Sara Rosenbaum Analyzes Impacts of New “Public Charge” Rule on Immigrants with Medicaid

Professor Sara Rosenbaum

In a new blog, Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law at the George Washington University Milken Institute School of Public Health, presents an authoritative analysis of the proposed "public charge" rule published last week by the Trump administration. The rule could affect millions of legal immigrants enrolled in Medicaid, she says.

“If finalized in its current form, this public charge rule would have a dramatic impact not only on coverage, but also on access to health care and the overall stability of the health care system in thousands of communities across the nation,” Rosenbaum states.

The proposed rule would place greater emphasis on immigrants' receipt of public benefits in determining whether they are considered to be a “public charge” dependent on the government, Rosenbaum explains. This status plays a role in determining admission to the U.S. and in granting permanent green-card status.

The rule, which is now in a 60-day comment period, would require virtually all forms of Medicaid to be considered as a public benefit. Current policy states that medical assistance counts as evidence of public charge only when it is used to pay for long-term institutional care.

The rule’s policy goal is self-sufficiency, but Rosenbaum argues that the logic behind this is difficult to understand. “When it comes to health insurance, almost no American would be insured without considerable government help,” she says. “Yet the rule classifies only Medicaid as a form of insurance at odds with self-sufficiency. Private insurance — even when subsidized by government through public grants such as the Children’s Health Insurance Program (CHIP), refundable tax credits for marketplace health plans, or tax breaks for individuals and employers with job-based insurance — is considered a sign of self-sufficiency. Why is only one form of subsidy equated with non-self-sufficiency?”

A New “Public Charge” Rule Affecting Immigrants Has Major Implications for Medicaid is published in the Commonwealth Fund’s To the Point blog.