E4A's Comments on Public Charge Rule

On October 10, the Trump Administration proposed a rule that expands how the
public charge” test is applied during the immigration process. The consequences of this rule could threaten the health and well-being of immigrant and non-immigrant families alike. 

E4A submitted following letter expressing our concern about this proposed rule, and we encourage others to participate in the rulemaking process by submitting a public comment here. Comments must be submitted by December 10, 2018.


Samantha Deshommes
Regulatory Coordination Division
Office of Policy and Strategy, U.S. Citizenship and Immigration Services Department of Homeland Security
20 Massachusetts Ave NW
Washington, DC 20529-2140

Ref: DHS Docket No. USCIS-2010-0012

The changes to the public charge rule proposed by the Department of Homeland Security will likely have serious public health consequences for children, families, and communities throughout the United States. As director of Evidence for Action, a research funding program of the Robert Wood Johnson Foundation, I am concerned that the changes, if implemented, will undermine decades of progress made toward ensuring that our nation’s social safety net adequately protects the most vulnerable members of our society.

Evidence for Action funds non-partisan, rigorous research to build unbiased evidence on the population health impacts of large-scale programs and policies. To date, we have funded studies involving a number of public benefit programs newly added to the proposed public charge determination, including public housing, Section 8 housing vouchers, and Medicaid – programs that help people with low incomes meet their basic needs and improve their ability to contribute to the economy. One study we recently funded on Medicaid found that providing prenatal care to immigrant women improved birth outcomes and vaccination rates among their U.S. citizen children, which has positive implications throughout the life course and for future adult productivity. These findings are consistent with a large body of evidence showing that public benefits help alleviate poverty and improve health outcomes in vulnerable groups.

The proposed public charge rule change is deeply troubling for many reasons. First, we know based on reports from our colleagues in research and practice that there has already been a “chilling effect” due to misinformation from earlier leaked versions of the proposed rule. Fear of jeopardizing one’s immigration status or path to residency is causing people to forgo valuable health and nutrition services such as Medicaid and SNAP for themselves and their children. The dramatic changes proposed in the rule would further add to this fear and drive away families in need, even those still qualified to use the services.

Second, the public health community has long sought to reduce stigma associated with using essential government services in times of severe need, especially among families with children. In 2015, nearly one-third of U.S.-born citizens participated in at least one of the programs identified by the proposed rule, such as Medicaid and SNAP. Singling out these important programs as determinants of public charge will exacerbate perceptions of stigma and shame associated with these services, deterring many families from using them – including families not otherwise impacted by immigration policies – and negatively impact children in those families.

Third, while the proposed rule provides an estimate of the economic impact of widespread dis-enrollment from public services, it does not acknowledge the broader poor outcomes that will likely offset savings. When people forego medical care, housing, and nutrition services out of stigma or fear, they increase their risk for more serious and complicated problems later, resulting in additional financial and social costs. Moreover, lost revenue for medical, dental, and other health providers and food retailers, along with accompanying job losses, can disrupt local economies and have lasting negative impacts that result in more, not fewer, people in need.

Finally, the proposed rule gives immigration officials the authority to determine whether someone is “likely” to become a public charge in the future, even if he or she has not used public benefits in the past. The determination method is ambiguous, and the inclusion of personal attributes as part of the determination procedure makes this process far too vulnerable to discriminatory practices, which can perpetuate inequities by race, income, and other personal or group characteristics.

Given that the proposed rule change will likely have many detrimental effects on population health with few (if any) predicted benefits, before such a rule is adopted the administration must demonstrate that 1. It will not harm population health by inadvertently driving U.S. children and families away from essential services for which they are qualified; 2. It will not cause a detrimental impact on the economy, workforce, or healthcare and retail food systems; and 3. It will not perpetuate racial and social inequities in our communities.

In the absence of this evidence, I strongly oppose the proposed rule change.

Nancy Adler
Director, Evidence for Action
A National Program of the Robert Wood Johnson Foundation at the University of California, San Francisco


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