The administration’s proposed policies instead insist on personal responsibility.
Entry into the United States by individuals “liable to be a public charge” was first restricted in 1882, and such restriction has repeatedly been reaffirmed as a principle of U.S. immigration law, most recently by the welfare-reform legislation of 1996. Yet, until recent reforms proposed by the Trump administration, health-insurance coverage has not been included in such determinations. That may have made sense in earlier decades, when health-care entitlements were small. But, as health care in 2018 accounted for 64 percent of federal spending on means-tested benefits, this omission looks increasingly outdated.
The proposed public-charge rule, which is currently blocked by a federal judge, has been supplemented by a proclamation that would deny immigrant visas to those who lack insurance coverage or other means to cover medical costs after becoming permanent residents. The administration’s proposals focus primarily on those seeking immigration on the basis of family ties and do not affect immigration by refugees, college students, or immigrants already in the country.
The Clinton, Bush, and Obama administrations had interpreted the public-charge rule as referring narrowly to cash benefits — specifically, to whether immigrants would rely on the government for more than half their income. However, it is hard to justify ignoring health-care benefits, particularly in the aftermath of the Affordable Care Act. In 2008, the federal government spent $225 billion on means-tested health-care programs — a number that the Congressional Budget Office estimates will increase to $813 billion in 2028 under current law, even if no additional spending commitments are made.
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