The Trump administration’s “public charge” rule, which would subject legal immigrants to a public charge determination if they use public health, nutrition and housing benefits for which they are eligible, represents a major threat to health, according to a “friend of the court” brief. The brief is signed by the American Public Health Association, American Academy of Nursing, and more than 60 deans and scholars from 27 schools of public health, public policy, nursing and medicine. The amicus brief has been presented to courts in multiple legal challenges to the rule now pending in federal courts in New York and California. The deans and scholars are urging the courts to block the rule from taking effect. The brief argues that the Trump administration acted arbitrarily, capriciously and contrary to law when it finalized this rule, which bars lawful permanent residence to people determined likely to become so-called public charges.

The public charge rule jeopardizes health care, with immigrants and their families likely to forgo critical benefits related to basic health needs, including immunizations that can keep an entire community healthy. The scholars state the rule will cause a substantial drop in enrollment in Medicaid and other essential health programs, leading to poor health outcomes and an increase in death rates.

The decline in Medicaid coverage and enrollment will result in significant decreases in Medicaid revenue that will affect the ability of health care safety net providers such as community health centers to serve all residents of their communities. An analysis prepared by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative concludes that as a result of declining Medicaid revenue, health centers across the nation could serve between 136,000 and 407,000 fewer patients annually. The brief further points out that patients, insured or otherwise, may simply forgo needed care for themselves and their families entirely, fearing the consequences.

The scholars also argue that the rule’s impact on the Medicaid program will lead to higher death rates, not just among immigrants but across communities. In a declaration filed in the U.S. District Court for the Northern District of California, Leighton Ku, PhD, professor of health policy and management at George Washington University’s Milken Institute School of Public Health, concluded that the “public charge” rule will cause between one and three million members of immigrant families, including U.S. citizens, to disenroll from or forgo Medicaid benefits each year, even if eligible. The loss would substantially reduce the ability of many racial and ethnic minority groups, especially Hispanic and Asian families, to afford health care and would lead to serious health problems. As a result, Ku states, there could be as many as 1,300 to 4,000 excess premature deaths per year.

The brief, which can be accessed here, was filed in the U.S. District Court for the Southern District of New York on Sept. 10. The deans and scholars, American Public Health Association, representing 25,000 public health professionals, and American Academy of Nursing, representing 20,000 nursing professionals, were represented by Ted Waters, Phillip A. Escoriaza and Christopher J. Frisina, of Feldesman Tucker Leifer Fidell, LLP of Washington, D.C.

The amicus brief was produced with support from the Robert Wood Johnson Foundation (RWJF). Read the full press release.