December 10, 2018
United States Citizenship and Immigration Services Department of Homeland Security 20 Massachusetts Ave. NW Washington, DC 20529-2140
Re: DHS Docket No. USCIS-2010-0012-0001, Comments in Response to Proposed Rulemaking: Inadmissibility on Public Charge Grounds
I am writing on behalf of the Japanese American Citizens League in response to the Department of Homeland Security’s (the Department) Notice of Proposed Rulemaking (NPRM) to express our strong opposition to the changes regarding “public charge,” published in the Federal Register on October 10, 2018.
JACL was founded in 1929 and has a long history of fighting against discrimination, particularly that which is rooted in xenophobia and targeting immigrant populations. The Japanese American community was subjected to harsh discrimination in the late 19th and early 20th centuries. Along with immigrants from other Asian and non-white countries, naturalized citizenship was denied. Alien land laws prevented the ownership of land. It was only through the landmark case of Wong Kim Ark that birthright citizenship was affirmed.
The anti-immigrant and anti-Japanese racism reached its zenith with the mass incarceration of 120,000 individuals of Japanese descent, citizen and non-citizen, in American concentration camps. In fact, the trumped up charges of disloyalty based on a large number of Japanese who had retained Japanese citizenship was only because of the inability to naturalize with American citizenship.
The proposed rule will have a dramatic impact on Asian American and Pacific Islander (AAPI) families. AAPIs are among the fastest growing populations in the U.S. in large part due to changes in U.S. immigration law in the 1960s that repealed restrictions on Asian immigration. In recent years, three out of every ten individuals obtaining permanent residence status are from Asia and Pacific Island nations. Forty percent of the millions of individuals and families waiting in long backlogs for family-based immigration are from Asia and Pacific Island nations. All of these potential new Americans would be scrutinized under the new proposed rule and many would be deterred from participation in programs that they are eligible for and need to improve their health and well-being and the health and well-being of their families.
The Proposed Rule Threatens to Dramatically Limit Who is Allowed into the U.S. and Who is Allowed to Stay
The proposed rule would greatly expand the public charge test in unprecedented ways. By heavily weighting many factors that impact AAPI communities, the proposed rule will limit which AAPI individuals and families are allowed to enter the U.S. and which are allowed to stay or apply for permanent residency. Being under 18, over age 62, having less education and limited English proficiency are all negatively weighted factors against an applicant. This has the potential to disproportionately impact AAPIs given that one in three AAPIs are limited English proficient. In addition, the proposal would equate any person with a serious health condition as effectively having a “pre-existing condition” that disqualifies them for immigration. This would have a profound impact on racial and ethnic minorities, including AAPIs, who because of many social determinants of health, disproportionately experience a number of chronic conditions including certain types of cancer, diabetes and heart disease.
While on its face the rule maintains the statutorily required “totality of circumstances” test, it re-defines how the test will be used for every applicant for lawful permanent resident status, regardless of whether that applicant has used any of the applicable public benefits. The proposed rule adds to, and heavily weights against the applicant, a number of factors that will restrict immigration. As such, the proposal is a drastic expansion beyond the currently used standard which only considers whether a person is likely to rely primarily on the government for “subsistence” income or institutionalized support. These provisions leave a lot of power in the hands of USCIS officials who will determine the likelihood of using one or more benefits.
Although on its face, there is not intent to discriminate against Asian immigration, the ultimate effect is to likely reduce immigration from Asian countries, returning us to the immigration patterns of the early 20th century.
The Proposed Rule Would Punish AAPI Immigrant Families for Meeting their Basic Needs and Create a Chilling Effect, Threatening the Health and Well-being of Millions of AAPI Families and Public Health
Under the proposed rule, any person who seeks or uses Medicaid, Medicare Part D, SNAP or housing assistance could be denied the ability to get permanent legal status or even enter the U.S. The proposed rule expands the number of programs that are necessary for meeting basic needs. Under current policy, only cash “welfare” assistance for income maintenance and government funded long-term care received or relied upon by an applicant can be taken into consideration in the “public charge” test. The proposed rule would alter the test dramatically, abandoning the enduring meaning of a public charge as a person who depends on the government for subsistence, and would instead punish immigrants for using services that meet their basic needs, like health, nutrition and housing and enable them to work.
The Migration Policy Institute has estimated that 1.4 million AAPIs who are not U.S. citizens are members of families who rely on Medicaid and CHIP. This includes 182,000 children. 523,000 AAPIs who are not yet U.S. citizens are members of families who rely on SNAP to put food on the table. The proposed rule explicitly counts use of Medicaid and SNAP against a person’s immigration status. Further, the proposal seeks comment on whether CHIP should be added to the list of negatively weighted programs — something that we strongly oppose. Together Medicaid and CHIP provide basic healthcare for individuals, children, and families that allows them to work, have better economic futures, and promote self sufficiency and our collective public
health. Even the Department concedes that the proposed rule would “increase poverty of certain families and children, including U.S. citizen children” and lead to “worse health outcomes, including prevalence of obesity and malnutrition, especially for pregnant and breastfeeding women, infants, and children,” among other health impacts.
The health of parents and children are inextricably linked. As such, any change that results in parents skipping or disenrolling from health, nutrition or housing programs will impact the health of children across the life-span. For example, one in four children live with an immigrant parent nationwide. The proposed rule will have a documented and substantial chilling effect, undermining access to essential health, nutrition and housing programs for eligible immigrants and their families, including those with U.S.-born children. The threats of chilling effects are of major concern, as history tell us. After the enactment of welfare reform in 1996, use of public benefits programs dropped significantly, even among groups such as refugees and U.S.-born children who were supposedly exempt from public charge determinations.
The Proposed Rule Would Jeopardize the Health Care Safety Net and Undermine Nation’s Public Health and Patient Access to Care
This proposal will harm the financial stability of our health care safety net of Community Health Centers and Safety Net Hospitals. Immigrants’ withdrawal from health insurance programs will undoubtedly lead to higher levels of uncompensated care. An analysis of 30 AAPI-serving health centers shows that up to 86,000 patients may disenroll from Medicaid, which translates to approximately $65 million dollars in covered care under existing public insurance programs. Health Centers—who generally run on margins of less than 1 percent—will have to cover these increased costs either with federal grants or by tapping into other vital funding streams that support the Health Center model of care.
Without health centers and timely primary health care, many patients will end up with worse health outcomes and more complex, costlier health services for them, their families, and their communities. Studies show that comparably, care not provided at a health center cost $2,371 more per patient per year. This proposed policy only makes patients costlier to treat in the long run, both for the individual and the U.S. taxpayer. The potential increase in unsought primary care will have a detrimental effect on our nation’s safety net health care system of public and other safety net hospitals. Increased emergency room utilization will lead to less efficient use of scarce health care resources and longer wait times for vital emergency services.
JACL knows all too well the challenges of health care access for Asian and immigrant communities. Much of our membership struggled with health insurance access for years, leading us to create the JA Health Insurance Plan many years ago. Many of our own members have been small business owners and in need of reliable insurance coverage. With recent expansion of public health insurance options, this need has dissipated to some degree, but demonstrates that a vacuum had existed for many years with limited health insurance access. now is not the time to return to the days of limited health care access for entire communities such as immigrants.
JACL reiterates its concern that this proposed policy will be a return to the discriminatory policies that targeted Asian immigration specifically. Our country is built upon a rich diversity of immigration, consisting
of many different means and family backgrounds. We urge the US Citizenship and Immigration Services remain true to the value of welcoming immigration to this country and not follow the restrictive policies of other countries which are finding they lack the workforce to properly maintain economic growth and development.
Thank you for the opportunity to submit comments on the NPRM. Please do not hesitate to contact JACL at 202-223-1240 or email@example.com to provide further information.
David Inoue Executive Director