In-Depth

Proposed Trump Administration Rule Could Make Houston Sicker

The Department of Homeland Security says the rule ensures people who come here are self-sufficient. Local health officials are speaking out.

Esmeralda Cedillo works for the Houston Food Bank and worries about how the public charge expansion will affect access to food and healthcare.

The Trump administration is proposing a new immigration rule that could have a major impact on public health in cities like Houston. The proposed public charge rule would make it harder for legal immigrants to get a visa if they use, or are deemed likely to use, certain public benefits like Medicaid, food stamps, and housing vouchers.

The Department of Homeland Security said the rule ensures people who come here are self-sufficient. 

“Under long-standing federal law, those seeking to immigrate to the United States must show they can support themselves financially,” said Secretary of Homeland Security Kirstjen Nielsen.

The department estimates some 382,000 applications would be under review each year and subject to the new rule. 

Meanwhile, some within Greater Houston’s health care community say one impact of the new rule is that it will make the city sicker.

Esmeralda Cedillo helps low-income families sign up for food stamps and Medicaid through the Houston Food Bank.

“They show you pictures of their children and whenever they have a question, they reach out to me and they say ‘Esmeralda I have this, what can I do to fix this?’” 

They go to Cedillo because she gets it. Her parents are immigrants.

“I went through the poverty, I went through seeing my parent’s fear,” she said.  

She works a lot with the Latino community and said ever since Trump took office, her job’s been harder. Her client base is just a fourth of what it use to be.

“So from 80 that we had in one week, it’s dropping to 15, the highest we’ve seen is 20,” she said.  

Cedillo said people come to her in fear; fear of jeopardizing their immigration status – or worse, being deported. She said the new “public charge” rule is making those fears worse.

“That was the hardest story I could hear… was that of eight household members the parents decided not to ask for help from the country… that their kids being born here was more than enough, it was a blessing for them, and they were just gonna file their taxes and work and see how they would provide medical and food assistance,” Cedillo said.  

Esmeralda Cedillo helps families sign up for Medicaid/CHIP and SNAP and says she’s already seen increased fear of enrolling among immigrants.

One example of how this fear is playing out locally is through access to nutritional assistance program WIC. Since Trump took office, the city has seen a 20% decline in enrollment.

“Since (the) election we went from 72,000 caseload to right now we’re barely at 58,000,” said Houston Health Department’s WIC Bureau Chief, Zahra Koopaei.

And experts say this new rule will make it worse.

That’s why the City of Houston’s Health Department, and other local health organizations, are voicing opposition to new rule. Houston Health Authority Dr. David Persse co-authored a letter against it to the Department of Homeland Security.

“If you put fear into people so that they won’t even take care with the assets that we have available the situation’s just going to get much worse,” said Persse.  

According to him, the immigrant community has limited access to health care as it is.

“There’s going to be a human price to be paid and there’s going to be a financial price to be paid, so it’s a lose-lose proposition,” said Persse.  

He argues the new rule will have a domino effect — fewer people will get preventative care, which means more will depend on more expensive emergency care. On top of that, Persse said fewer people will get vaccinated and more kids will go malnourished, all factors that will make the city sicker.

But not everybody agrees. 

Matthew O’Brien is director of research at FAIR (Federation for American Immigration Reform) and called this argument against the public charge rule “alarmist”.

“If you have people that are coming here and they’re getting the bulk of their income, housing, medical costs and other costs through social programs that taxpayers are funding, there’s no way… unless we have some sort of outbreak of disease of the type that we haven’t seen since the late 19th century in the United States, you’re not going to have those costs offset the costs that are being born by the American taxpayer in order to provide these benefits in the first place,” said O’Brien. 

A 2013 study by the Cato Institute showed that non-citizens use public benefit programs less than U.S.-born citizens. 

Undocumented immigrants do not have access to the large majority of public benefits, though their citizen children are eligible for benefits like CHIP. Green card holders are eligible for benefits only after five years of residency in the U.S. without using public benefits like Medicaid, SNAP and TANF. 

New American Economy estimates state and federal tax contributions of undocumented immigrants alone to be $41 billion in 2014. 

Public charge rules are currently listed in the federal register. Any citizen can make comment for or against the rules online at the City of Houston’s website, or directly on the federal register online.

The deadline to make public comment is December 10th.

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