In 2019, as the “public charge” rule made its way through the U.S. court system, many low-income immigrant parents of American children in the Johns Hopkins pediatric practice asked case managers to disenroll their children from the Supplemental Nutrition Assistance Program (SNAP), fearing it would affect their chances of obtaining legal status in the future or lead to deportation.
The new public charge rule, which went into effect on February 24, 2020, states that “aliens are inadmissible to the United States if they are unable to care for themselves without becoming public charges” (www.uscis.gov/greencard/public-charge. opens in new tab).
On the day of its implementation, there were 14 cases of Covid-19 in the United States. A month later, with more than 30,000 U.S. cases confirmed, the following message could be found on the U.S. Citizen and Immigration Services (USCIS) Public Charge web page: “USCIS encourages all those, including aliens, with symptoms that resemble Coronavirus Disease 2019 (Covid-19) (fever, cough, shortness of breath) to seek necessary medical treatment or preventive services. Such treatment or preventive services will not negatively affect any alien as part of a future Public Charge analysis.”
This statement may feel like vindication for those who have been warning about the negative impact of anti-immigration policies on public health, but the authors of this article fear this change is too little, too late.
Under the Trump administration, immigrants have faced relentless attacks — tightening of the public charge rule, threats to the Deferred Action for Childhood Arrivals program, raids by Immigration and Customs Enforcement (ICE), asylum restrictions, and separation of families at the border — so immigrants are justifiably scared. Expecting them to trust the government now, during the Covid-19 crisis, is naive at best
Covid-19 has exposed weaknesses in the U.S. health system. The country faces shortages of personal protective equipment, tests, and ventilators. As emergency departments (EDs) and intensive care units brace for surges in volume, public health officials urge people with symptoms to stay home and call their doctor before seeking in-person medical care.
Unfortunately, for many undocumented immigrants, calling their doctor is not an option. The Affordable Care Act excludes undocumented immigrants from eligibility for coverage, and an estimated 7.1 million undocumented immigrants lack health insurance. As a result, many undocumented immigrants do not have primary care providers (PCPs) and have had to rely on EDs for years. Telling people now to avoid EDs and call their doctors leaves those without PCPs in limbo. The Covid-19 epidemic has exposed the risk of limiting access to primary care for segments of the population, including undocumented immigrants.
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