The 'Public Charge' Rule

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Arifeen Rahman says a proposed Trump Administration rule will deny needed care to lawful immigrants who are entitled to it.

“Will it affect my immigration status?” a patient I will call “Li” asked me at our Stanford Student Free Clinic. She was a lawful resident of Santa Clara County and I asked if she was interested in applying for health insurance.

My instinct was to say I don’t think so, but I stopped myself. “I don’t know,” I admitted.

This conversation with Li happened in July 2018. On October 10, the Trump administration released a proposal to change the public charge rule for immigrants, penalizing those who use federal assistance for food and health insurance in the green card approval process. Many have argued that if implemented, this would cause devastating effects.

I believe that the damage is already done and a chilling effect is already in place.


As the manager of a free clinic in San Jose, I see a large immigrant population. In July, we started screening our patients for social needs like food insecurity and prescription assistance. It was how I ended up at a loss at how to answer Li’s question not only because of my limited legal knowledge, but also because of the anti-immigrant rhetoric that has created a culture of fear.

That fear has created a chilling effect. For the first time in 10 years, food stamp or (SNAP) participation declined among immigrant families in the first half of 2018. A California study estimates that up to 628,000 children in California may lose health insurance and 311,000 may lose SNAP benefits if the new public charge rule comes into effect.

At the end of our visit, I asked Li if she wanted to talk to community partners specializing in immigration about health insurance. At the time, I had no idea that the new public charge rule would be proposed in 3 months.

She refused.

The 60 day public comment period for the rule is now closed and waiting review. Yet even if the new rule does not come into effect, the damage may already be done. Families may go without food or health care because of the fear in today’s political climate for immigrants.

With a Perspective, I’m Arifeen Rahman.

Arifeen Rahman is a second year medical student at the Stanford School of Medicine and a manager of the Cardinal Free Clinics.