President Trump issued a presidential proclamation addressing exceeding costs and uncompensated care in the US healthcare system and its relation to low-income immigrants. In his statement, Trump hereby declares a suspension of entry of immigrants who cannot otherwise prove that they can afford healthcare should they be allowed to immigrate to the US.

US healthcare system

The announcement begins with an overview of the underlying issue with the US healthcare system. The US has long faced the challenge of rising health insurance premiums, higher fees for medical services, and higher taxes passed on to the American people. This results from the amount of uncompensated care for individuals who lack health insurance or the ability to pay for their medical services. Trump points to data showing the total uncompensated care costs have exceeded $35 billion in each of the last 10 years, averaging $7 million lost compensation for each US hospital alone. The US government has a long history of leaders characterizing this phenomenon as textbook free-riding—a market failure that occurs when a benefit is obtained at another’s expense. Furthermore, Trump introduces data that shows that lawful immigrants are about three times more likely than US citizens to lack health insurance. He states, “Immigrants who enter this country should not further saddle our healthcare system, and subsequently American taxpayers, with higher costs.”

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US Constitution

By asserting his authority vested by the Constitution and certain sections of the Immigration and Nationality Act, President Trump has hereby proclaimed suspension and limitation on entry of aliens who will financially burden the US healthcare system:

An alien will financially burden the United States healthcare system unless the alien will be covered by approved health insurance within 30 days of the alien’s entry into the United States, or unless the alien possesses the financial resources to pay for reasonably foreseeable medical costs.

This proclamation now requires visa applicants to prove that they will enroll in private health insurance upon arrival or otherwise have sufficient funds to cover future medical expenses. While the executive order does not clearly provide the procedure for determining whether an immigrant meets these requirements, it will be up to the State Department and individual consular officers when evaluating if this standard has been met.

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Medicaid Program

A major aspect of this requirement to give high attention to is that under the executive’s new policy, purchasing health insurance using subsidies such as on the Affordable Care Act/Medicaid program do not count as an eligible form of insurance to meet the burden. This rule creates a “Catch-22” dilemma for low-income immigrants because although they’re eligible for subsidized health covered through the program, applying for the health coverage means they cannot legally be in the country. The Administration describes this as an additional step to safeguard the healthcare system from free-riding.

The new policy will apply to thousands of people seeking to immigrate to the US as the proclamation seems to cover the majority of visa categories across the board. Parents and spouses of US citizens and immediate family members of lawful permanent residents are subject to the policy; however, there are few exceptions where the requirement will not be applied such as noncitizen children of US citizens, refugees, and immigrants who have won asylum.

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November 3, 2019

The additional standard for visa applicants will be effective on applications filed on November 3, 2019 going forward.

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