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The new proposed “Public Charge” rule was published on October 10, 2018. Check out the new fact sheet from CPPP for instructions on how to leave a comment.
Texas parents should never have to avoid getting food, housing, or medical care out of fear that accepting that help might derail the parent’s ability to complete the path to legal immigration. But this harsh scenario could become reality because of a federal proposal relating to what’s called “public charge.”
The Trump administration released language this weekend for proposed “public charge” rule changes that would strongly prejudice immigration pathways toward higher-income people, while raising new high barriers for prospective immigrants if they have lower incomes, or have used government benefits like Medicaid, SNAP (food stamps), or housing subsidies. If the government anticipates that an immigrant might need benefits in the future—like Medicare’s sliding-scale “Extra Help” with prescription medication costs for seniors—an immigrant could also be denied a Green Card (legal permanent resident status) for that reason. The new policy will also create higher barriers for people with a chronic illness or disability to gain a documented immigration status.
Experts are still analyzing exactly how many Texans could be affected by this harsh rule change, but the numbers won’t tell the whole story. Any suggestion that accessing public benefits could jeopardize a person’s chance at immigration adds to the overall climate of fear this Administration has created in the immigrant community. To avoid possibly interfering with a person’s immigration status, it is likely that hundreds of thousands of immigrants and their U.S. citizen family members will simply skip prenatal care, health care, food, and housing assistance.
The most directly affected Texans will be the people applying for an immigration status change—undocumented immigrants are not eligible for most federal benefits—but fear and confusion over the proposed rule would also affect their U.S. citizen family members who are qualified for health care from Medicaid or the Supplemental Nutrition Assistance Program (SNAP, formerly “food stamps”). We do know that there are about 1.8 million Texas children—24 to 26 percent of all Texas kids—who have at least one parent who is not a U.S. citizen. Many of those children – including U.S. citizen children – could lose public health and food assistance for which they lawfully qualify because a parent moving through the immigration system might fear that if their U.S. citizen family members access any federal programs, the parent would be denied immigration. Health centers, food banks, and hospital districts all over Texas have already reported widespread dropping of Medicaid and SNAP in 2018 by U.S. citizens who fear their own use of benefits will jeopardize a loved one’s ability to legally immigrate: a direct result of the Administration’s leaked threats.
Taken together, the effects of this callous rule could drive millions of Texans—including U.S. citizens and current and prospective authorized immigrants—to choose between meeting basic needs like health care, food, and the ability of a family member to legally immigrate.
This harsh regulation would make using health, anti-hunger, or affordable housing programs a disqualifier for immigration, putting hundreds of thousands of families at risk. The result would be a sicker, hungrier, poorer Texas. Entire families suffer when a mother or father can’t complete the immigration process, or can’t get needed health care. And whole families still need to eat even if the family member who has a Green Card has to give up food assistance in order to complete the immigration process.
What specifically do we see in the latest version of this proposed rule?
- If an immigrant uses Medicaid, a vital health care program that pays for half of all births in the United States and care for 45 percent of Texas children, then he or she could be penalized in the immigration process.
- A prospective immigrant who is judged “likely” to need ”extra help” subsidies for Medicare’s prescription drug program known as Part D (e.g., a couple earning less than $24,690).
- If an immigrant uses the Supplemental Nutrition Assistance Program (SNAP, formerly “food stamps”), then the immigrant could be penalized in the immigration process. Families will receive a smaller food budget for only the U.S. citizen members, or may drop the program altogether out of fear.
- The proposed rule specifically asks for public comments on whether past or future use of the critically important Children’s Health Insurance Program (CHIP) should penalize people in the immigration process. This could affect some children who must apply for Green Cards. This could also affect non-citizen mothers in Texas (both those with authorized immigration status and the undocumented) who get prenatal care from Texas’ CHIP-Perinatal (“CHIP-P”) program. Inclusion of CHIP in the Public Charge rule would push even more women to skip prenatal care, resulting in more high-risk pregnancies and Texas babies born with conditions and special needs that could have been avoided.
- Several new policies are proposed to favor higher-income immigrants, helping immigrants through the process if their household income is 250 percent of the Federal Poverty Level–nearly $63,000 annually for a family of four.
- This policy would also make it very difficult for an individual with an income below 125 percent of the poverty income (about $31,000 for a family of four) to get legal immigration status.
- People applying for a Green Card with lower incomes, a disability, or a health condition may be required to pay a minimum of $10,000 to go through the immigration system and would risk losing this money if they use any public benefits listed in the public charge rule.
CPPP and our partners will continue to study potential impacts to Texas from this proposed rule change, and share resources on the proposed rule. Once the federal government publishes the proposal in the Federal Register, concerned Texans will have 60 days to submit public comments in opposition. CPPP will provide links to help Texans submit those comment online.
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Testimony on 2020 Census
On September 12, the U.S. Census released the newest numbers counting Americans without health insurance. Disappointingly, the data show that the number of uninsured Texans in 2017 was 272,000 more than in 2016. After three straight years of historic improvements in our uninsured rates, Texas backslid in 2017, leaving 4.82 million (17.3 percent) of Texans uninsured, the worst Texas rate since 2014.
With this setback in 2017, Texas still has both the largest number and percentage of uninsured residents in the United States.
Yet recent polls found that most Texans don’t know the uninsured rate here Texas is higher than other states—let alone that we have been ranked worst for many years. Just over one-third (34 percent) knew that Texas’ uninsured rate is higher than other states (in fact, highest in the U.S.). Another 19 percent of those polled thought Texas’ uninsured rate was about the same as other states, and 16 percent thought it was actually lower than most other states.
| Year | Number of Uninsured Texans (all ages) | Share of Texans Uninsured |
| 2013 | 5.7 million | 22.1% |
| 2014 | 5.0 million | 19.1% |
| 2015 | 4.6 million | 17.1% |
| 2016 | 4.5 million | 16.6% |
| 2017 | 4.8 million | 17.3% |
| Increase from 2016 | 272,000 | 0.7 percentage point |
Note: Percentage increase in 2017 is a statistically significant change from 2016.
Kids Do Better than Adults- But Texas Needs to do Much Better! A much smaller percentage of Texas kids ages 18 and under (10.7 percent or about 835,000kids) are uninsured than adults ages 19-64 (23.5 percent uninsured). Only 1.8 percent of seniors ages 65 and over are uninsured, due largely to coverage under Medicare. The difference between kids and adults is almost entirely due to the availability of public insurance from Medicaid and the Children’s Health Insurance Program (CHIP) for kids. Texans just doesn’t offer much Medicaid coverage to adults.
While much better than adult coverage rates, Texas children’s uninsured rate still leaves us at the bottom of the rankings among the states with the worst uninsured rates for children and teens.
Who Did Better, and One Big Reason Why. Texas is one of 14 states whose uninsured rate and number got worse in 2017. Our neighbors in Arkansas, New Mexico, and Louisiana all did better, either holding steady from 2016 (Arkansas) or improving. Louisiana dropped its uninsured by 87,000 to just 8.4 percent uninsured. These three states have all expanded coverage using federal Medicaid dollars for their lowest-income adults, while Texas has not. Texas leaders are leaving a golden opportunity on the table and have so far refused to expand Medicaid coverage like 34 states have done.
Among the 13 other states whose uninsured problems worsened in 2017 are nine others that have not yet covered their poorest working adults through an expansion option. States like Texas without any form of Medicaid expansion have no subsidized coverage for working-poor adults, because the Affordable Care Act (ACA, or Obamacare) subsidies are only available above the poverty line. The 34 states with a Medicaid-financed coverage program for poor adults gained a major head start over the remaining states (three more states are looking at expansion through legislation or ballot initiatives) by covering their lowest-income adults.
Texas’ disadvantage shows in our sky-high uninsured rates for working-age adults: about 23.5 percent of working-age adult Texans (ages 19 to 64) were uninsured in 2017, compared to a U.S. average of 12.1 percent.
Federal Policies Hurt Enrollment in Several Ways. For uninsured Americans who make enough money to be above the official poverty line, a list of other policy changes launched by the current federal administration have eaten away at the affordability of coverage, opportunities to sign up for coverage, and access to help enrolling. Texas lost “Navigators” and contractors whose job was to help with enrollment, renewal, and choosing an insurance plan. Federal officials slashed marketing and outreach and shortened the sign-up period by half. And, when the Administration eliminated payments to insurers to lower co-pays and deductibles, it drove up the premiums and deductibles for moderate-income families with incomes above the subsidy level. All these factors contributed to lower coverage rates for Texans above the poverty line in 2017.
Texans Expect Better from State and Feds. The same major poll found that Texans want state and federal government to do more about the uninsured: a majority (54%) of Texans want spending on health care programs to increase, with only K-12 education being a higher spending priority. Two-thirds of Texans (64%) say that the state is not doing enough to help low-income adult residents get needed health care, and the same majority (64%) favor expanding the state’s Medicaid program to cover more low-income adults. EHF/KFF Poll: June 15 release
Texas can do better by accepting billions in federal funds to cover working poor adults, and taking steps to stabilize our state insurance markets: this is the job of the state Legislature and Governor. Congress can reverse destructive federal health insurance policies that are driving down insurance coverage for middle-income Americans. To get the job done, the solid majority of Texans who want to see Austin and Washington do more must do their part by demanding action from elected officials as health care voters!
Fast Facts:
- Number of Texans without health insurance 2017 (all ages): 4,817,000 (Table A-5)
- This is an increase compared to 2016, with the number of uninsured Texans rising by 272,000 from the 2016 number (Table A-5)
- But, this is still 931,000 fewer uninsured Texans than in 2013. (Table A-5)
- With this setback in 2017, Texas still has both the largest number (4.8 million) (Table A-5) and percentage (17.3 percent) (Table 6) of uninsured residents in the country.
- Since 2013, our state’s uninsured rate has dropped a total of 4.8 (Table 6) percentage points, with 931,000 fewer uninsured Texans (Table A-5) since new ACA coverage options started up in 2014.
Background: This week’s data from the Census Bureau’s American Community Survey—with a massive sample size of about 3.3 million people across the U.S.—confirm with a much higher degree of accuracy what earlier, smaller-sized surveys had predicted. For more information or to schedule an interview with a CPPP expert please contact Oliver Bernstein at bernstein@cppp.org.
Stay tuned as Thursday (Sept. 13) the Census Bureau will release more American Community Survey data, including Texas-specific data about poverty and income. To better understand the difference between the two American Community Survey (ACS) and the Current Population Survey (CPS), view our side-by-side comparison.
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OPM vs. SPM
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