WASHINGTON - Enrolling in Medicaid or an Obamacare plan doesn't hurt immigrants' chances of gaining permanent residency in the United States. That might change soon, under a major policy shift the Trump administration is considering that could curtail legal immigration.
Clinics that serve immigrant populations are anxiously watching the White House's budget office, where sources say the proposed changes are likely headed for consideration and are expected to be released before July. Providers told me they're already feeling the effects, as immigrants hoping to gain a green card or even citizenship back away from public safety-net programs, for fear it will score against them.
"When rules like this come out, they cause a lot of fear in our community regardless of whether someone is here lawfully or not," said Thu Quach, director of community health for Asian Health Services, a California-based chain of community health centers. "They'll go into the shadows because they're afraid."
The draft changes, first reported last month by The Post's Nick Miroff, would require immigration caseworkers to consider a much broader range of factors when determining whether immigrants or their U.S.-citizen children are using public benefits or may be likely to do so.
If an immigrant is determined to have a high likelihood of becoming a "public charge," it's much harder for them to gain longer-term approval for staying in the country.
The proposed changes from the Department of Homeland Security would broaden the government's definition of benefits to include not just Medicaid and insurance subsidies through the Affordable Care Act marketplaces, but also the widely used earned-income tax credit, food stamps and a host of other welfare programs.
We're not talking here about undocumented immigrants, who would see little change under this new policy. Instead, it would apply to the immigrants playing by the rules, including young people protected by the Deferred Action for Childhood Arrivals program if they attempt to file for full legal residency.
Expanding the "public charge" definition fits right into the administration's broader effort to curb legal immigration, which top Trump appointees view as a drain on federal budgets. DHS officials have said it's well within the government's scope to ensure that immigrants seeking to enter or remain in the United States are self-sufficient and won't pose a hefty bill for taxpayers.
"Any proposed changes would ensure that the government takes the responsibility of being good stewards of taxpayer funds seriously and adjudicates immigration benefit requests in accordance with the law," DHS spokeswoman Katie Waldman said last month.
But health advocates worry that the shift is discouraging immigrants from seeking out needed care, which could in turn lead to worse health outcomes and strain the workforce.
"We saw the chilling effects in our clinics - there were a lot more missed appointments," Quach told me. "We had one incident where a patient saw a doctor and said, 'I want to pay out of pocket, I don't want any record of this.' "
Last week, Philadelphia Mayor James Kenney requested to meet with officials from the Office of Management and Budget before they finalize the rule, saying he's worried about its economic effects on his city.
The current policy ensures "everyone can receive essential services, such as health and nutrition benefits, without being considered a public charge on that basis," Kenney wrote. "The proposed changes may cause immigrant families to forego needed health care or go hungry in an effort to keep their families together."
The director of the Asian American Research Center on Health weighed in, tweeting:
"The proposed regulation will target legal immigrants and their children (even if the children are citizens). Use of any public assistance - Medicaid, ACA, Food Stamps, WIC, SNAP, CHIP - can lead to denial of legal permanent resident status and possible deportation"
So did the Association of Asian Pacific Community Health Organizations, tweeting:
"Public charge is part of a broader agenda to marginalize immigrant families in this country. . . ."
The legality of such a change isn't really in doubt. For a long time, the U.S. government has been able to deny residency to immigrants who depend on public assistance. But here's the practical question: Do foreign-born people use public benefits more than then native-born population? The government's own research shows they don't.
In 2013, 3.7 percent of immigrants received cash benefits and 22.7 percent accepted noncash benefits, according to statistics from U.S. Citizenship and Immigration Services. The shares were only slightly lower for non-immigrants, with 3.4 percent receiving cash welfare and 22.1 percent receiving noncash benefits that year.
Immigrant rights advocates have long complained that even under existing policy - in which use of the Temporary Assistance for Needy Families programs and federally funded long-term care are considered in the public charge equation - immigrants are discouraged from seeking public assistance to an unfortunate degree.
"Immigrants' fears of public charge determinations are having devastating, widespread impact on the ability and willingness of immigrants to access public health and health care services," the National Immigration Law Center wrote in 1998 as part of a survey of how providers across the country were responding to policies under the Clinton administration.