03 | Public Charge: The Chilling Effect on Health Care Access

According to the Commonwealth Fund, the proposed rule puts the administration’s immigration policy in direct conflict with sound health policy and has the potential to disrupt preventive and ongoing care for millions of people. 

Additionally, the rule will have a significant impact on the delivery system, reducing Medicaid support for health care providers and driving up uncompensated care. Safety-net providers and health care providers in communities with large immigrant populations will be particularly hard-hit, affecting not only their fiscal health but their ability to serve the broader community.  

While the implications aren’t all immediately clear, our conversation with a public health sector leader will breakdown some of the key elements and outline ongoing advocacy and education campaigns that seek to support affected immigrant families and the organizations and institutions that provide direct services to those communities. 

In this episode, I’m talking with Luvia Quinones, Health Policy Director with the Illinois Coalition for Immigrant and Refugee Rights, or ICIRR, located in Chicago, IL.

The ICIRR is dedicated to promoting the rights of immigrants and refugees to full and equal participation in the civic, cultural, social and political life of our diverse society, and works with many member organizations on various programs and campaigns to empower the immigrant community in Illinois.

In her role as Health Policy Director, Luvia oversees the In-Person Counselor Program, Immigrant Health Care Access Initiative, and in collaboration with ICIRR’s members, develops ICIRR’s health policy agenda with a special focus on access to health care and on health care reform.

Can you tell us what is Public Charge and when does it apply? 

It’s a test, something that has been in immigration books for almost 100 years. A test that anyone who wants to come to the US with some kind of VISA or trying to adjust your status within the US needs to go through. 

What is being proposed, they want to change the definition of Public Charge. So, they want to go from saying if you’re using any of these benefits, either TANF or long-term nursing assisting as the expense of the government, to adding several programs including SNAP Medicaid housing.  

They want to change the definition to say how likely is it that any of these individuals will ever use any of these programs. Not only do they want to change the definition and give more authority to Immigration officers, but they also want to penalize individuals for being poor, sick or having several children. 

The more negative factors you have the less likely you are to get a green card. 

In regards to who it impacts, its mainly 2 groups of individuals who are trying to come into the US with a VISA or those trying to adjust their status, either one VISA to another or going from a VISA or from being undocumented to getting a green card. 

It does not affect people who already have a green card or those in the process of getting their citizenship. 

Which benefits are included in public charge in-admissibility? 

Of those benefits that were included in the proposed rule are SNAP, Medicaid housing and the 2 that are already included is long term nursing, assisting at the government’s expense and TANF. Not only is this proposed rule including these new programs but also adding this whole other piece of the negative vs positive factors, including income, health, and social status. 

Describe the effect this proposed rule has created for immigrant families seeking public benefits, and health care services and those sectors that serve them? 

We have already been seeing the chilling effect. There have been different iterations of it over the past 2 years. Unfortunately, because one of the versions that were previously leaked included penalizing the undocumented individual for having a child use these benefits, one of the things that are still continuing to happen to this day is families disenrolling their US citizen children from programs that not only do they meet the services but the children are eligible for. 

The chilling effect is larger than the numbers of people that is an impact. The last time this kind of thing happened at this level, was huge. Not only of a huge number of individuals disenrolling from programs but also a high numbers of individuals disenrolling that it did not affect. Refugee’s and Asylees disenrolling even though they were exempt from the rule. 

As a result of various proposed rules as well as other related executive orders that this administration has been introducing and implementing, all this together has been increasing fear in the community. We have seen several things of individuals refusing to go to the hospital unless it is a definite type of health emergency, for example, for fear that immigration eyes would be at the hospital or clinic. 

We see that as part of the chilling effect and also an ongoing attack of increasing fear and anxiety. 

What can you tell us about the advocacy and education work underway on this issue in Illinois? 

In the Illinois Coalition for Immigrant Refugee Rights, we have been developing an infrastructure to make sure that everyone within our staff is not only educated on the issue but is also integrating anything related to Public Charge into their day to day work. We have been working on several rapid response plans. One of community education, which includes ethic media and social media informing what actually is happening and what are myths and lies. Providing training and education and accurate information in as many languages as possible.  

Spanish, Polish, Korean, Arabic, and Cantonese being the top five. 

The other pieces also advocacy and organizing. As we are preparing to make sure that everyone knows this effect and who it does not affect, also making sure that our community is prepared to fight back.  

We believe in creating immigrant power, so making sure every organization knows the potential advocacy opportunist and litigation opportunities. Trying to educate our elective officials so we have passed both city and county resolutions to make sure our elective officials stand against the proposed public charge. 

In Protect Immigrant Families Illinois, a statewide coalition that was replicated from the national model of protecting immigrant families. There are close to 25 organizations working on this and representing the various sections affected by this, whether that be housing, health providers as well as those working around food and security and the disability community.  

Some of the work we have been doing there is preparing the framework as well as infrastructure to get everyone involved. We have organizations making sure the people working against poverty are up toi speed with everything that they know what to tell their clients and patients, what to health care providers tell their patients coming to the hospital and when the opportunity to get involved also creating spaces for that. 

How is advocacy and education work in IL unique among other states across the country? 

There’s a lot of great work happening in several states, whether it be Maryland, California as well as Washington State. They have been doing great work in getting the community involved. One of the things that Illinois as well as a handful of states, is the infrastructure we have created in the last year and a half and how fast we have been able to react and organize various stakeholders. 

Within a day of the rule being published in October, we organized a press conference, a Facebook LIVE, several pieces of training as well as holding a conference call with over 50 organizations to make sure that everybody was educated and informed.