The Trump administration has proposed a new regulation that would block immigrant families from having a permanent, secure future in the United States. Under the new public charge rule, immigrants who legally access health care, safe housing and healthy food programs could be denied admission to the country or refused a green card. The proposed rule also makes clear that earning low wages, having children, or dealing with a medical condition could be held against immigrants seeking a permanent future in America. Paige Cunningham of the Washington Post has more:
The way things stand right now, immigration officials consider whether an applicant received federal, state and local welfare assistance in making a public charge determination. But under the proposed rule, whether an immigrant enrolled in Medicaid, collected food stamps or participated in public-housing programs would also become factors for the first time — and they’d be weighted heavily in the determination of whether to award legal status. And that could discourage legal immigrants from availing themselves of government help for which they’re eligible, for fear it could jeopardize their prospects of staying in the United States for the long term.“This public charge proposal is presenting immigrant families with an impossible and truly unfair dilemma, which is to keep their families healthy and utilize bread-and-butter services or risk being separated and forego vital services,” Julie Linton, a pediatrician practicing in North Carolina who co-chairs the American Academy of Pediatrics Immigrant Health Special Interest Group, told me.
This proposed rule could force some immigrant families to choose between a green card or their health. Douglas Jacobs, a Harvard internal medicine resident at Brigham and Women’s Hospital writes in an opinion piece in the New York Times:
If the proposed rule is adopted, programs that are crucial for my patients’ health, including Medicaid, the Supplemental Nutrition Assistance Program (once known as food stamps), housing assistance and Medicare Part D (the prescription drug benefit), would all count toward the designation of a public charge. Accordingly, my pregnant patient from Cameroon may have to decide whether becoming a permanent resident is more important than providing her unborn child with the nutrients required to live a long life. My patient from the Dominican Republic may have to decide whether becoming a permanent resident is more important than taking the medication that will strengthen her bones and prevent a hip fracture. Even if my patient from Ecuador decides the unthinkable, forgoing Medicaid and chemotherapy to let his cancer slowly consume his body, the federal government could identify his cancer as a reason for denying him legal permanent resident status. This is because health conditions, in and of themselves, would also become heavily weighted factors in a public charge designation under this rule.
The rule is not final yet. The government is required to read and respond to every unique comment before issuing a final rule. You can submit comments on the proposal here.
Louisiana ranks low on infrastructure
Inadequate infrastructure spending has been a major problem for the United States. A new index by 24/7 Wallstreet examined road conditions, bridge deficiencies, dams at high hazard risk and state highway spending by state. The index ranked Louisiana 13th in the worst conditions for infrastructure. Samuel Stebbins of 24/7 Wallstreet, writing in the Daily Advertiser, looks at the issue of infrastructure and and where Louisiana ranks.
About seven out of every 100 miles of roadway nationwide are in poor condition; 9 percent of bridges nationwide are structurally deficient, meaning that they are in need of some repair; and 17 percent of dams in the country have a high hazard potential — meaning a functional failure would result in the loss of life. For many, the notion of crumbling infrastructure conjures images of a bridge collapsing during rush hour, or a speeding passenger train hurtling off a faulty track. While such tragedies occur on occasion, they are relatively rare. Most people are affected by aging infrastructure on a daily basis in a number of more subtle ways including traffic congestion, public transportation delays, and vehicle damage. Kristina Swallow, 2018 president of the American Society of Civil Engineers, explained the extent to which poor infrastructure affects our lives. “It’s hurting our economy, it’s hurting our communities’ ability to grow, it’s hurting our quality of life, and in some cases, there are public safety concerns,” Swallow said. “Our infrastructure is not meeting our needs.”
Film tax credits making a comeback
Louisiana has some tax credits that result in major business giveaways and leave Louisiana facing some serious issues with revenue. A recent audit by the Legislative Auditor examined the return on investment of a variety of state tax credits. The question that lingers is if the program is worth the small investment back on the state. Tim Morris in Nola.com| Times- Picayune has more:
The question is not whether we are losing this war, but whether we should be in it at all. You may recall that an economic-impact study conducted last year for the Louisiana Department of Economic Development found that the state had given film producers $282.6 million in tax credits in 2016 while economic activity from the movies made in-state generated only $63.2 million in state taxes. That’s 22 cents in taxes for every state dollar invested in the program. The study concluded that the film industry had created 14,194 direct and indirect jobs in 2016, a decent number and relatively high-paying, but still subsidized to some degree by the tax credit. Revenue Secretary Kimberly Robinson, who accompanied Edwards on his California trip, told reporters that the state expects to release a new economic-impact analysis of the film program next spring that will be more positive in light of changes made to the program in 2017. Robinson said she expects it will show that each $1 in incentives generates $5 in “economic activity” in the state. A positive review of film tax credits would be an outlier, by the way, as almost every independent study shows it to be a loser for taxpayers.
Skimpy insurance plans are junk
The U.S. Senate deadlocked in a vote to overturn President Donald Trump’s expansion of junk insurance plans that can deny coverage to people with pre-existing conditions. These plans are cheap for a reason – they have no consumer protection requirements. They have no requirement to cover prescription drugs, maternity care and hospitalization. This will reduce access to coverage while increasing the cost. Sarah Lueck of the Center on Budget and Policy Priorities has more on these plans :
Yet short-term plans are exempt from standards for individual health insurance, including protections under the Affordable Care Act (ACA). Short-term plans can deny coverage or charge higher prices to people with pre-existing conditions, and they typically don’t cover medical services related to pre-existing conditions. Also, they don’t have to cover the ACA’s essential health benefits, and they often don’t cover such essential benefits as maternity and mental health care, substance use disorder treatment, and prescription drugs. By providing fewer benefits and covering a less costly population, short-term plans lure this less costly population away from the individual insurance market and leave a costlier group behind — thereby raising premiums for people who need comprehensive coverage. Companies selling short-term health plans are poised to intensively market the substandard coverage during the six-week open enrollment period for ACA plans, which begins November 1. Short-term plans, however, are available all year
*Note* LBP is collecting stories about the impact of Medicaid and Medicaid expansion on Louisianans’ access to health care services. If you have a personal story to share, or if you work with Medicaid patients who would like to share their story, please reach out to Caroline Gilchrist via email at firstname.lastname@example.org or by phone at 225-573-9996.
Number of the day
15.1 percent – The amount of households in New Orleans making less than $10,000 annually, while 9.1 percent of households earn $150,000 and more. (Source: Bloomberg)