The Trump administration’s “public charge” proposal—which would make it harder for immigrants to qualify for citizenship if they use public benefits such as food stamps, public housing, or Medicaid—could have financial repercussions for hospitals.
A public charge is a person the U.S. deems likely to become heavily dependent on government assistance. For many years, the public charge designation has applied only to those immigrants who received a high level of cash assistance or help with long-term care. But the new proposal would broaden the category to include a number of safety-net programs. Critics of the proposal think it would have a chilling effect on immigrants’ willingness to seek sorely needed benefits.
Health policy experts interviewed on the NPR show “Marketplace” on December 10, 2018, said that immigrant families may decide to forego or drop Medicaid because they don’t want to risk derailing their citizenship bid—which, for hospitals, could mean the loss of billions in reimbursements from both Medicaid and the Children’s Health Insurance Program (CHIP). In addition, people without coverage would still use hospitals but may not be able to pay their bills, resulting in potential financial losses for doctors and hospitals.
“This could be really damaging for safety-net hospitals, especially for those that have high numbers of immigrant patients or families of mixed immigration status in their areas,” said Benjamin Sommers, associate professor of health policy and economics at Harvard T.H. Chan School of Public Health.
Listen to the Marketplace interview: What does public charge proposal mean for hospitals that treat immigrants?