“Public Charge” is a Public Health Disaster in the Making


I was born in a rural village outside of Hue, Vietnam in 1976, a year after Saigon fell and the war ended. My family of four struggled to survive in the post-war shambles, and in 1981, my mother had no choice but to flee Vietnam by boat with my older sister and myself. Through the support of the refugee resettlement program, we began our lives in the United States in 1982, wearing all of our belongings on our backs and not knowing a word of English.

Though we struggled for years to make ends meet, we sustained ourselves through public benefit programs: food stamps, Medicaid, Section 8 Housing, and cash aid. These programs were lifelines that enabled me to focus on my education, and they allowed me to be the physician and public health expert that I am today. Looking back, I firmly believe that the more we invest in the lives and livelihoods of immigrants, the more we invest in the United States, its ideals, and its future.

So, when I first learned of the current administration’s plan to make it harder for immigrants with lower socioeconomic statuses to gain permanent U.S. residence, the so-called changes to the “Public Charge” rule, I felt outraged and baffled by its short-sightedness.

U.S. Refugee Totals by Year. Courtesy of www.cgdev.org

If this proposal comes into effect, government officials would be forced to consider whether an applicant has used, or is deemed likely to use, public benefit programs like Section 8 Housing, Medicaid, the Supplemental Nutrition Program (SNAP), and Temporary Assistance for Needy Families (TANF). Additionally, applicants with pre-existing health conditions could be rejected purely on these bases.

The implications of this rule are not hard to predict (and have already been observed throughout the country): noncitizen parents who are hoping to get green cards will not enroll their citizen children in government healthcare, which they have a legal right to obtain, out of fear that harnessing public benefits will prevent them from gaining legal permanent residence. According to the Kaiser Family Foundation, President Trump’s proposal could lead to a decrease in Medicaid and CHIP enrollment by a minimum of 15% and as much as 35%. Any proposal that decreases the number of insured American citizens, as this measure surely would, would increase the financial strain on taxpayers who will be forced to compensate for unpaid coverage. Furthermore, Forbes estimates that Trump’s proposal would decrease legal immigration to the United States by more than 200,000 people a year and therefore “would have a negative impact on the Social Security System”- a deficit that American taxpayers would have to help cover.

If the moral argument that every human being deserves the pursuit of a better life doesn’t work for you, then let the economic one suffice. A 2016 study by the National Academies of Science, Engineering, and Medicine concluded “immigration has an overall positive impact on long-run economic growth in the United States” and “immigration is integral to the nation’s economic growth.”

Whether you are an immigrant or were born in the US, we all have a responsibility to vocalize dissent against the Department of Homeland Security’s morally and fiscally-flawed anti-immigrant proposal. Vote, attend town-hall meetings, write to your representatives, conduct personal research, engage in constructive dialogue, and comment below to get the conversation started. Remember, the Statue of Liberty reads: “Give me your poor, your tired, your huddled masses.” If we match xenophobia and ignorance with empathy and facts, we can ensure that America remains a beacon of hope for future immigrants, just as it was for me in 1982.

Internist, Pediatrician, and Associate Professor at UCSF, Dr. Le is also the co-founder of two health equity organizations, the HEAL Initiative and Arc Health. This article originally appeared on Arc Health here

5 replies »

  1. Thank you for posting Dr. Le.

    I appreciate your perspective and the sacrifices you and your family made along the way.

    The one comment I would make about “public charge” is that things have changed over the years as government and entitlements and support systems have grown. At the end of WWII my grandfather signed for a family friend and his wife and family – his signature being necessary for the family to leave the US POW camp they were in and begin the process of becoming US citizens. Despite being a member of Austrian royalty, a noted pianist (as a boy I remember his playing at holiday gatherings before and after dinner) and inventor (he) and a psychoanalyst and student of Sigmund Freud (she) the US government required a sponsor (my grandfather) to sign for the family and give his assurance that the family would never rely on public assistance. Despite losing everything in WWII and (also) coming here with only the clothes on their back, they were able to make a go of it despite many setbacks and being taken advantage of by our government and Ford Motor Company (not paid for his work and inventions). His work for the US Government included helping the Department of Defense with a weapon used in the Vietnam War that was jamming – he was able to fix it (as a noted armaments expert – one of his many skills as an inventor) and was never given official credit or paid for his work). There is another way – though I agree that restricting those who are industrious and wish to come here and become a member of society and contribute is not the best way to grow as a nation and as an economy.

  2. Anything that comes from Trump’s mouth first comes from his ass.

    He said he wants immigrants from Norway – why would they want to come to the U.S.

    Immigrants pick our fruits and vegetables, build our houses, clean our homes and businesses, work in our slaughterhouses and all sorts of other hard labor crap workplaces.

    Yes, we can invest in helping people be successful with government support – especially immigrants who want to succeed more than many U.S. residents. Trump had daddy to help him and the rich in the U.S. have socialism, while they say the rest of us will do better with capitalism.

    This is just another lie by Trump and the soulless repugs.

  3. The deeply unfortunate, underlying logic for considering the “public charge” concept for emigration is totally unrelated to emigration. Our nation’s entitlement spending by the Federal government continues to increase at a rate that now accounts for a large portion of our nation’s deficit spending. It is possible to estimate that the Federal government’s “excess obligation” to national health spending represents nearly 50% of our nation’s Federal deficit annually. The “excess obligation” assumes the following: our nation’s health spending now represents nearly 18% of our national economy (Gross Domestic Product), and the health spending by the other 34 OECD (Organisation for Economic Cooperation and Development) nations is less than 13% of their GDP. Of our nation’s health spending, the Federal Government contributes more than 40%, principally Medicare and Medicaid. In addition, Comprehensive Care Centers, Native American Health Services, Veterans Administration and Federal Penitentiary Health Services also contribute to the total.

    To further aggravate the emigration issues, our nation has no over-all, long-term plan to assure the appropriate availability of physician, human capital nation wide. Also, the contribution of in-bound emigration has no nationally considered contribution to this obligation. Our nation’s current, political climate increasing neglects the needs to foster the development of a high quality, efficient healthcare industry. The institutional diversity of our nation’s agriculture industry should be applied to our nation’s healthcare industry. As opposed to our nation’s healthcare, our agriculture industry is the most efficient and effective among the OECD nations, by a wide margin.

    Just after finishing the above, I note that there is a thoughtful VIEWPOINT regarding Immigration Barriers for Medical Education in this week’s JAMA edition for 2-26-19. Originating from the AMA Council on Medical education. Apparently, its “doi” site is not open to the public.

  4. Suppose we had completely open borders. Suppose we told people that if you want to come to America in search of a better life, get yourself a passport, pass a background check and you can come here. In all likelihood, more people would want to come here than already live here. It would overwhelm the society and the culture, especially if most of them needed the benefit programs that you referred to, at least for a period of time.

    We have a legal immigration process for a reason and there is a limit to how many immigrants we can absorb per year which is far below the number of people who would like to come here if they could. Illegal immigration remains a big problem for the U.S. and we need to do all we can to reduce it in my opinion. .

  5. We want to have legal entry. We want to be altruistic and kind. It’s just that we don’t want to always admit folks who are going to vote liberal all the time. Admit folks from Cuba. Admit folks from Russia or Poland. Or from Vietnam. These folks probably see both sides a little. We can be altruistic and not act against conservatism all the time.