Under Trump proposal, Minnesota immigrants might avoid medical care

Thousands of immigrant families across Minnesota would be pressured to drop out of government-funded health and social service programs if the Trump administration enacts a proposed change to federal immigration policy, state and local health officials warned.

Under the proposal, a legal immigrant could be denied a temporary visa or permanent residency through a green card if they use Medicaid, food stamps, low-income tax credits and a broad array of other state and federal social service programs. Even the use of such benefits by a child or a citizen spouse could jeopardize an immigrant's chances at permanent residency in the United States.

The proposal, which could become permanent this year, would be one of the most significant changes to immigration policy in decades and impact a broad swath of the nation's foreign-born population. Nearly half of noncitizens living in Minnesota — or about 100,000 people — live in a household where a member uses one of the four major federal programs identified in the leaked Trump administration draft proposal, according to a recent analysis by the Migration Policy Institute, a research group in Washington, D.C.

If the proposal is enacted in its current form, those immigrant families would be forced to make an agonizing decision about whether to keep government-funded health coverage and risk being blocked from staying in the U.S.

The Dayton administration and representatives of Minnesota's network of community health clinics have begun to raise alarms, saying the proposal could have a "chilling effect" on enrollment in public health programs. In a strongly worded letter to federal regulators, Gov. Mark Dayton pointed to the state's 2017 measles outbreak, which sickened dozens of people and cost the state more than $1 million, as an example of the public health risks associated with discouraging people from seeking basic medical care.

"If people decide to forgo well-child visits or receive needed immunizations because they withdraw from health care coverage, the entire state is put at risk for preventable disease outbreaks," Dayton wrote.

The plan comes as the Trump administration has taken an increasingly hard line against both illegal and legal immigration. The president and some conservative groups have argued that immigrants' use of public benefits is a threat to American prosperity and a drain on taxpayer-funded public benefits that should go to U.S. citizens.

"Noncitizens who receive public benefits are not self-sufficient and are relying on the U.S. government and state and local entities for resources instead of their families, sponsors or private organizations," the draft proposal states.

Under long-standing federal law, a noncitizen can be denied admission or permanent legal status if immigration authorities determine the person is likely to become a "public charge" — that is, someone reliant on government programs. In the past, this determination was based on a narrow set of cash-based assistance programs and only applied to those who were deemed to be "primarily dependent on the government for subsistence."

The Trump administration's proposal, by contrast, would dramatically expand the criteria used to determine whether someone is likely to become a burden.

An immigrant could be deemed a "public charge" if that person — or a dependent in the person's immediate family, including children — receives any of a far broader array of government programs. The expanded list includes the Children's Health Insurance Program (CHIP), which covers more than 125,000 children from low-income families across the state, and the Supplemental Nutrition Assistance Program (SNAP), also known as food stamps. Immigrants could also be penalized if they or a dependent received the widely popular earned income tax credit, Section 8 housing vouchers, and federal subsidies to help people afford health insurance.

"The big fear is this will lead to parents not applying for [public] health and nutrition benefits," said Ana Pottratz Acosta, a professor at Mitchell Hamline School of Law who specializes in immigration issues. "You could draw a straight line from this policy to children going hungry and not getting necessary medical care."

Jonathan Watson, executive director of the Minnesota Association of Community Health Centers, said the decline in patient visits could be so severe that the state's network of 17 nonprofit safety net clinics, which serve nearly 200,000 low-income Minnesotans, would have to cut staff and reduce services.

"It's a threat to the survivability of our community health centers that serve our neediest Minnesotans," he said.

Based on the proposed change, the percentage of noncitizens who could be classified as a "public charge," and risk jeopardizing their immigration status would grow from 3 percent to 47 percent, according to the Migration Policy Institute. Nationwide, 10.3 million legal immigrants and their family members could be affected by the change.

In contrast to the Trump administration's crackdown on illegal immigration at the border, the policy proposal would affect immigrants who live and work here legally and are eligible for public benefits. The proposed change would not apply to refugees and people going through the naturalization process, though it could jeopardize their ability to bring a family member from another country.

Monica Hurtado, a community organizer with Voices for Racial Justice, a Minneapolis nonprofit, said she has received a half-dozen calls from Latino immigrants in recent months seeking advice on whether to continue receiving public health benefits. Several callers were pregnant women wanting to know if they should forgo prenatal care to avoid jeopardizing their residency status. She said an immigrant mother was nervous about accepting a car seat for her newborn, because it was paid for by her public health insurance plan.

"It makes me so sad that I want to cry," Hurtado said. "The fear is already out there."

Concerns about the "chilling effects" of stricter welfare measures are not new. After welfare reforms in 1996, participation rates in federal benefit programs fell sharply among refugees and U.S.-citizen children, even though their eligibility for such programs was unchanged. One national study found that noncitizen families' food stamp use fell 43 percent in the late 1990s, and Medicaid use dropped 17 percent over the same period.

Michael Fix, a senior policy fellow and specialist on immigration and welfare at the Migration Policy Institute, said the number of immigrants withdrawing from public benefit programs could be much sharper now, because of "growing anti-immigration sentiment" and anxiety surrounding the federal government's stepped-up enforcement efforts. More broadly, the changes would introduce a "wide range of discretion" in the system for approving immigrants for visas and green cards, he said.

"This changes the whole equation in a dramatic way," said Fix. "It turns the [visa approval] system from a culture of 'Yes,' into a culture of 'Maybe' or 'No.' "

In March, the U.S. Department of Homeland Security sent a version of the draft rule to Office of Management and Budget, which is reviewing it for possible conflicts with existing law. It will then be published as a proposed rule open to public comment before it's finalized.