Immigration

Axios - The Trump administration is proposing to weigh immigrants' use of programs like Medicaid or SNAP, as well as other public benefits, when determining if they should get permanent residency.

The proposal is another case of the administration putting public health on a collision course with immigration policy.

A homeland security proposal published this week lays out a new version of a "public charge" policy, which was expanded during Trump's first term and then rolled back during the Biden years.

• Critics say the latest effort, if finalized, could further discourage the use of health, nutrition and housing services after the GOP reconciliation package limited legal immigrants' access to health insurance.

The Department of Homeland Security on Monday said the policy could save nearly $90 billion over a decade as people unenroll from or skip out on public programs.

• The 140-page rule seeks to override previous policies that outlined which public benefits could disqualify immigrants from getting a green card, instead leaving decisions to the discretion of individual immigration officers on a case-by-case basis.
• Limiting criteria goes against congressional intent, DHS wrote. The change could mean that officers also consider use of services beyond Medicaid, like getting care at a community health center, when looking at green card applications, legal experts told Axios.
• DHS acknowledged in the proposal that the policy could lead to worse health outcomes, like increased prevalence of obesity and communicable diseases.
• Emergency room doctors are concerned that more people will skip primary and preventive care, leading them to get care only in ERs.

The proposal comes after the State Department reportedly concluded this month that it can deny visas to the U.S. based on an applicant's health conditions, including obesity and diabetes.

• HHS this year also prohibited community health centers from serving undocumented immigrants, though the move is being challenged in court.  Keep reading