US
District Judges rule the patient access to care arguments presented by
plaintiffs call for an injunction on the DHS public charge rule.
By Sara Heath
October 14,
2019 - US Judges in New York, California, and Washington have filed
injunctions against the Department of Homeland Security (DHS) public charge
rule, in part on grounds that plaintiffs can successfully argue patient access
to care barriers as a result of the rule.
The rule, finalized in August, states that DHS
may take into consideration certain factors that could influence whether an
individual might become a public charge when issuing a green card to that
individual. DHS may also consider these factors when deciding to extend a visa.
A public charge is
defined as an individual who accesses certain public benefits, such as Medicaid
coverage. An individual will be deemed a public charge if they access this
benefit, as well as those related to cash income, SNAP, or some forms of public housing, for
more than 12 months during a 36-month period.
Specifically, DHS may
consider an immigrant’s age, health, family status, assets, resources,
financial status, and education or skills attainment when assessing whether she
may become a public charge.
The rule was met with
public outcry and lawsuits from some immigrant rights organizations, New York
State, New York City, Connecticut, and Vermont, each arguing that the rule
could have serious healthcare implications for legal immigrants.
An immigrant who
knows she may not receive a green card or a visa extension if she enrolls in
Medicaid benefits may choose to forgo healthcare coverage. In the case that she
develops a serious healthcare condition, she could incur considerable medical
costs. Those costs would likely be shifted to the healthcare institution and
taxpayers, plaintiffs argue, not to mention the damage it could do to the
immigrant.
“Multiple submissions
from the Plaintiff States and the amici briefs endorse an estimate that ‘the
Public Charge Rule could lead to Medicaid disenrollment rates ranging from 15
percent to 35 percent’ among Medicaid and Children’s Health Insurance Program
enrollees who live in mixed-status households, which ‘equates to between 2.1
and 4.9 million beneficiaries disenrolling from the programs,’” Judge Rosanna
Malouf Peterson, a district judge in Washington, reviewed.
And not only will the
rule lead to limited Medicaid or insurance enrollment, but it will also lead to
limited healthcare access.
“In addition to
making receipt of Medicaid health insurance and other public benefit programs a
negative factor, the Plaintiff States proffer that the Public Charge Rule
disincentivizes individuals from seeking medical diagnoses and treatment
because a diagnosis of a medical condition requiring extensive medical
treatment or institutionalization will be weighed as a heavy negative factor
when combined with a lack of health insurance or independent resources to cover
the associated costs; or weighed as a negative factor even with health
insurance or independent resources to cover the associated costs,” Judge
Peterson wrote.
Judge Peterson, as
well as Judge George B. Daniels, of the Southern District of New York and U.S.
District Judge Phyllis Hamilton, of California, agreed the plaintiffs have a
solid case against DHS and thus granted an injunction.
An injunction does
not mean the rule has been struct down. Instead, it means the rule has been
halted until it can be seen in court. Judges grant an injunction when they
believe a plaintiff’s case holds merit and could be viable in court.
But the judges went
further than pointing out a solid case against DHS, lambasting the rule as a
“policy of exclusion,” said Southern District of New York Judge Daniels.
“It is a rule that
will punish individuals for their receipt of benefits provided by our
government, and discourages them from lawfully receiving available assistance
intended to aid them in becoming contributing members of our society,”
Daniels said. “It is impossible to argue there is
no irreparable harm for these individuals, Plaintiffs, and the public at
large.”
The public charge has
the potential to seriously harm patient access to care, medical experts argued
following the rule’s final publication.
“America’s hospitals
and health systems work every day to provide care for those who need it and
ensure patients are able to access programs that provide critical services,”
American Hospital Association President and CEO Rick Pollack said in a statement.
“This rule is a step in the wrong direction
when it comes to fairness with regard to the treatment of legal immigrants
seeking a pathway to citizenship. And, it creates barriers to appropriately
caring for the sick and injured, and to keeping people healthy. Failure to
provide such services also has public health implications that could have
widespread impact.”
And the rule would go
beyond suppressing access to Medicaid, Pollack added.
“Access to nutrition
aid, housing support and other programs that address the social determinants of
health would also be jeopardized,” Pollack added. “No one should have to fear
obtaining needed services and medical care.”
Chip Kahn from the
Federation of American Hospitals (FAH) suggested the rule could have serious
financial implications for emergency departments. Again, if a legal
immigrant avoids healthcare for fear of losing
her legal status, she may incur a serious health event in the emergency
department. Serious, acute, emergency care is notoriously expensive, and much
of that cost could land with the hospital.
“Hospitals are
concerned that today’s decision will put the health of millions at risk by
creating a chilling effect on enrollment for vital health safety net
programs,” said Chip Kahn, the president and CEO
at FAH. “Many eligible people won’t sign up for health insurance coverage, like
Medicaid, over fears it could hurt their or their loved ones’ immigration
status.”
According to Margaret
A. Murray, the CEO at the Association for Community Affiliated Plans (ACAP),
the rule is especially egregious because it would target legal immigrants.
“In the overwhelming
majority of cases, undocumented individuals are already ineligible for
Medicaid. This rule would largely impact families with members who are citizens
or who are lawfully present,” said CEO Margaret A. Murray. “What do we
accomplish by discouraging enrollment in programs that help lawful immigrants
stay healthy and productive?”
The injunction is set
to hold until the cases can be seen in court.
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