Health access on the line: How Trump’s proposed public charge rule hurts all of us and weakens our health care system

Last week, Families USA submitted a comment on a proposed rule from the U.S. Citizenship and Immigration Services (USCIS) and Department of Homeland Security (DHS) titled Public Charge Ground of Inadmissibility.

This proposed rule would undo the current public charge protections that were finalized on December 23, 2022 (“2022 Final Rule”). If adopted, the proposed rule would penalize lawfully present immigrants for accessing important and life-saving services, instill fear across immigrant communities, and weaken the public health infrastructure that protects us all. At a time when families are already struggling to afford rising health care costs, the Trump administration is advancing yet another policy that discourages people from seeking heath care, with consequences that extend far beyond immigrant communities.

Instead of addressing the high and rising cost of health care, the Trump administration has repeatedly pushed policies that punish and deny immigrants access to health care. Immigration status should not be a barrier for families and individuals to attain high-quality, affordable health care. Accessing health care should never put immigrant families’ safety at risk. From excluding DACA recipients from the Affordable Care Act marketplace to the attacks on immigrant families embedded in HR 1, the administration has sent a clear message: immigration status is increasingly being used to deny people access to high-quality, affordable care. The proposed public charge rule is the latest — and one of the most dangerous — examples of this approach with serious consequences for families and communities. For these reasons, Families USA strongly opposes this proposed rule and urges DHS and USCIS to withdraw it.

The Proposed Rule Removes Critical Protections

The proposed rule dismantles two critical protections, established under the 2022 Final Rule, and that have guided public charge decisions for decades.

1. Removal of Public Charge Definitions

The proposed rule would eliminate the 2022 Final Rule’s definition for who is “likely to become a public charge.” Under the 2022 Final Rule, a person is considered likely to become a public charge only if they are primarily dependent of the government for support, shown by:

1. receipt of long-term cash assistance such as Social Security Income (SSI) or Temporary Assistance for Needy Families (TANF), and/or
2. require institutionalized long-term government assisted care such as Medicaid-funded nursing home or mental health institutionalized care.

This definition, codified in regulation and grounded in decades of U. S. Immigration and Naturalization Service (INS) guidance, makes clear that non-cash public benefits like Medicaid, Supplemental Nutrition Assistance Program (SNAP) funding, or housing assistance do not constitute public charge. The 2022 Final Rule reflects our nation’s economic reality, like many hard-working Americans, lawfully present immigrants may need health insurance coverage through a public program or other temporary supports during periods of transition, illness, or financial instability. Accessing these supportive resources does not mean that a person is primarily dependent on the government for assistance. Rather supportive resources, like Medicaid, allows individuals to remain healthy, work, and contribute to their communities.

By proposing to eliminate this definition without replacing it, USCIS and DHS would create widespread uncertainty about what benefits could be used against an immigrant in an admissibility determination. This uncertainty will create a “chilling effect” discouraging families from seeking care they are legally eligible for — hurting both individual families and public health. Additionally, the lack of definition gives USCIS officers broad discretion to deny visa applications for lawfully present immigrants based on their own subjective interpretation of whether someone is likely to become a public charge; inviting inconsistency, bias, and random outcomes in decisions that determine whether families can remain together in the United States.

2. Removal of the Existing Public Charge Inadmissibility Framework

The proposed rule also rescinds the framework that governs how public charge determinations are made. Under the Immigration and Nationality Act (INA), Congress established five statutory factors that officers must consider: age, health, family status, assets, resources and financial status, and education and skills. The 2022 rule strengthened these requirements by:

• prohibiting decisions based on a single factor, such as disability;
• ending the practice of assigning any positive or negative weight to a specific factor (e.g. weighting an applicant’s uninsured or disability status as a negative); and
• requiring officers to clearly explain the reasoning behind each determination.

These guardrails ensure fair, consistent, and transparent decision making; while recognizing that a person’s disability, illness, or temporary lack of insurance does not determine their ability to work, support their family, or remain self-sufficient.

The proposed rule eliminates these protections entirely. In their proposed rule, USCIS and DHS explicitly state their intent to restore an “inherently discretionary” process, allowing USCIS officers to consider information beyond those five factors established by Congress, weigh evidence however they choose, and ultimately deny applications based on their personal judgment. This not only allows but encourages officers to request data across systems to make public charge determinations, further expanding data sharing between immigration agencies and federal benefit programs, and increasing surveillance on immigrant families. In practice, the proposed rule gives officers unbridled permission to ignore favorable evidence, unfairly weigh numerous arbitrary factors, and deny applications without meaningful explanations. Under the proposed rule, public charge determinations will likely become subjective, discriminatory, and unpredictable.

Why This Matters for Everyone

For decades, public charge policy has recognized that access to health care and other vital resources strengthens families, communities, and our nation as a whole. This proposed rule abandons that principle. It removes the safeguards that save lives, support our public health and heath care systems, and promote fairness in our immigration system.

Together, the changes outlined in the proposed rule replaces clarity with confusion, standards with broad discretion, and fairness with bias. The proposed rule will also discourage lawfully present immigrants from accessing health care and other supports that keep them, their families, and their communities healthy and economically stable.

The proposed rule will also devastate our health system. Immigrants are a critical part of the health care workforce, and many rely on Medicaid for coverage. Eliminating public charge protections could push workers out of coverage or out of their jobs — worsening existing health workforce shortages. At the same time, fear-based losses in coverage would strain community clinics and safety net hospitals, limiting access to care for everyone.

For these reasons, Families USA strongly urges DHS and USCIS to withdraw this proposed rule. Read Families USA’s full comment letter.