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The Trump administration has put forth a rule change for immigration saying that if an immigrant gets one of a number of benefits from the government, it could lead to their being denied legal permanent residency or entry to the US. Will such a rule lead to some immigrant parents disnerolling their families from safety-net programs? How will this affect children? We’ve got data.

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1. The US Border and Family Separation:

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In October of last year, the Trump administration put forth a rule change for immigration. It said that if an immigrant is deemed a public charge, meaning that they got one of a number of benefits in the government, it could lead to there being denied legal permanent residency or entry to the United States.

There's a fear that such a rule might lead to some immigrant parents disenrolling their families from safety net programs, so as not to jeopardize their chances of staying in the U.S., even when the rule might not technically apply.

How might this affect kids? We've got data. This is Healthcare Triage News.


To the research!

JAMA Pediatrics, this week: Implications of Changing Public Charge Immigration Rules for Children Who Need Medical Care.

The point of this study was to simulate how the rule change might affect kids at risk for losing benefits from Medicaid, CHIP, or SNAP (which you think of as food stamps). 

The authors used nationally representative data from the Medical Expenditure Panel Survey to estimate how many kids might be at risk because they live with a non-citizen adult.

The main outcome of interest was the number of kids at risk to lose benefits, but they also estimated the number of kids with medical need who were disable or who had receive specific treatments in the last year.

And, here's what they found: More than 8 million kids who are currently enrolled in Medicaid, CHIP, or SNAP are at risk of disenrollment. 5 and a half million of those kids have specific medical needs. More than 615,000 of them have asthma, more than 53,000 have epilepsy, more than 3,600 have cancer, and more than 580,000 have disabilities.

Based on history, (for instance, how many kids disenrolled when similar stuff was going on after 1996 welfare reform) it's expected that somewhere between .8 million and 1.9 million kids with specific medical needs are likely to be disenrolled. 

Being disenrolled from these benefits would be bad for any kid, but it's especially concerning for those with real medical needs. It's likely to happen. The public rule is still being commented on, and nothing is final, as far as we know.

But, as the government moves to change its citizenship rules, we probably need to consider the all too real downsides. Kids without these benefits will be more likely to go hungry, and to go without needed medical care. I'm not even going to go into secondary or economic loses. It's hard to argue that this is a good thing. We need to be careful when making policy that unintended consequences don't overshadow our goals.


Hey did you like this episode? You might might enjoy this other episode on the U.S. border and family separation.

We'd especially like to thank our research associate, Joe Sevits, and, of course, our surgeon admiral, Sam. And, like them, you can support the show at

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