APHA Joins Dozens of Public Health and Policy Experts to Urge DHS to Withdraw Proposed Public Charge Rule

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Dozens of Public Health and Policy Experts, Along with the American Public Health Association and Robert Wood Johnson Foundation, Urge DHS to Withdraw Proposed Public Charge Rule

A public comment filed by 65 public health deans and scholars, along with the American Public Health Association (APHA) and Robert Wood Johnson Foundation (RWJF), strongly opposes the Department of Homeland Security Notice of Proposed Rulemaking (NPRM) on the “Public Charge Ground of Inadmissibility.”

The public comment calls on DHS to withdraw the proposal, which rescinds the 2022 Public Charge Final Rule without replacing it with any substantive guidance—granting immigration officers broad discretion to consider virtually any public benefit or factor when determining whether an individual is likely to become a “public charge.”

They warn the proposed rule would lead to a severe chilling effect on the use of essential health and social services by lawfully present immigrants, mixed-status families, and U.S. citizen children.

"We encourage careful consideration of the potential impacts of this proposal on families and communities,” said Kelly Gebo, Dean of the George Washington University Milken Institute School of Public Health. “For decades, clear public charge rules have provided stability and clarity for both agencies and the public. As DHS makes changes to these rules, it will be important to ensure that families, including U.S. citizen children, continue to feel confident accessing the health care, nutrition, and public health services for which they are eligible and that contribute to overall public well-being."

For nearly all of the last 25 years, federal policy—starting with the 1999 Field Guidance and continued in the 2022 Final Rule—said that only cash welfare benefits or long-term institutional care at government expense could be counted in public charge decisions. Non-cash programs like Medicaid, SNAP, CHIP, and housing assistance were clearly excluded. These long-standing rules were meant to keep decisions consistent and avoid confusing or scaring the public.

The new DHS proposal would eliminate these protections entirely. 

APHA Executive Director Georges C. Benjamin, MD adds, “Safe shelter, food on the table and access to health care services are key to improving the health of all people in our nation. Families should have equal access to life’s necessities. The chance to live a healthy life as long as you can is a fundamental human right, regardless of your status in our country. Denying access to programs that connect millions of families to safe shelter, keep children fed and provide important health care services not only leads to poorer health outcomes in those populations, but also affects us all indirectly.”

Researchers from George Washington University estimated a range of potential impacts from the proposed public charge rule. Their midpoint estimates were:

• 3.7 million members of immigrant households could lose Medicaid, CHIP, SNAP, SSI, or housing benefits.
• Federal benefit losses could reach $21.3 billion in 2026, with ripple effects shrinking state economies by $27.4 billion as health care providers, grocery stores and other businesses lose revenue due to public charge rule..
• As many as 212,000 jobs could be lost, including 73,000 jobs in health care.

“RWJF strongly opposes this proposed rule, which is one part of a broad assault on immigrant families and the communities where immigrants live,” said Richard Besser, president and CEO of RWJF. “Community health depends on everyone having access to the support and services they need to thrive. This proposed rule would harm families and communities across the nation and take us farther away from a future where health is no longer a privilege for some, but a right for all.”

The economic and employment losses would not be confined to immigrant households. As business losses ripple out through the state economies, the employment and incomes of all types of households would also be harmed.

The scholars, APHA, and RWJF are calling on DHS to withdraw the NPRM and preserve clear, evidence-based standards that protect families and promote community well-being.

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The American Public Health Association champions optimal, equitable health and well-being for all. With our broad-based member community and 150-year perspective, we influence federal policy to improve the public’s health. Learn more at www.apha.org.