New US public charge rule may deter immigrants from vaccinating children

A just-published report in STAT documents how immigrant parents are denying their children essential medical care—including vaccinations—for fear of it being counted against their applications for permanent residency.

Two weeks ago, the Trump administration announced that it had finalized changes to the “public charge” rule applied to immigrants, expanding the category of “public charge” to include programs such as non-emergency Medicaid for non-pregnant adults, the Supplemental Nutrition Assistance Program (SNAP) and several housing programs. In essence, officials can now declare immigrants to be ineligible for “permanent residency” based on their use of these programs.

While the rule is not set to become official policy until October, its dire effects are already visible amongst the immigrant community.

Free vaccinations are not in fact listed even in the new rules as a service that could be counted against an immigrant in the “public charge” determination. However, there is widespread confusion about the kind of public services that have been included in the new policy. Part of it stems from the sheer volume of the listed changes.

The new rule is more than 100 pages long and as determined by a federal regulatory impact analysis, would take “between 16 to 20 hours to read...depending on an individual’s average reading speed and level of review.” But, perhaps, even more relevant is the general climate of fear that immigrant communities have increasingly faced as their daily reality.

As the Trump administration continues to wage its war against immigrants, families across the United States have faced brutal separations, unlawful detentions, as well as psychological and physical torture. These measures, as experts have consistently warned, have had a tremendous negative effect on the mental health and well-being of immigrant children in particular.

In one of the more recent displays of the administration’s egregious cruelty, ICE officials in Mississippi swept up 680 undocumented migrants on a single day, leaving numerous children to return home to locked houses and missing parents after their first day at school. Responding to questions about the spectacle, including the sight of sobbing children, Trump blithely responded, “This serves as a very good deterrent….I just hope to keep it up.”

Given this context, it is hard to believe that the lack of clarity with regard to the new rules is not part of a calculated strategy to sow more fear and confusion amongst members of a community already under attack.

And as preliminary reports indicate, this is a strategy that is working from the standpoint of the Trump Administration. Even the mere announcement of the proposed changes has had an impact on the ways in which immigrant parents are accessing health services.

Dr. Jeffrey Duchin, chief of communicable diseases for the Seattle and King County Health Department, told STAT: “We’ve had incidents where mothers have refused infant child services, where children have been dis-enrolled from preventive health care benefits that they are eligible for….[and] we fear that this is not an isolated issue, that throughout the community there’s significant reluctance now and fear to access health care services that people need both to treat illness and to stay healthy.”

Another expert interviewed by STAT, Dr. Elizabeth Barnert—a pediatrician and Assistant Professor at the University of California Los Angeles’ David Geffen School of Medicine—highlighted a recently-published study by the University of California, San Diego’s (UCSD) U.S. Immigration Policy Center. The study involved 506 undocumented immigrants. Half were read a brief description of the old public charge rule and were then asked how likely they were to apply for a range of services like food stamps, emergency health care and free vaccinations for their children.

The second half was read that description and the new definition of a public charge and then asked if they would be likely to apply for the services. Nearly 82 percent of undocumented immigrants from the first group said they would vaccinate their children; only 69.3 percent read the new version said they would.

As Dr. Barnert pointed out, while already statistically significant, the results of the UCSD study were an underestimation particularly given the prevailing official attitude towards immigrants. “Fear is infectious,” she said. “The real effect may well be worse, as things are broadcasting on television, as people are hearing from family members, as people are watching family members get denied, get deported.”

The criminality of this situation is further underscored by the fact that a large number of children in immigrant families are in fact US citizens, and therefore not bound by the “public charge” rule at all. It is estimated that in 2017, approximately 10 million American children—about 13 percent of the total child population—had a non-citizen parent.

Immigrant families, public health experts maintain, have consistently wanted to access available health-care to provide a better life for their children. This, in the past, has included providing the children timely vaccinations. Creating the conditions where parents driven by fear would choose to deny these services to their children will unquestionably be a threat to their health. Beyond that, a growing population of unvaccinated children would also have a wider impact in terms of spread of infectious diseases.

As Amy Pisani, Director of “Vaccinate your Family,” told STAT, this will lead to the general weakening of “herd immunity,” a phenomenon that is already visible in some places. “Outbreaks of vaccine-preventable diseases like measles happening now...are primarily among people who have declined to vaccinate their children,” Pisani said. “The next step is going to be people who wanted to vaccinate their children, but either couldn’t access the services or feared retaliation if they did.”