New England Journal of Medicine
September 6, 2018 Vol. 379 No. 10
A New Threat to Immigrants’ Health — The Public-Charge
Krista M. Perreira, Ph.D., Hirokazu Yoshikawa, Ph.D., and Jonathan Oberlander, Ph.D.
The United States is making major changes to its immigration policies that are spilling over into health policy. In one such change, the Trump administration is drafting a rule on “public charges” that could have important consequences for access to medical care and the health of millions of immigrants and their families.1 The concept of a public charge dates back to 19th-century immigration law. Under current guidelines, persons labeled as potential public charges can be denied legal entry to the United States. They can also be prevented from adjusting their status from a nonimmigrant visa category (e.g., a student or work visa) to legal permanent resident status. In addition, if they become public charges within the first 5 years after their admission to the United States, for reasons that existed before they came to the country, in rare cases they can be arrested and deported. Immigrants and their families consequently have strong incentives to avoid being deemed public charges.
Current guidelines define a public charge as a person who is primarily dependent on the government for more than half of personal income. In evaluating whether a person is likely to become a public charge, immigration officials take account of factors such as age, health, financial status, education, and skills…