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AHIP Comments On Proposed Rule Impacting Public Charge Determinations

by Kristine Grow

December 7, 2018

WASHINGTON, D.C. – AHIP submitted its comments on the Department of Homeland Security’s (DHS) proposed rule to expand the types of public benefits that would be considered in public charge determinations as part of immigration proceedings for legally present immigrants. Currently, the types of public benefits counted in public charge determinations include cash benefits, such as Supplemental Security Income (SSI), Temporary Aid for Needy Families (TANF), and Medicaid coverage of institutional long-term care/nursing home care. Immigration applicants who are found likely to rely on taxpayer-funded programs and become “public charges” can be denied permanent resident status.

Here are a few highlights from our comments:

AHIP and its members have serious concerns about these proposed changes, which would impact hardworking Americans and legally present immigrant individuals, as well as their families. Based on our industry’s experience, we believe such changes would have serious negative consequences for public health and the U.S. economy, including: sicker people, including seniors and children; weaker communities, resulting from sicker populations and weakened hospital systems; weaker American businesses, resulting from a sicker employee base; and higher taxes, as federal and state costs increase for emergency care and premiums go up for everyone.

Moreover, the Proposed Rule includes only a basic economic analysis of the impact of the major changes proposed by DHS. Changes of this magnitude hold the strong potential for unanticipated negative consequences—especially if carried out without the necessary level of economic analysis—and we are concerned this Proposed Rule presents just such a risk.

For these reasons, DHS should not:

  • include use of Medicaid or Medicare Part D low-income subsidy (LIS) as negative factors in public charge determinations.
  • include use of the Children’s Health Insurance Program (CHIP) in public charge determinations.
  • consider premium tax credits for purchasing individual market coverage in a public charge determination (following DHS’ broader question about factors that may be considered in public charge determinations).

Our comments continue to describe how the Proposed Rule is inconsistent with the nation’s goal of encouraging a healthier population, would result in poorer health outcomes and more expensive care, lead to poorer health and less cost-effective care for Americans, and negatively impact state autonomy, flexibility, and budgets.