Stephen Miller's rule on "public office" will hurt public health

Last weekend, the Trump administration finally released the text of a rule proposal that would make it more difficult for them to obtain legal status for immigrants who they were using. most public benefits, including Medicaid and food vouchers. The policy, led by Stephen Miller and known as the "rule of public office," has already been widely denounced by advocates of immigrants and the poor. A letter opposing the rule has been signed by more than 1,100 organizations across the country. It is a vicious and pernicious policy that will literally affect the health of the United States.

The rule would add new barriers for those seeking permanent resident status, also known as the green card, by adding new categories of benefits that may lead the government to determine whether an immigrant is a "public office". a legal category dates back to 1882, but the idea of ​​limiting poor immigrants to immigration is much older. The term also offers a historical parallel to the Trump administration's work requirements, which rely on the 17th century English laws, which excluded "physically fit people" who would have chosen not to work to receive work. help. (Great Britain, my country of birth, also restricts immigration on the basis of income.) And just like Medicaid, working conditions will not improve work while radically affecting health outcomes. will undoubtedly make immigrants and native Americans sicker.

Shawn Fremstad, senior researcher at the Center for American Progress, highlighted on Twitter over the weekend, some of the potential negative impacts that the Department of Homeland Security itself recognizes in its proposal. These are numerous, ranging from the implications for state and local economies and the reduction of revenue for grocery stores that accept food stamps. Among potential health risks, the rule explicitly states:

• Worst health outcomes, including increased prevalence of obesity and malnutrition, particularly among pregnant or breastfeeding women, infants or children, and reduced compliance;
• Increased use of emergency rooms and emerging care as a primary health care method due to delayed treatment;
• The increased prevalence of communicable diseases, including among the United States population who are unvaccinated;
• Increase in uncompensated care in which a treatment or service is not paid by an insurer or a patient.

The rule is narrower than some previous versions had been: It does not penalize people who have purchased health insurance on the exchanges created by the Affordable Care Act, for example, which was previously a possible restriction. for not having health insurance if you have a health problem. Immigrants can claim benefits that only cover their children who are US citizens without affecting their green card applications, but they can not get the same benefits – such as food stamps – to cover themselves. I hope you like tense peas.

Lawyers work overtime to inform people of the details of the proposal, but we will not know exactly what the rule implies before it is finalized. Cheryl Fish-Parcham, Director of Families USA's Private Insurance Program, told Splinter, "It's really important that [immigrants] know that this has not yet come into force, "adding," Retroactivity is not planned, "which means that immigrants will not be penalized for the benefits they have used in the past. The rule is "likely to be confusing," she said, and "immigrants must consult a lawyer or public benefit officials." Immigration lawyers are already too expensive for many poor people. as the National Center for Immigration Law also monitors the situation. However, it seems inevitable that some immigrants are abandoning the programs to which they are still entitled; Politico reported that this had already happened with the WIC program, which is not even included in the final regulation.

Overall, Fish-Parcham said the rule "will make it much harder for immigrants to get the health care they need to stay healthy and for their families." endanger all children by communicable disease; Fish-Parcham mentioned strep throat as an example of an illness that, if left untreated because the child does not have insurance, will be more likely to be passed on to other children. Your neighbor wearing the MAGA hat might like this rule in the abstract, but that means his unhappy kids are also at risk of getting sick.

This demonstrates a fundamental principle of public health. A person who does not have access to health care is bad in itself, but it also endangers the rest of the population by encouraging the spread of the disease. If an immigrant can not afford health insurance and can not access Medicaid without compromising his immigration plans, perhaps he will not be treated for the flu. Kelly Whitener, Associate Professor at the Center for Children and Families of Georgetown University, told Kaiser Health News that immigrant families who feared the impact of the rule on their legal status might be too scared to resort at steps penalized under the rule. Higher rates of unvaccinated children represent a significant risk to public health; vaccines depend on "collective immunity" to be effective.

Although it is difficult to assess the impact of policies such as these solely on their cost, it is worth noting the number of DHS-related harms associated with these costs. Reduced adherence to medications (patients not taking prescribed medications), for example, costs money; A study published this year in the British Medical Journal found that "non-compliance imposes a significant cost on health systems." Using the emergency room costs more than consulting primary care physicians and is more common among low-income people. the rooms simply can not provide the full range of effective preventive care that primary care can provide. We know it A 12-year-old could understand that. Stephen Miller either not or, more likely, do not care.

The potential negative effects of this rule on the health of immigrant families go beyond those explicitly linked to our health system. Limiting the availability of food stamps will have an impact on nutrition, which, according to Fish-Parcham, "makes a huge difference" to overall health. Limiting housing subsidies will make people less healthy; The Pew Charitable Trusts said in 2016 that research "has always demonstrated a well-established link between housing and health" and that being able to afford housing "allows others to meet their basic needs", including care. medical.

Fish-Parcham pointed out the stakes: "If people are poorly housed in houses filled with lead paint, cold or overcrowded or homeless, this certainly has an impact on their health." Situation the rule would put poor immigrants in: do you want a house, or do you want to stay in this country?

Navigating changing immigration rules is hard enough for anyone – take it for me – but it will be even harder for poor immigrants, who will be harder to attach to information about what they can and can not do. not access is approved. As we saw in Arkansas, where many Medicaid recipients were apparently unaware of the new work requirements before they were kicked out of their health care – thousands of low-income, crafty residents . Low-income residents tend to change addresses more often, making it more difficult to access them by mail; they are less likely to have Internet at home or smartphones. Word of mouth may be the only way they hear about the rules, but it may mean spreading false information the atmosphere of confusion and fear.

Going through the legal process of immigration to the United States is already incredibly difficult, an even worse process with less money and privileges. It's not just the infinite forms and expensive lawyers; it is the constant and overwhelming fear of losing its status here, either because one of the myriad small rules is wrong, or because the government has messed up. This rule will reinforce this terror for people who are already living in uncertainty, for the sin of using government programs on which count millions of native – born Americans. No one born here can be expelled from the country because he's applied for Medicaid. In a just world, we would be able to significantly expand our welfare state, not to restrict it. The immigration status of a person would not allow them to be denied benefits, they would not come back to haunt them because they would ask for permanent residence.

But this is not the vision of Stephen Miller and Donald Trump for America. Their new rule exists to make immigrants frightened, simple and simple. There is to improve the climate of fear that has been so carefully developed by the Trump administration: afraid to knock on the door, afraid to ask for benefits to feed and house your children, afraid to express on social media, afraid to drive to work or even to the hospital, or take your kids to school, or be anywhere without your papers. It does nothing to encourage immigrants to come here "in a good way", this big right lie. This only makes the process more difficult for everyone, in a way that disproportionately affects poor Hispanic immigrants. It's cruel, it's stupid, and it's pure Stephen Miller.