US District Judges rule the patient access to care arguments presented by plaintiffs call for an injunction on the DHS public charge rule.
US Judges in New York, California, and Washington have filed injunctions against the Department of Homeland Security (DHS) public charge rule, in part on grounds that plaintiffs can successfully argue patient access to care barriers as a result of the rule.
The rule, finalized in August, states that DHS may take into consideration certain factors that could influence whether an individual might become a public charge when issuing a green card to that individual. DHS may also consider these factors when deciding to extend a visa.
A public charge is defined as an individual who accesses certain public benefits, such as Medicaid coverage. An individual will be deemed a public charge if they access this benefit, as well as those related to cash income, SNAP, or some forms of public housing, for more than 12 months during a 36-month period.
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Specifically, DHS may consider an immigrant’s age, health, family status, assets, resources, financial status, and education or skills attainment when assessing whether she may become a public charge.
The rule was met with public outcry and lawsuits from some immigrant rights organizations, New York State, New York City, Connecticut, and Vermont, each arguing that the rule could have serious healthcare implications for legal immigrants.
An immigrant who knows she may not receive a green card or a visa extension if she enrolls in Medicaid benefits may choose to forgo healthcare coverage. In the case that she develops a serious healthcare condition, she could incur considerable medical costs. Those costs would likely be shifted to the healthcare institution and taxpayers, plaintiffs argue, not to mention the damage it could do to the immigrant.
“Multiple submissions from the Plaintiff States and the amici briefs endorse an estimate that ‘the Public Charge Rule could lead to Medicaid disenrollment rates ranging from 15 percent to 35 percent’ among Medicaid and Children’s Health Insurance Program enrollees who live in mixed-status households, which ‘equates to between 2.1 and 4.9 million beneficiaries disenrolling from the programs,’” Judge Rosanna Malouf Peterson, a district judge in Washington, reviewed.
And not only will the rule lead to limited Medicaid or insurance enrollment, but it will also lead to limited healthcare access.
“In addition to making receipt of Medicaid health insurance and other public benefit programs a negative factor, the Plaintiff States proffer that the Public Charge Rule disincentivizes individuals from seeking medical diagnoses and treatment because a diagnosis of a medical condition requiring extensive medical treatment or institutionalization will be weighed as a heavy negative factor when combined with a lack of health insurance or independent resources to cover the associated costs; or weighed as a negative factor even with health insurance or independent resources to cover the associated costs,” Judge Peterson wrote.
Judge Peterson, as well as Judge George B. Daniels, of the Southern District of New York and U.S. District Judge Phyllis Hamilton, of California, agreed the plaintiffs have a solid case against DHS and thus granted an injunction.
An injunction does not mean the rule has been struct down. Instead, it means the rule has been halted until it can be seen in court. Judges grant an injunction when they believe a plaintiff’s case holds merit and could be viable in court.
But the judges went further than pointing out a solid case against DHS, lambasting the rule as a “policy of exclusion,” said Southern District of New York Judge Daniels.
“It is a rule that will punish individuals for their receipt of benefits provided by our government, and discourages them from lawfully receiving available assistance intended to aid them in becoming contributing members of our society,” Daniels said. “It is impossible to argue there is no irreparable harm for these individuals, Plaintiffs, and the public at large.”
The public charge has the potential to seriously harm patient access to care, medical experts argued following the rule’s final publication.
“America’s hospitals and health systems work every day to provide care for those who need it and ensure patients are able to access programs that provide critical services,” American Hospital Association President and CEO Rick Pollack said in a statement.
“This rule is a step in the wrong direction when it comes to fairness with regard to the treatment of legal immigrants seeking a pathway to citizenship. And, it creates barriers to appropriately caring for the sick and injured, and to keeping people healthy. Failure to provide such services also has public health implications that could have widespread impact.”
And the rule would go beyond suppressing access to Medicaid, Pollack added.
“Access to nutrition aid, housing support and other programs that address the social determinants of health would also be jeopardized,” Pollack added. “No one should have to fear obtaining needed services and medical care.”
Chip Kahn from the Federation of American Hospitals (FAH) suggested the rule could have serious financial implications for emergency departments. Again, if a legal immigrant avoids healthcare for fear of losing her legal status, she may incur a serious health event in the emergency department. Serious, acute, emergency care is notoriously expensive, and much of that cost could land with the hospital.
“Hospitals are concerned that today’s decision will put the health of millions at risk by creating a chilling effect on enrollment for vital health safety net programs,” said Chip Kahn, the president and CEO at FAH. “Many eligible people won’t sign up for health insurance coverage, like Medicaid, over fears it could hurt their or their loved ones’ immigration status.”
According to Margaret A. Murray, the CEO at the Association for Community Affiliated Plans (ACAP), the rule is especially egregious because it would target legal immigrants.
“In the overwhelming majority of cases, undocumented individuals are already ineligible for Medicaid. This rule would largely impact families with members who are citizens or who are lawfully present,” said CEO Margaret A. Murray. “What do we accomplish by discouraging enrollment in programs that help lawful immigrants stay healthy and productive?”
The injunction is set to hold until the cases can be seen in court.
Source: Patient Engagement Hit