Norma Martinez: Hi sir, how are you? Good morning! Can I share with you information about public charge? Have you heard people talk about the public charge? 

Simon Ostrovsky: Norma Martinez is what’s known as a Volunteer Health Promoter. She’s handing out fliers and explaining to members of this mainly immigrant Latino community in Takoma Park, Maryland that they don’t need to give up their health insurance.

Norma Martinez: When you go apply for a green card, they tell you “Ah, you are a public charge to the government, I will deny it, I will not give it to you.” Well, this is the strategy that the new administration is using. It hopes to terrify us.

Simon Ostrovsky: In 2018 the Trump Administration announced plans to expand regulations governing whether immigrants receiving government benefits are eligible for permanent residency. The new rule which came into force in February involves what’s known as “public charge,” and expands the list of government assistance that will count against a permanent residency application. Formerly, only those receiving cash from the government were affected. But now, benefits like medicaid are also taken into consideration. The more forms of assistance an applicant receives, the worse their chances of getting a green card. The changes have been spreading fear in immigrant communities nationwide, causing one in seven to avoid public benefit programs, according to the Urban Institute. Many immigrants in the country legally, including those who aren't applying for residency and are not affected, have taken the public charge rule to mean that receiving any type of government assistance could get them deported.

Woman:  Well according to what they say on the news, if you are labeled a public charge you have to leave this country if you do not work, if you receive state benefits for housing or food stamps.

Simon Ostrovsky: Experts warn that the growing number of uninsured people in America -- which is part of a larger trend affecting all demographics, not just non-citizens -- is especially worrying at a time of increased concern over a viral pandemic.

Simon Ostrovsky: Public charge is definitely a big issue that shoppers here are concerned about right now because they’re worried it’s going to affect their immigration status but you can tell from the content of people’s shopping carts that the other thing they’re worried about is the spread of coronavirus and its at a time like this that health professionals say it's important for as many people as possible to have medical insurance and coverage.

Michelle Larue: We’ve been seeing a decrease in volume of people looking to renew or enroll in Medicaid. We have seen it, local departments of social services have seen a decline.  

Simon Ostrovsky: Michelle Larue is a medical doctor and senior manager for Health and Human Services at Casa De Maryland, an immigrant advocacy and assistance organization.

Michelle larue: The biggest change is really the fear and confusion that it is perpetrating in immigrant communities. I think right now in the environment that we’re living in with this pandemic, we don’t want people that are fully eligible for health insurance to go without health insurance. Especially young children. You know right now in this context we need everyone to have access to healthcare in case they need it.

Simon Ostrovsky: Larue says many eligible medicaid recipients are cancelling their plans simply out of an abundance of caution but the new rules affecting immigrants and the fear they are generating are only one piece of America’s health insurance puzzle.

Donald Trump: Repeal and replace the disaster known as Obamacare. 

Simon Ostrovsky: During the 2016 presidential campaign Donald Trump repeatedly promised to repeal and replace the Affordable Care Act and as president-elect he went a step further saying he’d make sure all Americans had health insurance. 

Simon Ostrovsky: That meant he’d have to better the ACAs record. 

Aviva Aron-dine: As a result of the Affordable Care Act which was enacted in 2010, 20 million people gained health coverage, which took the uninsured rate to the lowest it's ever been in the entirety of US history. 

Simon Ostrovsky: Aviva Aron-Dine is a former Obama Administration health care official and Vice President for Health Policy at the Center on Budget and Policy Priorities, a progressive think tank in Washington DC.  

Aviva Aron-Dine: Since president Trump took office in 2016 1 to 2 million people have lost coverage eroding about 10 percent of those gains. And then there’s a risk that all of those gains could be lost if the administration gets its way in court or in congress and undoes the rest of the law. 

Simon Ostrovsky: The figures Aron-Dine cites come from the U.S. Census Bureau.

Video: Between 2017 and 2018 the uninsured rate increased 0.5 percentage points and the number of uninsured people increased by 1.9 million. 

Simon Ostrovsky: According to the Census Bureau, this represents the first increase in the uninsured rate since 2009. Aron-Dine worries that the fear of high medical costs could potentially discourage people exhibiting early symptoms of Covid-19 from seeking medical attention in a timely fashion.

Aviva Aron-Dine: Well if you think about the fear that I think all of us are feeling as we face this unprecedented public health crisis, imagine that being compounded by worrying that you can't go to the doctor, that if you do go to the doctor, it could mean medical debt that would compromise your future. One of the things a public health crisis drives home is that all of us are better off when everybody can get the coverage and care they need. All of us are at risk when people are afraid to seek care.

Simon Ostrovsky: So why is the national uninsured rate going up? 

Sarah Miller: I certainly think that the decisions that the White House has made haven’t helped at all, but some of these trends are ongoing and existed before Trump and so certainly you can’t say increasing healthcare costs are just because of the Trump administration.

Simon Ostrovsky: Sarah Miller is a researcher at the University of Michigan’s Ross School of Business, who tracks trends in healthcare.

Sarah Miller: First of all there was the repeal of the individual mandate, so there used to be laws in place that you had to purchase insurance, now those have essentially been removed. People hear that the mandate was repealed maybe they weren’t sure if that meant that other aspects of the law were repealed. Maybe they weren’t aware that they could still get marketplace coverage. And then I think on the employer side, the cost of insurance has been going up, as the costs go up, you know, it becomes more unaffordable to more people and that can also discourage people from taking up coverage. 

Simon Ostrovsky: Maria Brodskaya is a recording artist and music producer who came to the United States from Russia seven years ago on a so-called “extraordinary ability” visa to further her musical career. Like many applicants for permanent residency she gave up her medical plan, most of which was subsidized under the provisions of the ACA, when the Trump Administration announced plans for its new rules. 

Maria Brodskaya: The moment when the Public Charge rule came out I was in the process of working on my green card and of course we didn't have any other option except for just to get off, to show that you are not using it anymore and hoping that they’re not going to punish you retroactively. 

Simon Ostrovsky: And so your immigration lawyer said that this was the best course of action?

Maria Brodskaya: Yeah, she said that basically it was the only course of action. Otherwise they would just not even consider me eligible for being permanent resident. If something happens to me I don’t even know where to go and what kind of help I can receive.

Simon Ostrovsky: She’d like to buy a private plan but worries she won’t be able to afford one now that all of her performances are being cancelled as a result of social distancing measures that people around the country are now facing.

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