The “Public Charge” Proposed Rule and Access to Medical Care

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And you thought medical jargon was unintelligible!? (Linked to full rule on DHS website).

Only one more day stands between me and freedom from anatomy! Although, as our awesome lecturers have reminded us, anatomy is a key component of the actual practice of medicine. If you don’t know cardiac anatomy, how can you listen to the various valves of the heart, one of the most basic exams in clinical medicine?

Since histology ended a week ago, most of my time has been spent with a Netter’s atlas in the anatomy lab learning the cranial nerves and all their innervations. My free time consists of going to the grocery store and maybe an episode of The Office before bed. But there is one recent JAMA article that I did take a moment to read and feel needs to be shared. 

A few weeks ago, the Department of Homeland Security (DHS) proposed a change in policy that will allow for the denial of lawful permanent residency (aka a green card) for immigrants in the U.S. receiving certain public benefits, including Medicaid, Medicare Part D, and the supplemental nutrition assistance program (SNAP–or food stamps). Currently, immigrants can be refused green cards if they are deemed to rely on government assistance for more than half of their income. [Here is your reminder that immigrants–documented and undocumented–pay taxes that fund many of the benefits they could lose if this policy is implemented.]

As the JAMA article points out, “Physicians and other clinicians are trusted sources of information for patients. This may be especially true for immigrant populations who are unfamiliar with the US medical system. However, if this revision to the public charge rule goes forward, it may be difficult for physicians and others to provide sound health care counsel.”

This proposal is an important reminder that public policy from nearly every sector–housing, environment, economic, and now immigration–can impact the health of individuals, communities, and the health care system at large. The most direct and long-lasting impact of this proposed rule change will be to 10.5 million children in families receiving public assistance benefits with at least one noncitizen parents or guardian. It is likely that many of these children are U.S. citizens, which means that their health and well-being will be contingent on their parent’s immigration status as opposed to the child’s citizenship status. 

The 60-day public comment period is currently open for this proposed rule. The proposed rule has been opposed in a joint statement by The American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, and the American Psychiatric Association. Collectively, these groups represent 400,000 physicians. As the JAMA article points out, the American Medical Association Code of Medical Ethics has two principles applicable to this proposed policy: “A physician shall support access to medical care for all people,” and “A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.”

An article by three primary care physicians in Boston fittingly summarizes the concerns of this proposal: “By merely proposing this rule, the Trump administration has eroded hard-won trust that doctors, public health officials and others must work to restore for the benefit of our communities. If this regulation is signed, we may never be able to rebuild that trust.” 

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