A PRESIDENTIAL PROCLAMATION by President Trump requiring future green card applicants to show they can afford health care is leaving Massachusetts critics and medical experts skeptical about the nuances of the policy, and the basic facts surrounding it.
On Friday night, the White House announced that immigrants applying for visas starting November 3 would have to show they have health insurance within 30 days of entering the country or the financial capacity to pay for their own health care. Otherwise, the immigrants will be barred from entering.
The proclamation would not impact lawful permanent residents, but it would apply to their spouse, children, and parents, who immigrants often try to bring to the United States.
The concern, the White House wrote, is that health care providers and taxpayers bear substantial costs in paying for medical expenses “incurred by people who lack health insurance or the ability to pay for their healthcare.” The proclamation pointed to unreimbursed services that hospitals give their patients that exceeded $35 billion in each of the last 10 years.
“Immigrants who enter this country should not further saddle our health care system, and subsequently American taxpayers, with higher costs,” Trump said in his proclamation.
It is not clear if Trump’s numbers on unreimbursed services are directly related to immigrants who cannot pay for health care, or a general calculation lumping in citizens who are not insured and cannot afford care but are accessing it.
Several studies by Massachusetts researchers indicate Trump’s allegation of immigrant burden is not the case, and that in fact, most noncitizens are not a drain on the health care system, and contribute significantly to it.
A report from 2014 indicated that immigrants contribute more to Medicare than receive health benefits.
A 2018 study based on the federal government’s own population data found that immigrants accounted for 12.6 percent of premiums paid to private insurers but were only 9.1 percent of insurer expenditures. Their annual premiums exceeded their care expenditures by $1,123 per enrollee, which offsets a deficit of $163 per US-born enrollee.
“US individuals drain on a system subsidized by immigrants — it’s exactly the opposite of the argument used in the proclamation,” said Leah Zallman, lead author of the report and assistant professor of medicine at Harvard Medical School.
According to 2017 US Census Bureau information, 58 percent of noncitizens in Massachusetts had private insurance, 35 percent were on public insurance, and 7 percent had no insurance at all.
Nationwide, the numbers are 57 percent of noncitizens privately insured, 30 percent with public insurance, and 13 percent not insured.
The new requirement will impact at least hundreds of Massachusetts green card holders who wish for their family members to come to the United States, according to Mahsa Khanbabai, New England chair of the American Immigration Lawyers Association. There is also little clarity over how consular officers abroad will execute the new Trump policy, Khanbabai said.
“What kind of guidance or instructions will be provided to these consular officers? How will they determine financial ability? Will the person need to have documents to have insurance within 30 days? It’s too vague,” Khanbabai said.
The proclamation goes beyond a rule called “public charge” that goes into effect later this month that will require many of the same applicants to show they won’t become reliant on public benefits, including Medicaid, upon arrival.
The rule will require enrollment in private insurance for those without the financial means to cover their own expenses. The rule does not apply to those granted asylum or refugees.
The State Department did not respond to a request for comment over what the monetary threshold is for meeting the standard to pay for foreseeable medical costs.
One thing that is known is that subsidized plans bought through the Affordable Care Act, which can cost hundreds of dollars through insurance exchanges, won’t count as a valid form of insurance. Most low-income immigrants with legal status aren’t allowed to access Medicaid for many years, but are allowed to receive premium subsidies, which would now not be allowed for those applying for green cards.
It’s a Catch-22, argues health law professor Wendy Parmet of Northeastern University. “The reason why immigrants are less likely to be [publicly] insured is because they’re less likely to be eligible for health insurance programs. Congress and states have decided not to provide coverage. They’re uninsured because of public policies.”
While the State Department and Citizenship and Immigration Services do not break up visa applicants by state, national data shows that in 2018, the US issued 534,000 visas, and on average issues 1.1 million green cards a year, often to people who applied up to a decade before.