Trump Administration's Public Charge Rule Would Derail Efforts to End the U.S. HIV Epidemic

After reading this article, make sure to TAKE ACTION by submitting a public comment using our HIV-specific comment template. The public comment period closes on 12/10.

It is often said that we have the tools to effectively address and even end the HIV epidemic in the United States. Such language was used in the most recent iteration of the National HIV/AIDS Strategy and was central to mission and message of the recently released roadmap to end the HIV epidemic by 2025 that was marshalled by AIDS United and the Act Now: End AIDS coalition. It is a sentiment that is marked by an optimism about the trajectory of the HIV epidemic in this country that was unthinkable even a decade ago. However, at the end of such a bold, hopeful statement, there is an unwritten addendum--a blank that anyone who has engaged in HIV advocacy for even a brief while can fill in with an array of laments that demonstrate why the HIV epidemic in the United States continues in spite the tools that we have.

In the immediate aftermath of the passage and implementation of the Affordable Care Act and piecemeal Medicaid expansion, the chief obstacles in the way of optimal utilization of the tools in the HIV toolbox had been monetary, coming in the form of static and insufficient federal funding or rising pharmaceutical and medical costs that made accessing care and prevention services prohibitive for many people. However, over the past 2 years, new roadblocks have been set in front of the HIV advocacy community that have little to do with cost and everything to do with overt, cold-blooded discrimination against populations in need.

Earlier this fall, the Trump administration released a notice of proposed rulemaking concerning Inadmissibility on Public Charge Grounds, a document whose technical-sounding name belies its capacity to destroy lives and upend the US immigration system as we know it. Under this proposed public charge rule, the definition of what constitutes a public charge in the immigration process -- i.e., a person who would likely be primarily dependent on the federal government for subsistence -- would be significantly expanded, creating what would amount to a financial and medical litmus test for all immigrants coming to the United States.

Currently, public charge determinations are only negatively influenced by use of specific types of public assistance, such as an immigrant's receipt of cash benefits like Supplemental Security Income or the Temporary Assistance for Needy Families program, which are only used by 3 percent of all US noncitizens, or the use of long-term institutional care at government expense. However, under the Trump administration's new rule, the definition of what programs would negatively impact an immigrant's chances at receiving citizenship or a green card would be significantly expanded to include an array of programs related to health, nutrition, and housing. Among the programs that could be used to negatively impact an immigrant's chances of obtaining US citizenship are Medicaid, the Supplemental Nutrition Assistance Program (commonly referred to as "food stamps"), Section 8 housing, and the Medicare Part D Low-Income Subsidy Program.

To make matters worse, the Trump administration's proposed public charge rule purposely discriminates against immigrants living with pre-existing health conditions, creating what is essentially a de facto ban on all immigrants living with HIV and other chronic health conditions from becoming US citizens. In the proposed rule, the Trump administration allows US Citizenship and Immigration Services (USCIS) to deem an immigrant "inadmissible on a health-related ground" for a variety of illnesses impacting people living with and affected by HIV. And, while HIV is not specifically mentioned in the administration's public charge rule, it does single out "communicable disease[s] of public health significance" as negative factor in their determinations.

There is certainly no shortage of reasons to be opposed to the Trump administration's proposed public charge rule. Should it be approved, the rule would grossly distort the US immigration system, turning it into little more than a fast-pass lane for well-to-do and healthy immigrants to obtain citizenship while kicking millions of working-class immigrants and those living with pre-existing conditions like HIV to the curb. From this point forward, identification by the USCIS as one of the poor, tired and huddled masses seeking to breathe free on American shores will label you as defective -- a person undeserving of citizenship and all the benefits it brings with it.

However, beyond the sheer injustice of it all, the Trump administrations public charge rule is unacceptable because it makes ending the domestic HIV epidemic by 2025 all but impossible. It is hard enough to reach and treat every person living with HIV in a country where tens of millions still lack access to health care and where the funding and workforce capacity is always stretched beyond its limits. Trying to ensure that every person living with HIV in the US is virally suppressed and that those at high risk of contracting HIV are on receiving prevention services when millions of immigrants are terrified of seeing medical care for fear that they or their loved ones' may be deported is an unwinnable battle.

We are already seeing a disturbing "chilling effect" among immigrants in the United States who are dropping out of public welfare programs in droves amid fears of deportation due to the Trump administration's draconian immigration policies, with up to 6.8 million US citizen children of noncitizen parents being placed at risk as well. If this new public charge rule is approved, the number of immigrants dropping out of or refusing to seek care for HIV and other medical issues will surely increase, slamming the proverbial HIV toolbox shut for thousands of immigrants living with and affected by HIV and endangering any chance the United States has of ending the country's HIV epidemic in the near future.

On Monday, December 10th, the public comment period for the Trump administration's proposed public charge rule will come to an end. But, before it does, AIDS United asks the HIV advocacy community to come together and tell the Department of Homeland Security that this hateful, harmful and discriminatory policy is unacceptable. AIDS United has worked with the California Primary Care Association and the National Immigration Law Center to create an HIV-specific template that you can use to submit your comment.

Click on this link and then click the arrow by "Organizations and Health Centers/Option A" at the bottom of the page to access the HIV public charge comment template, which you can then submit on regulations.gov. When filling it out, be sure to add some content of your own in the highlighted areas of the text as it is vital that the experiences and concerns of the HIV community are logged on public record and because each comment needs to be unique in order to be read by DHS.

AIDS United will continue to monitor the status of the Trump administration's public charge rule and will keep you up to date on any developments and any future advocacy on behalf of immigrants living with and affected by HIV.

[Note from TheBody: This article was originally published by AIDS United on Dec. 7, 2018. We have cross-posted it with their permission.]