The Center for Elder Law and Justice (“CELJ”) strongly opposes the proposed changes to the public charge rules for immigration, which would add many potentially disqualifying factors to the list used to evaluate applications for permanent residency. These proposed changes are not based on sound evidence, are incompatible with our citizenship and naturalization policies, and would cause a drop in immigrant population that could have devastating effects on the healthcare and long-term care workforces in America.
Since 1999, the United States Citizenship and Immigration Service and its predecessor, Immigration and Naturalization Services have used a fairly narrow definition of individuals suspected to be “public charges” in immigration proceedings. The current test is limited to whether the immigrant is likely to become “primarily dependent” on government resources for survival. This determination is influenced by the immigrant’s receipt of a limited number of cash-assistance programs, but does not take into account safety-net government programs, the immigrant’s age and health, or the immigrant’s English language proficiency. For nearly 20 years this policy has fostered lawful immigration and allowed entry into our country for millions who continue to make America great.
The new proposed “public charge” determination is a vast and unwarranted expansion of the current definition. The proposed determination takes into account many more factors, including receipt of safety-net public benefits such as SNAP and non-emergency Medicaid, reduced-price school lunches, and Affordable Care Act exchange subsidies for purchase of private health insurance, as negative indicators. Further, it discriminates against the very young and the elderly by weighing as a negative factor a person’s age under 18 or above 61. It also considers an individual’s lack of English proficiency, medical conditions, and disabilities as negative factors.
IMMIGRANTS WHO ACCESS PUBLIC BENEFITS ARE NOT A SOCIETAL BURDEN
Promoters of this new rule claim that immigrants taking public assistance create an unbearable burden on our country’s resources, and that we should limit immigration to only those that can make positive contributions without the need for public assistance. Both of these claims are without merit. Receipt of safety-net public benefits such as food assistance and medical care sustains an individual so that he or she can contribute to society, not burden it.
According to the Center for Budget and Policy Priorities, 58% of households with at least one able-bodied working-age adult that receive SNAP benefits find employment within 1 month of receiving benefits, while 82% find employment within one year. Among SNAP households with children, 62% find work within 1 month and 87% find work within one year. Proper nutrition allows these individuals to find employment so that they can support their families and benefit their communities. The Center for Budget and Policy Priorities also found that, for every dollar invested in SNAP programs, as much as $1.70 is generated in economic activity through food purchases, job creation at all levels of the food industry, and purchases of other goods and services that wouldn’t be possible without food assistance. Not only do SNAP benefits allow individuals to contribute to society, but they also create a positive economic wave felt throughout the consumer goods supply chain.
Employment rates for Medicaid recipients are similar to those of SNAP recipients. According to the Kaiser Family Foundation, 60% of Medicaid-enrolled recipients are already working, and nearly 8 in 10 recipients live in a household with at least one working adult. Receipt of Medicaid allows these individuals to access preventative care that identifies problems early before they become expensive and unworkable. It also allows recipients to receive care from primary physicians instead of emergency rooms, which is much more cost-effective.
Nor have these safety net programs seen a significant expansion of costs from immigrants seeking to “game the system” by coming to the US specifically to live off government benefits. According to the Center for Budget and Policy Priorities, SNAP caseload numbers and overall program costs have dropped since the peak of the Great Recession and are projected to fall even further in the coming years. According to the Kaiser Family Foundation, Medicaid has always been more efficient than private health insurance, and its cost per patient is more than 25% lower than insurance offered by the private sector. According to the CATO Institute, for immigrants in particular the average cost of services for a Medicaid recipient is significantly less than the cost of services for a native-born Medicaid recipient. The same study found that immigrants overall access 27% fewer public benefit entitlement programs than native-born Americans. Thus, the claim that immigrants drain American resources through receipt of public benefits is wholly unsupported by fact.
THE NEW PUBLIC CHARGE DETERMINATION IS INCOMPATIBLE WITH CURRENT LAW REGARDING PERMANENT RESIDENCY AND NATURALIZATION
In addition to the proposed determination’s lack of basis in sound evidence, it is also out of step with our nation’s permanent residency, naturalization and citizenship laws. In the United States, there is no English language requirement to obtain Lawful Permanent Residency (“LPR” or “green card”) status. The English language requirement to naturalize is also waived for elderly individuals having lived in the US for 15 years or more, or for individuals who suffer a disability that makes it impossible for them to learn English. Disabled individuals are also not barred from applying for LPR status or naturalization. Indeed, special protections are in place to ensure that disabled individuals have access to LPR status and naturalization, including testing modification, interview accommodations, and oath waivers. Means-tested benefits have no negative impact on applications for LPR status or naturalization. In fact, for individuals who seek LPR status or to naturalize the application fee is waived based on, among other things, receipt of means-tested public benefits such as SNAP and Medicaid.
The proposed determination of who is considered a “public charge” and therefore ineligible for permanent residency in the United States takes all of these factors into account. This creates a disconnect between the public charge determination and decades-old statutory requirements and case law regarding obtaining LPR status and for naturalizing as a citizen. If our nation’s lawmakers and courts have long held that age and receipt of means-tested benefits should not be a bar to permanent residency or citizenship, and that valid reasons exist as to why an individual who doesn’t speak English should still become a citizen, why should that longstanding jurisprudence be overturned by such a cavalier change to the public charge determination?
THE PROPOSED RULE COULD HAVE A DEVASTATING EFFECT ON THE DIRECT CARE AND HOME HEALTHCARE WORKFORCE
The proposed change to the public charge rule, and its associated expected decrease in immigrant population in the US, could decimate industries which employ a significant number of immigrants. The direct care and home healthcare workforce is a prime example of this. According to the Paraprofessional Healthcare Institute, some 20% of nursing assistants and 28% of home healthcare aides are immigrants. Primarily because these industries are low-wage, 44% of immigrant direct care workers rely on Medicaid and SNAP to supplement their modest earnings.
Not only would the proposed rule change have a chilling effect on current immigrants, who might disenroll from public benefits programs and find it impossible to remain in the United States, it would also deprive our nation of scores of new immigrants who are eager to take these jobs despite the low pay. According to the Bureau of Labor Statistics (“BLS”), the caregiver workforce has already seen shortages of as much as 30% of the desired workforce. The reasons for this are obvious – caregiver work is difficult and not financially rewarding. Thus, fewer native-born Americans are willing to take these jobs.
If the caregiver workforce, already facing staffing problems, were to then lose its immigrant population, its existing staff shortage would rise to crisis levels. The caregiver workforce is expected to expand 31% by 2026 according to the BLS. Concurrently, the population of senior citizens in America, a group most likely to utilize caregiver workers, is expected to double in size by 2060 according to the Population Reference Bureau. The intersection of a sudden decrease in reliable immigrant workers with the exponential increase in demand for caregiver work would leave millions of Americans, both at home and in institutional care, without the care they need to survive.
For the above reasons, CELJ strongly opposes the proposed change to the “public charge” determination which affects applications for permanent residency in the United States. The proposed change has no basis in evidence, does not comport with statutory or case law concerning residency and naturalization, and would have a devastating effect on industries, such as home care and healthcare, that rely heavily on immigrants to maintain adequate staffing levels. The proposed change should be rejected in its entirety.