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Collateral Damage: The Administration’s Public Charge Immigration Restrictions are Endangering Health Coverage for U.S.-Citizen Children

By Stan Dorn, Rebecca Dorn,


For more than a generation, Democratic and Republican administrations alike held to two core commitments: Children should have the health insurance they need for a good start in life; and immigrant families should be encouraged to seek essential benefits for which they qualify, including health care for their U.S.-citizen children.

The Trump administration has reversed both of these longstanding commitments. Instead of assuring parents that they can safely seek help for their families, the administration’s public charge rules, which become effective on February 24, 2020, deny lawful immigration status when families seek or obtain nutrition assistance, housing, or health care for which they qualify. That is one important reason why, for the first time in decades, children are now losing rather than gaining health insurance.

This report is the first to analyze Census Bureau data documenting recent health insurance changes for U.S.-citizen children with immigrant parents. We find that, while children have been losing health coverage during the Trump administration regardless of their parents’ birthplace, U.S.-citizen children with immigrant parents experienced particularly great harm, losing Medicaid at four times the rate of other children.

We also find that 7.8 million U.S.-citizen children with immigrant parents rely on Medicaid to obtain necessary health care. They comprise more than one in five (22%) children covered through Medicaid. The administration’s harsh new immigration restrictions will have the foreseeable effect of causing many of them to lose coverage.

The final regulation contains an exception that excludes Medicaid for children under 21 from public charge consideration, but few immigrant families pay close attention to such regulatory details. To limit harm, trusted community groups need funding to conduct robust public education. Ultimately, Congress must step in to reverse the new, harsh public charge restrictions that abandon decades of bipartisan American support for immigrant families and for children’s health care.

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