The public charge rule crosses the line, and doctors need to push back

An impossible choice: your child’s health or your child’s future.

This is the choice being posed to immigrant families with the proposed changes to the public charge rule.  These changes would make those using government aid — such as food stamps, housing assistance, or Medicaid — less likely to be granted a green card.  Under this rule, immigrant families will need to decide whether to choose health care coverage over better chances of citizenship.

Physicians are faced with a choice, too: Speak up or give up.

Give up our right to give the very best care that we can.  Give up our commitment to serve those most in need.  Give up the freedom to be the best versions of our physician-selves.

The public charge rule isn’t just about immigrants; it’s about doctors.  And it’s time to speak up.

As a pediatric airway/ENT surgeon in New York City, over half of my patients come from immigrant families.  Many of them get their health care coverage through Medicaid.

Navigating the health care system is not easy for immigrants.  There are barriers of language, transportation, and finances. Yet the love of migrant parents is ultimately what gets children the health care they need.

The proposed changes to the public charge rule pose a very real risk that fear and confusion will lead families to decline benefits their children are entitled to.  A July 2019 study in the Journal of the American Medical Association states that 0.8 to 1.9 million children are at risk of losing government-supported health care benefits.  Findings were based on the widespread disenrollment that occurred after changes were made to Medicaid eligibility in 1996.

Many parents risk their lives to get their children to this country for a better life.  And they fight tirelessly to give their children the best future possible.

One of my patients — a 12-year-old girl from the Dominican Republic — has recurrent airway tumors that require surgery every few months.  Her father stays up after his night shift has ended to bring his daughter to see me.  She has been in the United States for two years and doesn’t have her papers yet.

If she loses her Medicaid coverage, how will we continue to take care of the tumors before they become so big that she can’t breathe?

But the changes to the public charge rule aren’t a loss just for immigrants.  We all will lose.  Immigrants will lose access to routine primary health care.  This will mean an increased burden for emergency rooms and public hospitals for preventable conditions.

This also means greater risk that immigrant children won’t receive vaccinations.  Immigrants being targeted are currently among the most likely to vaccinate.  According to a CATO Institute analysis of WHO statistics from 2017, many countries in Central and South America, including Mexico, have higher vaccinations rates than we do in the United States.

Loss of Medicaid could lower vaccination rates among migrant communities, placing unvaccinated immigrants at risk for illness.  Entire communities may be at risk for outbreaks of preventable diseases like the measles.

Failure to vaccinate also means loss of access to education.  All 50 states require vaccination for school entry.  Not only could children’s health be at risk, but their right to education is on the line.

As of August 20, a total of 19 states and Washington D.C. have filed suits against the public charge rule.  Numerous community and advocacy groups have filed suits as well.

There is opposition in medicine also, but we need to do more.  Six national professional organizations on the front lines of primary care — including the American College of Physicians — put out a joint statement opposing the rule on August 13.  We surgeons should follow their example.  And we shouldn’t stop until every professional organization in health care has rejected the public charge rule.

We must stand up for the right of every human being to access health care, and we must stand up for our right as providers to treat those most in need of our care.

The public charge rule crosses the line.  Now it’s our turn to push back.

Susannah Hills is an otolaryngologist.

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