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California has been in the forefront of a pushback against a Trump administration draft proposal that could deny permanent residency or even citizenship to immigrants who have accessed public assistance programs or are expected to do so in the future. (Illustration by Edel Rodriguez for the Times)<\/p>\n
\u201cWhat if I get deported?\u201d asked Kim, who immigrated to the United States from Korea nearly a decade ago and has a 21-month-old child with her husband, a U.S. citizen. \u201cMy baby and my family are here. What would happen to me?\u201d<\/p>\n
Kim, who spoke using a pseudonym, was explaining why she has not signed up for Medi-Cal, the California Medicaid program, even though she\u2019s eligible. Her decision means she can\u2019t get a mammogram because of the expense, even though doctors recommended an annual screening.<\/p>\n
Kim\u2019s fears aren\u2019t unusual in California\u2019s immigrant communities, even among naturalized citizens and lawful permanent residents (holders of \u201cgreen cards\u201d). The anxiety level spiked immediately after Trump was elected president on a platform including uncompromising hostility to immigrants. But over the last few months, a more specific concern has taken over, signified by a two-word shorthand: \u201cPublic charge.\u201d<\/p>\n
This will close the door to anyone except white, English-speaking, wealthy immigrants.<\/strong><\/p>\n JACKIE VIMO, NATIONAL IMMIGRATION LAW CENTER<\/p>\n The term refers to a draft proposal by the Trump administration<\/a><\/u> that could deny permanent residency or even citizenship to immigrants who have accessed public assistance programs or are expected to do so in the future. The plan\u2019s implicit assumption is that immigrants are a burden on the public purse, so it\u2019s better to weed out the costliest newcomers. But the assumption is a canard. A 2016 study by the National Academies<\/a><\/u> showed that while first-generation immigrants are more costly to state and local governments than the native-born \u2014 mostly because of the cost of education \u2014 members of the second generation are \u201camong the strongest economic and fiscal contributors in the U.S. population, contributing more in taxes than either their parents or the rest of the native-born population.\u201d<\/p>\n Although public charge rules long have been part of the immigration and naturalization process, leaked versions of the proposal indicate that the administration intends a major tightening of the federal standards. Its aim appears to be to vastly expand the list of programs that would be counted against applicants for residency or citizenship.<\/p>\n In addition to cash assistance programs such as Temporary Assistance for Needy Families (TANF), which is commonly described as \u201cwelfare,\u201d it would weigh programs such as the earned income tax credit (EITC), the Children\u2019s Health Insurance Program (CHIP), health plan subsidies under the Affordable Care Act and food stamps against applicants for the first time.<\/p>\n The change in policy would have a massive impact on California and Californians. The state is home to one-quarter of the 43.2 million foreign-born residents of the U.S., according to figures sent by Atty. Gen. Xavier Becerra to Office of Management and Budget Director Mick Mulvaney<\/a><\/u>; half are naturalized citizens, and one-fourth each are legal permanent residents or undocumented. The 2 million California children enrolled in CHIP, a part of Medicaid, amount to 25% of all the program\u2019s enrollees in the nation.<\/p>\n As a result, California has been in the forefront of a pushback against the proposal. On June 1, six representatives of Becerra\u2019s office met in Washington with OMB officials to outline the potential economic impacts. They were joined in the room or by phone by representatives of Gov. Jerry Brown\u2019s office and state health officials. Four San Francisco officials held a teleconference with the OMB on Aug. 13. Whether they received more than a polite brushoff isn\u2019t clear \u2014 and won\u2019t be until the final rule is published.<\/p>\n California\u2019s public services are designed to be inclusive; the bars to immigrant access of healthcare and other programs are lower here than in many other states. \u201cThe leaked regulations would have an outsized effect on states which have reasonably generous eligibility, exactly like California,\u201d Michael Fix, a senior fellow and former president of the Migration Policy Institute, told me.<\/p>\n Some clinics serving immigrant communities across California and nationwide say they\u2019ve detected a marked dropoff in patients since earlier this year. That\u2019s when rumors of the proposal intensified, following leaks of a policy draft submitted by the Department of Homeland Security to the OMB.<\/p>\n Patients eligible for Medi-Cal are shunning enrollment, figuring it would count against them in their applications. Others have simply stopped coming in for appointments. At Kheir Clinic, enrollments in Medi-Cal, Obamacare health plans, and My Health LA, a county program for low-income and uninsured residents, fell to 519 in July from 694 in March. Among the possible factors in the decline, the clinic believes that immigration policy issues play a role, according to Kirby Van Amburgh, its director of external affairs.<\/p>\n \u201cThe first sign for us is that our waiting rooms get empty,\u201d says Isabel Cortez, operations director at Clinica Romero, which serves about 12,000 patients from two locations, including one on the edge of Boyle Heights across the street from Los Angeles County\/USC Medical Center. Cortez estimates that monthly patient enrollments fell by about one-third after Trump\u2019s election, and another 25% since the public-charge proposal leaked out.<\/p>\n The proposal hasn\u2019t yet been formally published, and could differ significantly from the leaked drafts. But immigration advocates see the leaked versions as an attempt to rewrite immigration rules that were enacted by Congress in 1996.<\/p>\n \u201cThis is a radical proposal to do an end run around Congress,\u201d says Jackie Vimo, policy analyst at the National Immigration Law Center in Washington. \u201cThis will close the door to anyone except white, English-speaking, wealthy immigrants.\u201d That means abandoning the principle of inclusion on which America was built: If the same standards were in effect in the past, Vimo observes, \u201cMost of us wouldn\u2019t be here today.\u201d The proposal is widely attributed to Stephen Miller<\/a><\/u>, Trump\u2019s hardline anti-immigration advisor.<\/p>\n This column is one of a series on the conflicts between California and the Trump administration. Feel free to send comments or ideas to Calvstrump@latimes.com<\/a><\/u>.<\/em><\/p>\n Serving immigrant communities can be difficult under the best circumstances, whether they\u2019re documented or not. With irregular living arrangements and wariness about official authority, they can be hard for doctors to reach or to keep on prescribed medication, sometimes because of its unaffordability.<\/p>\n Since Trump\u2019s election, clinicians say, alarm has spread that immigration agents have been hanging around or trying to access personal information in the clinics\u2019 files, or preparing to stage raids on the premises. The clinics have done their best to assuage their patients\u2019 fears, but many still think it\u2019s more prudent to stay away.<\/p>\n After Trump\u2019s election, \u201cSo many patients came by just to say goodbye to their clinicians,\u201d says Erin K. Pak, CEO of the Kheir Clinic. \u201cThey would tell us, \u2018As a family, we decided we shouldn\u2019t walk into any place but school and the grocery store.\u2019\u201d<\/p>\n \u201cSubconsciously you always have fear,\u201d says Maria (also a pseudonym), a patient at Clinica Romero. She emigrated from Mexico a few years ago, married an American citizen and has begun the application process for permanent residency. \u201cTo have access to healthcare, you have to show your address, your name and your phone number.\u201d<\/p>\n A sufferer from diabetes, Maria hasn\u2019t signed up for any public program that could count against her except for My Health LA. Clinics say they\u2019ve been assured that enrollment in the program won\u2019t show up on the federal radar screen; county health officials told me they\u2019re \u201ccommitted to safeguarding the privacy of patient personal information.\u201d<\/p>\n The climate of heightened fear poses a quandary for doctors and clinics geared to serving immigrants. At both the Kheir Clinic and Clinica Romero, diabetes and hypertension are their top treatment concerns. Both require regular follow-up visits to be effectively managed and kept from turning into acute episodes of illness. That\u2019s obviously a problem when patients turn into no-shows.<\/p>\n \u201cIf the patients are not following up,\u201d Cortez says, \u201cthe next thing you hear is that they\u2019re in the emergency room.\u201d<\/p>\n The Trump administration has been vague about when it might formally submit the public-charge rule or what it will look like once it\u2019s made final \u2014 conceivably because the ambiguity makes it harder for critics to mount a campaign to block it.<\/p>\n California far outstrips other states in the number of immigrants in families receiving public services. (Migration Policy Institute)<\/p>\n \u201cThe clinics are in a tough position, since it hasn\u2019t happened yet,\u201d Courtney Powers, director of government affairs at the Community Clinic Assn. of Los Angeles, told me. The latest rumor is that the rule will be submitted formally either just before Labor Day or within a few days after that.<\/p>\n All signs point to the administration\u2019s intention to fast-track the measure. The leaked draft describes the rule as merely a \u201cclarification\u201d of existing policy. OMB, which has the final say on the rule, has attested that the proposal wouldn\u2019t break the threshold of $100 million in annual impact<\/a><\/u> that would make it \u201ceconomically significant,\u201d which would trigger a more detailed and public approval process.<\/p>\n The impact of a change in the public-charge definition could have an especially severe effect on mixed-status households \u2014 those comprising citizens and non-citizens, possibly including undocumented family members \u2014 because citizens and legal residents might steer clear of programs they\u2019re eligible for in order to protect family members of lesser status. Those households aren\u2019t uncommon: About half of California\u2019s children have at least one immigrant parent.<\/p>\n Drafts of the proposed new policy would drive the number of immigrants subject to public-charge assessment from 3% of noncitizens to 47%. (Migration Policy Institute)<\/p>\n The Department of Homeland Security currently applies the rule to those \u201cprimarily dependent\u201d on the government, which it defines as obtaining more than 50% of income from cash programs such as welfare. When the rules were last codified in 1999, what was then the Immigration and Naturalization Service excluded non-cash programs from its calculation; its goal was to quell immigrants\u2019 fears about using programs that enhanced public health or enabled them to find and keep jobs, such as transportation vouchers and child-care assistance.<\/p>\n In the most recent draft leaked publicly, Homeland Security suggests redefining the term to include \u201cany government assistance\u201d \u2014 not just 50% \u2014 from any means-tested program aimed at helping households meet needs for \u201chousing, food, utilities, or medical care,\u201d whether involving cash or not.<\/p>\n Under the existing regulations, Fix calculates, fewer than 3% of non-citizens living in the U.S. could have been designated public charges. The leaked proposal would increase that figure to 47%.<\/p>\n State and local officials and immigration experts consider OMB\u2019s assertion that the proposal would have an economic impact of less than $100 million a year to be transparently absurd. San Francisco Mayor London Breed informed OMB Director Mulvaney in a July 19 letter<\/a><\/u> that the cost in her city alone would come to between $129 million and $368 million in lost spending from food stamp benefits, Medi-Cal benefits, child-care subsidies and EITC income \u201cdue to families withdrawing from public supports \u2026 or not applying in the first place.\u201d<\/p>\n Breed also pointed out the folly of raising obstacles to programs that serve a broad community purpose.<\/p>\n \u201cThis proposal,\u201d she wrote, \u201cwill do irreparable harm to the productivity of our economy and compromise the health and safety of our communities.\u201d<\/p>\n![\"\"](\"https:\/\/www.lakheir.org\/spanish\/wp-content\/uploads\/2018\/12\/45.jpg\")
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