All Are Welcome Here . . .

t’s no secret that immigration issues have been heavily debated political topics currently and in years past. Here at the clinic we see patients from numerous countries who each have their own story and reasons for coming to live in the United States. Politics focuses many times on statistics, but we see the individual faces of people impacted by immigration policy.

I wanted to let you know about several updates to immigration policy recently. Legislation has been proposed to expand public charge. Currently it only applies to Medicaid. However, the expansion would include things like Hawki (Healthy and Well Kids in Iowa), food stamps, and subsidized housing. The idea behind accessing public charge is that it could impact your ability to be approved for citizenship later on or to petition to bring a relative here. The mindset behind the legislation is that it encourages people to be self-sufficient and not to rely on the government. It was slated to take effect October 15, 2019. However, federal judges blocked it and now it is being re-discussed. Furthermore, there is also discussion from the Executive Branch to make it mandatory for immigrants to show how they will have non-government insurance within 30 days of hitting US soil prior to being approved for their permanent residency (this does not apply to refugees or asylees).

Here at the clinic we may have different opinions on best practices regarding immigration policy. However, I am not here to invoke political discussions. I simply wanted to make you aware because some of our patients may be extra nervous to talk about insurance or even to apply for financial assistance at the hospitals. Marketplace insurance and hospital financial assistance are not included in the public charge expansion. For example, I had a man who I signed up for Marketplace last fall call me on the 15th this month. His wife gets regular iron infusions. He heard about the proposed legislation, didn’t understand it fully, and in a moment of fear that they were jeopardizing their chances of becoming citizens one day, he cancelled their marketplace insurance on October 14th. He then called me the following day to discuss it further, but it was too late. They didn’t have a special enrollment period, so they will have to wait until January 1, 2020 to have coverage again.

Unknowns can enhance anxiety. Hearing mixed messages from the media and trying to sort out rumors from truth can be both frustrating and invoke fear. I just wanted you to be aware of the potential changes and how they could impact the way immigrants access healthcare.