Implications of the Public Charge Rule on Child Health: A Growing Threat to the U.S. Health Care System

In recent months, the current administration has proposed a series of recent federal policy changes, namely the Public Charge Rule, intended to limit immigrants into the U.S. on the basis of financial grounds. In essence, the Public Charge Rule redefines the term “public charge”. Under this policy, most applicants for permanent residency who use any number of public benefits—including Medicaid, government housing, and the Supplemental Nutrition Assistance Program (SNAP)—count toward being flagged as a public charge, or an individual likely to become dependent on the government for subsistence; this will count against them in residency status applications. Even in the wake of the recent Supreme Court ruling and early implementation of the policy, the Public Charge Rule has shown increasing disenrollment from public benefits along with a growing climate of fear, mistrust, and misinformation in relation to connecting with the healthcare system. This policy particularly threatens low-income children, the majority of which are U.S.-born legal citizens, who are incredibly vulnerable to poor health outcomes without longitudinal, preventive health services. Recent studies show that two million children legally eligible for Children’s Health Insurance Program (CHIP) could be disenrolled from the program due to this climate of uncertainty. This policy brief investigates the role of health systems and providers in bracing for the expected impacts and develops a set of policy recommendations that providers and health administrators may use as a tool for protecting patient health and ensuring patient-centered care. To achieve this, a literature review was performed with a compilation of current population health trends and a historical case study. This compilation of data was analyzed to better understand the current political, social, and economic landscape in the United States. From this, three potential policy recommendations were outlined for health providers. Based on current research and the analysis conducted, community engagement and policy advocacy was identified as the most effective policy option for health providers to best provide patient-centered care. However, a more holistic solution should be considered for states that serve populations that are deemed high-need, namely Arizona. Education within clinic walls for providers and patients will bridge the misinformation gap and build shared understanding between provider and patient. Beyond clinic walls, community engagement and policy advocacy mends community mistrust of health systems. Further pilot investigation is warranted at high-utilization medical centers.