Dec 05, 2018
At a news conference today, leaders of NYC Health + Hospitals and the Mayor’s Office of Immigrant Affairs joined advocacy groups, elected officials, and labor partners in calling on all New Yorkers to speak out and reject the proposed changes to the “public charge” rule. The news conference was held at NYC Health + Hospitals/Gouverneur.
According to a new modeling analysis, the proposed Department of Homeland Security policy could impact 350,000 NYC Health + Hospitals patients and hit the public health system with a loss of up to $362 million in the first year.
The term “public charge” is currently used to describe a person deemed to be primarily dependent on government assistance. Changes to the federal public charge rule, if they were adopted, could prove to be a far-reaching and highly damaging immigration policy shift, penalizing immigrants for utilizing certain public benefits for which they are eligible—essentially forcing them to choose between proper medical treatment and pursuing a green card or visa renewal. The proposed changes to public charge would penalize individuals that the federal government deemed likely to become a “public charge” in the future, based on a variety of characteristics—including age, health status, employment history, education, and use of certain public benefits.
“As New York City’s single largest provider of health care to Medicaid recipients, we are alarmed as we hear about legal immigrants who are dropping their Medicaid coverage out of sheer fear that it may jeopardize their path to getting a green card or visa approved in the future,” said Mitchell Katz, MD, President and Chief Executive Officer of NYC Health + Hospitals. “New Yorkers should not have to choose between the health care services to which they are entitled and a green card.” Dr. Katz noted that the health system has already had patients decline to enroll in Medicaid, others who have disenrolled from its MetroPlus health plan, and still others who have opted out of the WIC program (the Special Supplemental Nutrition Program for Women, Infants, and Children). Yet the current impact pales in comparison to the much larger anticipated effects if the rule is to be implemented.
“All Americans have a right to speak out against federal regulations, and the law requires that what we say gets reasonable consideration,” said Henry Garrido, Executive Director of District Council 37, New York City’s largest union of municipal employees. “We are asking our workers and, in fact, all New Yorkers to voice their opposition to the federal public charge proposal by visiting www.nyc.gov/PublicCharge and submitting a comment by December 10 before the public comment period ends. Without action, this proposed rule could undermine many positive financial and patient service improvements that management and labor have worked together to achieve in recent years.”
“This ‘public charge’ proposal is complex, but the stakes are simple—the Trump Administration is attempting to undermine the health and well-being of the ultimate city of immigrants,” said Bitta Mostofi, Commissioner of the Mayor’s Office of Immigrant Affairs. “Many independent analyses, including the latest from NYC Health + Hospitals, quantify the harm it could do to our communities and to our health care system. The de Blasio Administration stands with all New Yorkers—regardless of immigration status—and we’ll fight this with everything we’ve got. I urge New Yorkers concerned with how this proposal could impact themselves or their families to get informed. Visit NYC.gov/PublicCharge, call 311 and say ‘Public Charge’ for more information, or say ‘ActionNYC’ for a free immigration legal screening.”
Serving more than one million New Yorkers annually—40 percent of whom are born outside the United States—NYC Health + Hospitals is likely to bear a disproportionate burden if the changes to public charge were to take effect. The proposed rule would pose significant risks, partially due to fear, and could harm 350,000 of its patients, according to a review conducted by the public health system on the potential impact.
Specifically, NYC Health + Hospitals’ analysis suggests that as many as 62,000 patients could abandon Medicaid and other insurance. Also concerning, more than one million patient visits could be skipped. And much-needed prescriptions to prevent or treat contagious diseases like the flu and tuberculosis could go unfilled. Just as disturbing are the predicted declining health outcomes that could result, including increased complications in pregnancy, more premature births, and maternal deaths.
The analysis conducted by public health experts at NYC Health + Hospitals involved extensive modeling based on real-world outcomes of the Welfare Reform Act of 1996, U.S. Census data drawn from the American Community Survey, and de-identified patient insurance coverage information from within the public health system. A range of effects were modeled, based on resulting estimates of patients who could drop insurance coverage (including but not limited to Medicaid), patients who may forgo their current ongoing medical care, and patients who may ultimately need more expensive emergency care as a result.
Beyond the negative health impact on patients and their families, NYC Health + Hospitals’ analysis shows that its health system could get hit with a financial loss of as much as $362 million in the first year. This total does not include all related financial impact; for example, thousands of NYC Health + Hospitals’ frontline staff, including medical providers and social workers, would need to be trained on the nuances of the proposed rule and how to best support patients—at a cost yet to be determined.
“As the State Senator of a district with a diverse immigrant population, and as New Yorker, I cannot sit idly by while the Trump administration continues to advance policies that aim to curtail our immigrant communities’ rights,” said State Senator Gustavo Rivera. “The proposed changes to the public charge rule make it abundantly clear that this administration is not only seeking to limit legal immigration, but that it is willing to do it by targeting the most vulnerable and at the expense of states, such as New York. I urge every New Yorker to not remain silent, and submit a public comment against this rule before the December 10th deadline. This is our time to honor our State’s long-standing history of embracing our immigrant roots and communities.”
“No one in America should be denied access to health care, and patients, doctors, and hospitals should not face financial hardship just because of the patient’s immigration status,” said New York State Assembly Health Committee Chair Richard N. Gottfried. “The Trump administration’s proposed public charge rule is mean-spirited and harms both patients and health care providers. I urge all New Yorkers to join me in submitting comments in opposition to this proposal.”
“The proposed changes to ‘public charge’ policies targets our immigrant communities and harms the individuals who need health care the most,” said New York State Assemblymember Yuh-Line Niou. “A recent report by the Mayor’s Office of Immigrant Affairs projects that up to 20% of our community is likely to drop important health care coverage in fear of endangering their immigration status. This is a defective and unfair consequence for immigrant families seeking health services for which they are eligible. New Yorkers should not have to choose between the health services they are entitled to and lawful immigration status.”
“This data adds to the mountain of evidence that the federal government’s proposed rule punishing immigrants for using publicly funded services is just that—a vicious attack on people applying for lawful permanent residence in this country, and a policy that solves no problems and in fact creates them,” said Manhattan Borough President Gale A. Brewer. “This rule will hurt our hospitals and our public health, and much more besides, all in the name of victimizing people who have done nothing wrong. It is disgusting, it is un-American, and we must fight it with everything we have.”
“Immigrants are the lifeblood of New York City, with over 3.5 million immigrants contributing $195 billion to our economy,” said Councilwoman Carlina Rivera, Chair of the New York City Council’s Committee on Hospitals. “Whether it’s SNAP, non-emergency Medicaid, Medicare Part D, or federally funded housing assistance, these New Yorkers should not have to make an impossible choice between accessing these important programs and losing their residency. And at our hospitals, these public charge rules changes would only inspire more fear and make more people think that their only option for health care is a crowded emergency room. Health + Hospitals already does so much to serve our immigrant communities as our true safety net system. We need to be encouraging more New Yorkers to use new urgent care clinics and primary care doctors, and this fear-mongering decision by the federal government will only make that effort more daunting.”
“The Trump administrations proposed change to the ‘public charge’ rules not only represent a threat to nearly half a million immigrant New Yorkers, but to our entire economy,” said City Council Health Chair Mark Levine. “This action is as heartless and draconian as anything the Trump administration has done. Our city can and must act locally to remedy this dangerous situation, to ensure that every New Yorker—regardless of immigration status—receives essential, health care.”
“Trump’s cruel proposal to change the public charge rule is another example of this White House’s hostility towards immigrants and its rejection of our most fundamental values as Americans,” said Council Member Margaret S. Chin. “The proposed change, should it go through, will force legal immigrants to make an impossible choice between Medicaid coverage and their green card application. The move could have an immediate impact on 350,000 patients of NYC Health + Hospitals, which remains the largest single provider of Medicaid in the City. In the weeks to come, it is critical that we as a community stand our ground and fight back, and I urge community leaders and allies to submit their comments about this rule change by the December 10th deadline. I thank NYC Health + Hospitals, DC37, and the Mayor’s Office of Immigrant Affairs for their continued advocacy for our immigrant communities and their willingness to stand up against this toxic Federal Administration.”
“The proposed public charge rule is an attack on families and their right to vital services,” said Frank Proscia, MD, President of Doctors Council. “The regulation will cause many patients to avoid needed care and services because of concern about compromising their immigration status. Avoiding essential health care, such as screenings, tests, and immunizations, certainly will increase the chance of outbreaks of transmissible pathogens. This will in turn jeopardize patients’ own health and that of their communities. Patients who fear accessing medical or dental care or who defer such care until an emergency situation results face more complex medical and public health challenges. For example, patients with end-stage renal disease who receive emergency dialysis have higher mortality than patients who receive scheduled maintenance dialysis. And we know emergency care increases costs to the health care system well beyond those costs incurred in the course of clinical visits. The regulation will also place a governmental barrier between health care providers and patients. All people are potential patients who deserve and need access to care. As physicians, we see patients in front of us and are not concerned with immigration status. We oppose this proposed rule and urge that it be withdrawn.”
“As nurses, we are outraged by the proposed ‘public charge’ regulations that will effectively keep lawful immigrants and applicants from accessing the health care they need and deserve,” said Jill Furillo, RN, NYSNA Executive Director. “The regulations would result in safety net hospitals being weakened for all they serve. The contributions of immigrants to America are many, yet the federal government seeks with this proposal to punish them. We forcefully disagree.”
“LegalHealth, a division of the New York Legal Assistance Group, is proud to partner with NYC Health + Hospitals by providing free legal services in the health care setting,” said Randye Retkin, Director of LegalHealth, NYLAG. “Since the rule was announced, many patients have been referred to our legal clinics seeking clarification of the harsh reality of choosing between applying for a green card or receiving urgent medical treatment. This is a choice no one should ever have to make.”
“The Trump Administration’s proposed public charge regulation change is yet another example of the administration’s attack on low-income immigrants,” said Rebecca Telzak, Director of Health Programs at Make the Road New York. “This rule will force families to decide between accessing vital health and nutrition programs or keeping their families together. Due to the complexity of the rule, it is important that individuals who think that they could potentially be at risk of being a public charge consult with an advocate or attorney at a community-based organization for assistance. The role of community-based organizations during this time is more important than ever—to provide updated information to families so they understand if and how this proposed regulation could impact them. Individuals should continue accessing key public benefits for now since this is still a proposal and the rule has not gone into effect yet. Individuals should also continue accessing health care services, including services at Health + Hospitals facilities.”
“Trump’s public charge proposal would force New Yorkers to choose between their health insurance and their immigration status—an impossible choice to make,” said Max Hadler, Director of Health Policy at the New York Immigration Coalition. “The New York Immigration Coalition is committed to working with Health + Hospitals to combat Trump’s fear tactics and ensure that immigrant families understand their right to continue seeking health care services. We call on all New Yorkers to oppose this anti-immigrant and un-American rule by submitting public comments before the December 10 deadline.”
Speakers at the event underscored that:
“We’ve been encouraged by the recent developments and progress of our public health care system and are currently undergoing a transformation in the right direction, with still more work to be done toward continued growth,” said Dr. Katz. “That such a misguided and dangerous proposal would even get this far is baffling and unfortunate, but we’re here for the long haul: No matter what happens in Washington, our mission remains intact, NYC Health + Hospitals with its diverse and dedicated workforce will continue to provide care to all New Yorkers. Without exception.”