2021

How immigration policies can harm health: Study sheds light on ‘public charge’ rule


Dr. Ninez Ponce releases new data on the impact of the “public charge” rule that made it harder for immigrants to obtain legal residency.

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Immigration policies like the Trump-era expansion of the “public charge” rule that made it harder for immigrants on public assistance to obtain legal residency can have a chilling effect on the health and well-being of immigrant communities in California, according to a new study by the UCLA Fielding School of Public Health's UCLA Center for Health Policy Research, led by Dr. Ninez Ponce, Fielding School professor of health policy and management.

The study, based on data from the center’s 2019 California Health Interview Survey, shows that 1 in 4 low-income immigrant adults in the state have avoided accessing public assistance like health, food or housing programs at some point for fear of jeopardizing their own or a family member’s immigration status. More than half of them indicated they had shunned these programs in the time between the Trump administration’s proposed rule changes in 2018 and their implementation in 2020.

The new public charge legislation penalized immigrants who rely on Medicaid, food stamps or housing vouchers — even for short periods — by decreasing their chances of getting a “green card,” or lawful permanent residency.

Immigrants’ avoidance of these public programs was linked to worse access to health care and higher food insecurity, the researchers say. They found that among California immigrants who had reported avoiding programs over the past year, 37% were uninsured and 54% were food insecure, compared with 16% and 36% of immigrants who didn’t avoid them.  

In addition, those who had avoided public programs in the past year were twice as likely as those who hadn’t to report delays in receiving needed medical care and prescription medication, as well as not receiving mental health treatment — all of which suggest negative health outcomes for this group.

Surprisingly, the authors also found that the proposed public charge changes seemed to have an adverse impact on immigrants who weren’t even subject to the rule. More than one-quarter, 27%, of those who were already lawful permanent residents reported avoiding public assistance programs.

“Policies that sow fear and confusion around immigration status contribute to the avoidance of public programs, which can have serious implications for health and well-being,” said Dr. Susan Babey, a senior research scientist at the center and the study’s lead author. “Programs like Medi-Cal and CalFresh, for food assistance, serve as a crucial safety net for California families, and inclusive policies that provide access to public programs could help protect the health of Californians, particularly during a pandemic.” 

While in February 2021 President Biden called for an immediate review of the public charge rule and the Supreme Court agreed to take up a case challenging the legislation, the researchers noted that complex and sometimes confusing immigration policies have long prevented eligible immigrants from seeking public assistance.

Although this is true for many segments of the immigrant community, avoidance was found to be particularly high among noncitizens who are not permanent residents (42%), those between the ages 18 and 34 (34%), Latinos (30%), those who are married with children and single with children (36% and 32%) and those who do not speak English well (29%).

The study data adds to the evidence of how the public charge rule, in particular, had a negative impact on immigrant communities and forced individuals to make tough choices about their health and well-being — choices made even more difficult by widespread uncertainty about which public assistance programs were included, who the rule applied to and how it might affect citizenship applications.

“The findings suggest the crucial need to provide accurate and easy-to-understand information about immigration rules and the impact they may have on public health,” said Ponce, director of the center and a co-author of the study.

The authors say that information campaigns led by legal and advocacy organizations, with resources available in various languages, can help immigrants overcome misinformation and confusion related to immigration policies. They also recommend avoiding policies — and reversing existing policies — that negatively impact participation in health and food programs that serve as important safety nets for Californians.

“California is home to over 10 million immigrants and about a quarter of the immigrant population in the U.S., more than any other state in the nation,” Ponce said. “The COVID-19 pandemic, fraught with catastrophic life events and economic loss, further amplifies the need to preserve vital services for all residents.”

by Elaiza Torralba


The UCLA Fielding School of Public Health, founded in 1961, is dedicated to enhancing the public's health by conducting innovative research, training future leaders and health professionals from diverse backgrounds, translating research into policy and practice, and serving our local communities and the communities of the nation and the world. The school has 631 students from 26 nations engaged in carrying out the vision of building healthy futures in greater Los Angeles, California, the nation and the world.

Faculty Referenced by this Article

Dr. Ninez Ponce
Ninez Ponce
Health Policy and Management
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Dr. Dylan Roby
Dylan Roby
Health Policy and Management
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Jean Balgrosky
Health Policy and Management
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Sangeeta Ahluwalia
Sangeeta Ahluwalia
Health Policy and Management
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Dr. Daniel Eisenberg
Daniel Eisenberg
Health Policy and Management
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Roshan Bastani
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Brennan Spiegel
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Lillian Gelberg
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Dr. Joann Elmore
Joann G. Elmore
Health Policy and Management
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Kadiyala, Srikanth
Srikanth Kadiyala
Health Policy and Management
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Dr. Yvonne Flores
Yvonne Flores
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Warren Scott Comulada
Warren Scott Comulada
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Neal Halfon
Health Policy and Management
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Freund, Deborah
Deborah Anne Freund
Health Policy and Management
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Dr. Kenneth Wells
Kenneth Wells
Health Policy and Management
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Comanor, Bill
William Comanor
Health Policy and Management
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Julie A. Elginer

EMPH Academic Program Director with expertise in healthcare marketing, finance, and reproductive health policy, teaching in the EMPH, MPH, MHA program

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Jose J. Escarce
Health Policy and Management
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Ron Andersen

Dr. Ron Andersen is the Wasserman Professor Emeritus in the UCLA Departments of Health Policy and Management.

Health Policy and Management
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Dr. Jonathan Fielding
Jonathan Fielding
Health Policy and Management
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Lori Pelliccioni
Health Policy and Management
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Robert Brook
Health Policy and Management
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Alan Tomines
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Carol Mangione
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Elizabeth (Becky) Yano
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Xi Zhu
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Risha Gidwani
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Emily Abel
Emily Abel
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Ron D. Hays
Ron D. Hays

@UCLA since 1997

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Dr. Stephanie Taylor
Stephanie L. Taylor

Nationally recognized health services researcher and sociomedical scientist with 25+ years' experience in effectiveness and implementation research.

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Thomas Priselac
Health Policy and Management
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Vickie Mays
Vickie Mays
Health Policy and Management
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Ty Robbins
Health Policy and Management
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Steven Teutsch
Health Policy and Management
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Yusuke Tsugawa
Yusuke Tsugawa
Health Policy and Management
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Dr. Alice Kuo
Alice Kuo
Health Policy and Management
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Gerald Kominski
Gerald Kominski
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Avram Kaplan
Avram Kaplan
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Samuel Sessions
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Arlene Fink
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Dr. Thomas Rice
Thomas Rice
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Susan Ettner
Health Policy and Management
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James Macinko
James Macinko

Professor of Community Health Sciences & Health Policy and Management, and Associate Dean for Research

Community Health Sciences Health Policy and Management
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Clifford Ko
Clifford Ko
Health Policy and Management
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Patricia Ganz
Patricia Ganz
Health Policy and Management
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Dr. Felicia Hodge
Felicia Hodge
Health Policy and Management
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Dr. Paul Fu, Jr.
Paul Fu, Jr.
Health Policy and Management
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Dr. William McCarthy
William J. McCarthy
Health Policy and Management
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Jody Heymann
Jody Heymann
Epidemiology Health Policy and Management
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Isomi Miake-Lye
Isomi Miake-Lye
Health Policy and Management
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Barbara Berman
Health Policy and Management
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Galper, Michael
Michael Galper
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Jack Needleman
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Kristen Choi
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Robert Kaplan
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Leah Vriesman
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Michael Ong
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Olivia Jung
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Jennifer Wortham
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Moira Inkelas
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Nadereh Pourat
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Thomas D. Gordon
Health Policy and Management
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Burt Cowgill
Burt Cowgill
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Pamela Davidson
Health Policy and Management
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Paul Chung
Paul Chung
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Z. John Lu
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Dr. Anthony Schiff
Anthony Hunter Schiff
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Linda Rosenstock
Environmental Health Sciences Health Policy and Management
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David Hayes-Bautista
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Corrina Moucheraud
Corrina Moucheraud
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Dr. Frederick Zimmerman
Frederick Zimmerman
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Aronberg, Sandra
Sandra Aronberg
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Dr. Arturo Vargas Bustamante
Arturo Vargas Bustamante
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Mark Litwin
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Laura Erskine
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Aria Fallah
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Emmeline Chuang
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Jeanne Miranda
Jeanne Miranda
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Diana Hilberman
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Dr. Beth Glenn
Beth Glenn
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Michelle Keller
Michelle S. Keller

Dr. Michelle S. Keller is a health services researcher whose research focuses on the use and prescribing of high-risk medications.

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Annette Maxwell
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