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Advancing Community wellness in the Coachella Valley

Federal policy decisions may harm Coachella Valley health, economy

Dr. Conrado Barzaga on public charge

On August 12, the U.S. Department of Homeland Security announced a change in our immigration laws that redefines who is eligible for legal permanent residence. The new rule, which revises the definition of "public charge," may harm the health of immigrant families, with undesirable side-effects on the Coachella Valley economy.

The “public charge” rule has no effect on illegal immigration. It targets those who come to or already are in our country, legally.  When a person applies for a permanent resident status, or for an immigrant visa to enter the U.S., immigration officials conduct a public charge test to determine whether that person is likely to become dependent on the government to meet basic needs. Traditionally, the government has used very narrow criteria to make that determination. The new definition broadly expands that standard.  Along with a variety of other criteria, participation in non-emergency Medi-Cal (California’s Medicaid program), CalFresh (California’s Supplemental Nutritional Assistance Program) and certain types of federal housing assistance, among other programs, will now make those applicants ineligible for a green card. In other words, it punishes people for accessing services to meet basic needs such as health care, food, and housing — services for which they are legally eligible.

The Coachella Valley’s agriculture, construction, and hospitality industries largely depend on a healthy immigrant population. Because of the “public charge” rule, many in this workforce who are indispensable to our local economy, will stop using services essential to their health and well-being. It is very likely that the number of uninsured will grow. The rule will likely lead to declines in participation in Medi-Cal and other programs broadly across immigrant families, including their primarily U.S.-born children.

Doctors across the country and public health organizations like the Desert Healthcare District are warning that there will be a surge in expensive emergency rooms, people with chronic diseases skipping regular checkups, children with asthma not getting preventive care.  All this, because people without insurance are more likely to forego regular checkups and to seek routine care in emergency rooms, where health care is expensive and inadequate for primary care. For our hospitals, this means an increase in uncompensated care. We have seen it happen in our recent past. Before the Affordable Care Act was implemented in 2010, uninsured patients — many of them immigrants — sought care at hospital emergency rooms. The state had to establish the Disproportionate Share Hospital supplemental program to offset some (not all) of their uncompensated costs. The combination of higher cost of care and lower patient revenue typically results in an undesirable reduction in personnel (read unemployment).


For local employers in the hospitality, agriculture, and construction industries, a less healthy workforce means loss of productivity. When an employee seeks routine care at an already impacted emergency room, it results in long wait hours. Long hours away from work.

There is strong evidence of the Trump administration’s “war on the poor,” which has led to eroding progress on health care, weakening safety-net programs, and attacking immigrant communities. The public charge rule is just the latest episode. Our local business community must join local nonprofit organizations, healthcare providers, and community workers that are working to lessen the fear and confusion this new rule is creating among immigrant families.

While this new rule does not go into effect for another 60 days, and there are efforts to stop its implementation, many immigrant workers may assume that they or their family members are subject to this new rule. They should be informed of the facts and receive guidance before making any decisions regarding their participation in Medi-Cal or other public benefits.   Fourteen states have filed lawsuits challenging the Trump administration's new rule. Several organizations, including the California Primary Care Association, have also filed similar lawsuits. 

It is imperative that our local media join healthcare workers and nonprofits in providing accurate and accessible information about the new rule to immigrant communities and families. For these are our neighbors. For our local economy depends on them.


Conrado Bárzaga, MD

Chief Executive Officer

Desert Healthcare District and Foundation