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Trump's New Immigration Rule Could Threaten Health Care for 6.8 Million Children Who Are U.S. Citizens

There is less than one week left of the public comment period for the proposed "public charge" rule.

Nurse walking child through hospital hallway.
(TNS/Miami Herald/Matias J. Ocner)


  • One-fifth, or 6.8 million, of the children on Medicaid or CHIP are citizens but have noncitizen parents, according to a report released on Tuesday by the Urban Institute.
  • The Trump administration's proposed "public charge" rule could discourage their parents from enrolling them in health insurance.
  • The public comment period for the new rule ends Dec. 10.
With less than a week left in the public comment period for a new immigration rule, a study released on Tuesday calculated the number of immigrant children who could lose their health insurance if their parents opt out as a result of the new policy.

The Trump administration in October proposed a new "public charge" rule that would penalize legal immigrants for using government aid -- even when they qualify for it. If enacted, the rule will make it harder for legal immigrants to obtain green cards or permanent residency status if they have used certain government benefits, including Medicaid, food stamps and housing subsidies. Currently, legal immigrants are only considered a public charge for using long-term care or cash welfare.

According to the Urban Institute's study, 6.8 million children on Medicaid or CHIP (the Children's Health Insurance Program) are citizens but have noncitizen parents. That represents one-fifth of all children in those programs. The study also shows that Medicaid and CHIP participation increased by 15.5 percent among citizen children with noncitizen parents from 2008 to 2016.

Jenny Haley, a researcher who worked on the report, says these numbers show that “losses in coverage could be quite large. Some communities are already seeing a reduction in food assistance programs.”

Though these children, who are citizens but have immigrant parents, would not be directly impacted by this rule, the Urban Institute study notes that “policy changes can have broad ‘chilling effects’ that lead to immigrant families opting out of public benefits and avoiding interactions with government authorities.”

The number of U.S. children without health insurance rose for the first time in nearly a decade last year, according to a recent report from Georgetown University. Researchers partially attributed the rise to anti-immigration rhetoric from the Trump administration; in such an environment, they said, some immigrant parents opted not to sign up their kids for health care. The White House began discussions about updating the public charge rule shortly after Donald Trump took office in 2017.

Backers of the Trump administration's new public charge rule argue it is a modernization of a Clinton-era definition of what welfare is and who is allowed to access it.

“For our fellow citizens, such assistance is justified, though we can argue about the best way to go about it. But what justification can there be for admitting people from abroad who can’t pay their own way?” Mark Krikorian, executive director of the Center for Immigration Studies, which favors severely curtailing immigration, wrote in the National Review.

Meanwhile, left-leaning and bipartisan groups argue that the rule would have ripple effects beyond health insurance and beyond immigrants.

“This proposal will compromise children’s health, nutrition and development; impact access to health care for legal immigrants and citizens alike; reduce housing options; and negatively affect our local economies," said Steven Benjamin, the mayor of Columbia, S.C., and the president of the U.S. Conference of Mayors, in a statement in September. "Make no mistake: The consequences will be dire and will force families to choose between the things they need and the people they love."

As Governing previously reported, the Affordable Care Act marketplace has struggled to attract younger, healthier populations, which has contributed to rising premiums. If more legal immigrants -- and their children -- forgo health insurance because of the new public charge rule, the cost of health care, for everyone, could rise further.

“There is additional research out there that shows health coverage early in life has impacts on education attainment and adult health," says the Urban Institute's Haley. "With a fifth of children [on Medicaid or CHIP] potentially impacted by this rule, this could have impacts on society at large.”

The 60-day public comment period ends Dec. 10.

Mattie covers all things health for Governing.

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