President Donald Trump (Photo by Gage Skidmore via Flickr Commons)
In mid-August, Democratic attorneys general including Pennsylvania’s Josh Shapiro announced they were suing the Trump administration over proposed changes to what’s known as the “public charge rule.”
Since the 19th century, the U.S. has evaluated immigrants to see if they are likely to become dependent on the government for subsistence.
That rule has evolved. Currently, it applies to people seeking a visa or green card, and allows immigration officials to consider a person’s use of state or federal cash assistance, including Temporary Assistance for Needy Families and Supplemental Security Income.
The U.S. Department of Health & Human Services finalized a regulation on Aug. 14 that would expand the rule to include use of food stamps, housing assistance, or Medicaid as determining factors. It’s set to go into effect this fall, but is being challenged by multiple lawsuits.
This isn’t the only way the Trump administration’s regulatory actions are touching health and human services here in Pennsylvania. Below, we dig into how this process works.
How rule-making works
President Donald Trump and his top officials’ use of rule-making to further their priorities is not unique to this administration.
Agencies are empowered by Congress to issue regulations. They first issue a proposed rule in the Federal Register, which the public is invited to comment on for between 30 and 60 days, sometimes longer.
After the comment period closes, the agency must then go through the submissions before it drafts a final rule.
“To move forward with a final rule, the agency must conclude that its proposed solution will help accomplish the goals or solve the problems identified,” according to a Federal Register explainer. “It must also consider whether alternate solutions would be more effective or cost less.”
There’s no timeline for an agency to publish a final rule, which contains the language that’s actually instituted.
“When an agency publishes a final rule, generally the rule is effective no less than thirty days after the date of publication in the Federal Register,” according to the explainer. “If the agency wants to make the rule effective sooner, it must cite ‘good cause”’ (persuasive reasons) as to why this is in the public interest. Significant rules … and major rules are required to have a 60 day delayed effective date.”
The public charge rule met the latter definition and is set to go into effect on Oct. 15, barring successful legal challenges.
The ‘public charge rule’
Ken Cuccinelli, acting head of Citizenship and Immigration Services, told NPR the public charge rule change promotes self-sufficiency.
Both Shapiro and Gov. Tom Wolf, as well as advocates for immigrants, believe it will discourage immigrants from accessing services they need.
“While this rule does not apply to all government benefits or all immigrants, it is undeniable that this is a scare tactic intended to deter immigration to our country and put up additional barriers for immigrants to access family-sustaining benefits,” Shapiro said in a statement.
In a press release, Wolf’s administration argued “the rule change could have a direct, negative effect on the more than 837,000 immigrants across Pennsylvania, including children, the elderly, and people with significant medical needs.”
According to a spokesperson for the state Department of Human Services, “there are 120,770 immigrants with legal status in Pennsylvania who are eligible for and receiving Medicaid benefits in June 2019. Of those 120,770 people, 9,113 are legal residents awaiting green cards.”
“There are 50,416 legal immigrants who receive SNAP benefits in Pennsylvania,” the spokesperson added.
Sundrop Carter, executive director of the Pennsylvania Immigration and Citizenship Coalition, told the Capital-Star “this rule is just very clearly part of an agenda this administration has to attack immigrants and communities and limit the definition of who gets to come to this country and become quote ‘a real American.'”
Since rule language leaked in 2017, Carter said immigration activists nationwide have mobilized to do community education and to ask congressional lawmakers to prevent implementation. Even the proposed language had a “chilling effect,” she said: Working families with members who are seeking green cards aren’t seeking out public benefits out of fear.
“They don’t want to jeopardize that,” she said.
Another final rule advanced by the Trump administration in August seeks to undo a 1997 legal settlement that guaranteed certain standards for family detention centers and established a 20-day limit on the detention of children.
Planned Parenthood announced this week it was withdrawing from the federal family planning program Title X.
Title X is “designed to provide contraceptive supplies and information to all who want and need them, with priority given to persons from low-income families,” according the Health & Human Services department. Health care providers are eligible for federal reimbursements when they provide contraception and services like STI testing to this population.
Earlier this year, the department issued a final rule to prohibit funding recipients from providing abortions, referrals, or information about the procedure. Planned Parenthood, which formerly served 40 percent of all Title X patients nationwide, described the change as a “gag rule” aimed specifically at the organization.
Planned Parenthood and the American Medical Association are suing the Trump administration in federal court over the rule.
The health care provider planned to stay in the Title X program until a final court determination was made. But on Aug. 19, Planned Parenthood announced it was withdrawing after a court temporarily allowed the rule to go into effect.
According to Planned Parenthood Pennsylvania Advocates, 65,000 of the more than 169,000 patients who fall under Title X go to its commonwealth clinics — 38 percent. Planned Parenthood of Western Pennsylvania said it stands to lose $400,000 a year, Pittsburgh City Paper reported.
Statewide, losses are expected to total $2 million, a spokesperson said. Planned Parenthood as a whole will forgo $60 million.
“It will hurt patients the most, especially those who already face systemic issues in accessing health care such as people with low incomes, people of color, and people in rural areas,” spokesperson Laura Weis said.
Food stamps and Medicaid
The Trump administration is also attempting to alter who is eligible for food stamps, formally known as the Supplemental Nutrition Assistance Program, and Medicaid in at least three ways.
One involves curtailing something called broad-based categorical eligibility, which makes certain families automatically eligible for food stamps if they use a non-cash service funded by Temporary Assistance for Needy Families including childcare.
Experts say this rule change would affect working families on a bubble — making more money than they used to, but still not enough to make up for the loss of SNAP.
During a July press call, state Department of Human Services Secretary Teresa Miller pushed back on the idea that the eligibility standards are a loophole, as the Trump administration has claimed.
“It is a commonsense mechanism through which the federal government has allowed states flexibility to determine appropriate income threshold,” she said. “This flexibility is important because the cost of living can be so significantly different from one state to another.”
The state Human Services department has estimated that 200,000 adults and children could be affected by this change.
The Trump administration is also expanding, or attempting to expand, work requirements for both public assistance programs through executive action.
At the moment, so-called “able-bodied” adults who receive food stamps and don’t care for children are subject to federal work requirements. States can request waivers from the U.S. Department of Agriculture for areas with high unemployment or a lack of jobs.
States may group counties that share a border together into one area, which is how Pennsylvania has exempted 63 counties from the rule.
A rule change proposed in February would curtail that practice by limiting the grouping of municipalities.
A final rule has not been submitted by the USDA. A federal official wrote in a letter to Pennsylvania’s Human Services department last December that they expected the rule to be in place by October.
These waivers have been subject to numerous lawsuits, including in Arkansas — the first state to implement these requirements.
Arkansas’ program, blocked by a federal judge this spring, was studied by Harvard researchers, who found it did remove people from the rolls but did not have a meaningful effect on employment.
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