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If one of our patients withheld food or medication from her child, we would report her for child abuse. But come Oct. 15, when the Trump administration’s new public charge immigration rule goes into effect, we’ll have to rethink that strategy.

The public charge rule refers to a term used in immigration law to identify an individual who is primarily dependent on the government for support. The Trump administration has broadened the definition of what can be taken into account when denying green cards to include immigrants who use one or more of three government programs: Supplemental Nutrition Assistance Program (SNAP, also known as food stamps), some federal housing subsidizes, and adult Medicaid.


Although the new rule would, in theory, not penalize Medicaid enrollment by individuals who are pregnant, have given birth within the past 60 days, or are under age 22, fear and confusion are causing many immigrant families to disenroll from these governmental assistance programs.

Redefining the public charge rule aims to punish immigrant parents — including those who have entered the U.S. legally — by punishing their children, most of whom were born in the United States and so are U.S. citizens. For the first time, it takes prior use of health, nutrition, and housing benefits into consideration when determining if an immigrant can get a green card. It forces low-income families that are legally eligible for food stamps and Medicaid to decide whether or not to enroll in these vital benefit programs, knowing that if they do they risk being deported back to countries where violence or hunger await them.

The rule’s more than 200 pages of byzantine language are designed to create fear and confusion among immigrants, prompting parents to forgo benefits for their families. The public charge proposal “presents immigrant families with an impossible choice: keep yourself or your children healthy but risk being separated, or forgo vital services like preventive care and food assistance so your family can remain together in this country,” said Dr. Colleen Kraft, president of the American Academy of Pediatrics, in a statement.


Child abuse occurs when a child suffers serious harm due to the actions, or failure of action, of those entrusted with her or his care. The government is the ultimate caregiver, vested with the duty to ensure the safety of America’s children. So by that definition, under the public charge rule the Trump administration is abusing children. By forcing families to give up access to nutrition and health care, the government has rewritten its role from protector to perpetrator.

According to research that we published with several colleagues in JAMA Pediatrics, the Trump administration has chosen to jeopardize the health and well-being of children in immigrant families, most of whom are legal citizens of the United States. Even though the children of immigrants are, on average, slightly healthier than other children, two-thirds of the 8 million children in immigrant families have or will have medical needs for routine immunizations and require doctors’ visits for serious illnesses like asthma, diabetes, and epilepsy. The families of up to 2 million of these children are expected to pull out of these benefit programs and are thus likely to go without care and adequate food.

Let us be perfectly clear: Some of the children who will go without adequate food and medical care will suffer permanent injury and even die. A toddler without medications for asthma will find herself unable to breathe because her airways will close, denying her organs the oxygen they need to survive. A child with diabetes whose family cannot afford enough insulin will develop permanent kidney and nerve damage, and can slip into a coma and die. A teenager will go to school with hunger pains, unable to focus on his studies or change the trajectory of poor health and productivity that await him due to this lack of food.

This suffering is completely preventable with routine medical care available across the country and the food stamps that people are legally eligible to use.

Some of our patients have been asking if they should disenroll from Medicaid, SNAP, and housing assistance. When we ask how they will feed their children or get the care their families need without the benefits, they share that they aren’t sure. But, they say, returning their families to the violence and hunger that awaits them in the countries of their birth is worse, so for now they will forgo public assistance to steer clear from getting caught by the public charge rule.

Many of those who already have green cards aren’t sure that taking part in these program is worth the risk, even after we explain that the public charge rule does not apply to them. As mothers ourselves, and knowing the fierce drive to protect our children at all costs, we find ourselves at a loss of words.

If physicians like us can report parents who withhold food or medicine or housing from their children for committing child abuse, we should be able to charge the Trump administration with the same thing and use that leverage to overturn the new public charge rule.

Leah Zallman, M.D., is a primary care physician at Cambridge Health Alliance in Cambridge, Mass., the director of research at the Institute for Community Health in Malden, Mass., and an assistant professor of medicine at Harvard Medical School in Boston. Stephanie Woolhandler, M.D., is professor of health policy at Hunter College, City University of New York, in New York City and a lecturer in medicine at Cambridge Health Alliance and Harvard Medical School.

  • Trump or not, all they have to do is do it the legal way!
    I am without health insurance because I cannot afford it! We need to give our CITIZENS assistance first before giving everyone else a food voucher, insurance, and tax funded incomes.

    • Hello. IMO I do NOT agree with your article! It is OUR jobs as our children’s parents to provide their basic living necessities, NOT our governments jobs, NOT our president’s job, NO one, but ours! You can also look at the facts that our country would be able to afford to help more of our own citizens be able to live better, more productive, more affordable lives and help them provide the same quality to their families if our government was not providing SO MANY resources to SO MANY ILLEGAL immigrants and their families! Our country is SO,SO DEEP in debt, by the billions! We are barely able to help our country’s citizens, yet SO MANY are SO QUICK to down talk our country’s president, politicians, and ANY other U.S. citizen that even tries to disagree with the same way of thinking and believing as the writer of this article! Ex 1: If you went over to ANY of their countries, you were poor and struggling to financially support you and your family , needed help to lead a better quality of life or to provide your family with food and/ or medical necessities, how many of their countries/governments would offer you the equivalent to EVEN ONE U.S. PENNY!!!???? EXACTLY ZERO!!! Yet you are so quick to down our government for not being able to help every single person who walks the earth?? Esp when our country helps so many already?? Ex 2: When we experience any natural or man made or ANY KIND of disaster, what one of their countries/ governments, or even one citizen comes to aid us and give us a hand with repairing and/or rebuilding the city in where it happened or try to send over ANY kind of EVEN BASIC DAILY LIVING ESSENTIALS!? Like food, water, hygiene products, tents for shelter, blankets, clothes, etc. etc. etc. ???? NONE, NOT ONE, that’s who and/ or how many of them! Yet, we ALWAYS try to help ANY and ALL we possibly can, no matter who they are, where they are from, if our 2 country’s have ever been at war, or if our country has EVER been targeted by terrorists from there, etc, etc, etc.. ( NONE OF WHICH I AM COMPLAINING ABOUT BECAUSE AS WE ARE ALL GOD”S CHILDREN and if we can do, WE NEED AND SHOULD DO)! Ex 3: Most other country’s have called us names, look down at us, think and feel VERY low and horrible of us and hated us for NO REASON, EXCEPT just for the fact of us being U.S. citizens, etc… We ARE NOT A RICH COUNTRY! WE MUST MAKE SURE WE CAN HELP OUR OWN CITIZENS FIRST! We have, prob, millions of poor, starving, homeless, raped, tortured, murdered, terrified, abused, neglected, abandoned, robbed, mutilated, molested, etc of our own citizens that we can not, will not, have not helped out as of yet! I say, PLEASE, LET US BE ABLE TO HELP THEM FIRST! Let us guarantee we are taken care of FIRST! Then, once we have succeeded with that, then, BY ALL MEANS WE POSSIBLY CAN, let us help others! Anyway, I just realized how much I have started on a rant and I apologize. I am just SO sick and tired of walking down our own streets and seeing so, SO MANY of our own citizens in SUCH DIRE AND EMERGENT NEED of ALL the things I hear and see, on the news, of our country and/ or U.S. citizens helping and/ or giving to other citizens of other countries and I always find myself asking why we DO NOT make ALL of our own feel safe, protected, warm on cold nights or cool on heat wave nights, or dry on wet nights, and make sure they are ALL clothed, bathed, fed, sheltered, have water, toothpaste, a tooth brush, razor, shampoo, body wash, education, etc… (okay, again, sorry for the ranting and venting) I DO believe in if you lay down and create a life, you should DEF have a plan on how you will feed, clothe, shelter, educate, provide all of their medical needs, etc… I Do NOT believe in packing them up and traveling to a foreign country with them, ESP if it is ILLEGALLY, ESP in a country that is built on being SO ACCEPTING of ALL PEOPLE coming in, LEGALLY! How are we supposed to keep our babies and families safe if we open our boarders and just allow ANY AND EVERY SINGLE PERSON to just walk right on through?? What??, without having ANY kind of procedures to allow for our government and authorities to be able to do their jobs in keeping our country and it’s citizens safe and protected? If we did NOT have these procedures in place, our amazing country and all of us citizens, who are from here and/ or legally reside here now, would most likely have been long gone by now! If they are illegally here, then why should they be allowed to legally receive government programs? A U.S. citizen ,or legal resident of, who is wanted by the authorities, or do some kind of drugs or are an alcoholic, or have a record, or bad credit, etc do NOT qualify for most of those programs for themselves or their families! They should have the opportunity to do so? Even illegally? And when so many of our citizens can not if they do not qualify!?? So, should we just allow any and everyone to receive any one of those programs regardless of who they are, where they are from, what their legal status is, if they committed a crime, are here legally or not, if they are a terrorist or not, if they’re on drugs or not, etc etc etc??? Then, we would not be able to afford to have ANY of those programs any longer and SO MANY would be REALLY suffering!!! It is just a known fact that our government can not afford to offer the programs to every single person in this country! That is why there are qualifications set in place so they can try to make sure that those whom TRULY are in need of them can and will receive them and that they do not run out of funding for the programs by giving to those who do not qualify!

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