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As a faith-based health system focused on improving the health of individuals and communities, we are disappointed that the Department of Homeland Security finalized its Inadmissibility on Public Charge Grounds rule. Ascension is committed to the principle that basic healthcare is necessary for preserving human dignity, ensuring proper human development, and advancing the common good. Because the proposed rule failed to support this principle, we had encouraged DHS to withdraw the rule in its entirety.

Without offering comment on the overarching appropriateness of a “public charge” test, Ascension believes the long-standing approach to this issue articulated in 1999 struck a more appropriate balance. The broadened definition of “public charge” and factors identified under the final rule will negatively impact the health of millions of lawful immigrants – and potentially many other individuals across the United States – ultimately increasing healthcare spending, reducing business income, decreasing workforce participation and productivity, and shrinking the tax base.

While we appreciate that DHS listened to comments and excluded some of the most vulnerable populations initially ensnared in the proposed rule, we remain concerned that millions of immigrants who have legally made a home for themselves and their families in the United States will lose or forego health coverage and care. As with the proposed rule, the final rule is exceedingly complex and allows for subjective assessments by Immigration Officers. The result will be that many immigrants and citizen family members not specifically targeted under the final rule will undoubtedly avoid using benefits or seeking healthcare, due to fear and confusion.

Across the healthcare industry, immigrants comprise nearly 16 percent of the total healthcare workforce and 22 percent of “low-skilled” healthcare workers. Ascension employs more than 150,000 associates and engages roughly 40,000 aligned providers. Nearly 700 of these individuals are foreign-born legal residents, 80% of whom serve in a clinical capacity. Ascension is additionally supported by many more such individuals through partnerships, alignments and joint ventures. Many, if not all, of these individuals could be negatively affected – directly or indirectly – by this unnecessary redefinition of benefits considered under “public charge.”

The direct and indirect chilling effect of the rule will also make it more difficult for providers to deliver comprehensive, preventative and life-saving care – with more individuals delaying treatment until healthcare emergencies arise. Our mission calls us to be part of the safety net, but rules such as this unnecessarily stretch the safety net to the breaking point.

We believe this rule will have a negative impact on millions. We will support efforts to revisit this decision, whether they be made in the courts, the Congress, or by the administration.

Joseph Cacchione, MD, FACC
Executive Vice President, Clinical & Network Services, Ascension