our patients and our community members, many who have waited for years on an H1B visa and minimum wage while in the application process for a green card, will have to choose between the health of their families and their immigration status. As a result of the threat to their immigration status, it is estimated that  2.1 – 4.9 million people will dis-enroll from Medicaid or CHIP.

As future medical providers, how will we safeguard our patients’ health when they are forced to disenroll from Medicaid or CHIP for basic services, such as immunizations and prescription drugs, which are no longer affordable? How many patients will stop coming for follow-up medical visits and present to the emergency room instead because of lack of insurance?

As medical students from immigrant backgrounds, we see our own stories reflected in the narratives of our patients. They have uprooted their families from every corner of the world to seek the American Dream: the opportunity to achieve a better life through hard work, determination, and initiative. The expansion of public charge is in direct opposition to that ideal. It implicitly and incorrectly assumes that people who receive benefits now cannot become productive contributors to our country in the future. We ourselves have been fortunate enough to have had the support – some of us through these very same public support programs – to pursue a medical career and give back to this country that has given our families so much.

We have a responsibility to speak up on behalf of both our patients and fellow immigrant families when their pursuit for a healthy life is in jeopardy.

We urge you to leverage your voice as an agent of change by submitting a comment opposing the proposed rule to the U.S. Department of Homeland Security before the deadline, December 10, 2018.

Make your voice heard so that families across the country do not have to choose between their health and their immigration status.