Maanvi Singh, The Guardian, March 29, 2020

As the coronavirus spread through California and the economic fallout of the pandemic began to hit Patricia’s community in the rural Coachella Valley, she said a new Trump administration policy had layered worries upon her worries.

The so-called “public charge” rule, which allows the government to deny green cards and visas to immigrants who rely on public benefits, went into effect in late February, just as the first cases of Covid-19 were being reported across the US.

“Now, we are in panic,” said Patricia, a 46-year-old mother of three and daughter of two elderly parents. The Guardian is not using Patricia’s real name to protect her and her undocumented family members.

Patricia’s father, who stopped seeking treatment for his pancreatic cancer after a lawyer advised that using some public medical benefits could affect his bid to gain legal status, is among the most at-risk for complications from contracting the coronavirus. So is her mother, who is diabetic.

“I have a broken heart,” she said. “We’ve been told that if we want papers to feel secure and calm here, there’s a tradeoff.”

Although the US Citizenship and Immigration Services last week announced under pressure from lawmakers and advocacy groups that immigrants who undergo testing or treatment for Covid-19 would not be denied visas or green cards under the new rule, fear and confusion are stopping people from seeking medical care. In the midst of a pandemic, health and legal experts say that policies designed to exclude vulnerable immigrant communities from medical care are fueling a public health disaster.

“The community doesn’t trust the government right now.” said Luz Gallegos, who directs the Todec Legal Center in southern California. As Covid-19 spreads across the state, much of the center’s efforts recently have been dedicated to reassuring immigrants that they can and should take advantage of health programs if they can.

Patricia, who went to Todec for advice, said even though she’s been told that the public charge rule doesn’t apply to those who want to get tested for the coronavirus, she can’t help but worry. “With this president, you can never know,” she said. When immigration policies can change overnight, she said, “how can we have trust?”

Even before the public charge rules went into effect, a UCLA analysis found that more than 2 million Californians enrolled in the state’s public food and medical benefits programs could be affected by the rule, which allows immigration officials to turn away those seeking green cards and visas based on who are “likely to be a public charge”.

“We can’t stop the spread of disease while denying health coverage to people,” said Ninez Ponce, director of the UCLA Center for Health Policy Research. “It’s irresponsible public health policy.”

Although several groups of immigrants, including asylum-seekers and refugees, are exempt from the rule, the complicated, 217-page regulation has a “chilling effect”, Ponce said, driving people to withdraw from social services even if they don’t have to.

On Sunday, local health officials announced a sixth death due to the virus in Riverside county, where Todec is based. “It feels like people are between walls,” Gallegos said. “They’re afraid of the outbreak, and they’re afraid of getting help. There’s a lot of trauma in the community.”

For Binyamin Chao, who grappled with the public charge regulations before recently gaining a green card, his new legal status hasn’t given him much relief. His mother and younger brother are still undocumented.

“We’re experiencing the pandemic like everyone else, but the thing is, there’s all these additional barriers to where we can get help,” said Chao, 24, who works as a campaign coordinator at the California Immigrant Policy Center. He’s been helping friends and family – some of whom have been unable to work in bars and restaurants, or as domestic workers or caregivers – navigate the complex public benefit rules, reminding them that community health clinics and state health programs that aren’t funded by the federal government are safe to use.

The economic fallout from the pandemic could leave many immigrants in need of public assistance now, more than ever, Chao noted. But he understands why many immigrants are avoiding seeking medical care altogether. “When I filed to adjust my status, my spouse and I disenrolled from CalFresh,” said Chao, referring to a program that provides food assistance for low-income Californians.

Even though it was his partner, not him, who had signed up for the program, and even though he knew that taking advantage of that assistance wouldn’t necessarily disqualify his application for a work permit, “I just went with what gave me peace of mind,” he said. “And at that point I had probably internalized what I’d heard from the president, about what kind of immigrant I’d be if I was burdening the government.”

Mariana Garcia said she and her family were similarly shaken by the administration’s recent policies. The 25-year-old, who is authorized to live and work in the US through the Obama-era Daca program, has health insurance – for now. But she worries about her father, who still suffers from health complications after being stabbed in the stomach years ago, who has refused to see the doctor recently. “He’s so afraid of seeking medical care for the virus, or for anything else,” she said, tearing up. “I’m afraid my parents will fall sick.”

In an open letter to Mike Pence and other leaders, nearly 800 public health and legal experts urged officials to make healthcare facilities immigration enforcement-free zones. In a separate letter, 17 attorneys general – including from California, New York and Washington state — implored the Trump administration to fully suspend the public charge rule, so people feel comfortable seeking medicare for any and all health issues during the crisis.

“Healthcare is not just about addressing an emergency situation,” said Ponce of UCLA. Immigrants who aren’t able to get treatment for underlying health issues before they become serious are not only more likely to die from Covid-19, they’re also more likely to end up in already overwhelmed emergency rooms and intensive care departments. “We want to do everything we can to help people stave off and fight infections,” Ponce said. “And that includes preventative healthcare.”

In California, where a quarter of the population is foreign-born, and more than half its citizens has an immigrant parent, leaving even a small segment of immigrant families unable or afraid to seek medical care could undermine statewide efforts to contain coronavirus, Ponce added.

The coronavirus pandemic is “Exhibit A for why the public charge rule is stupid” said Almas Sayeed, at the California Immigrant Policy Center. Because many of the immigrants eligible for safety-net public health programs work low-wage jobs, the coronavirus crisis has left them needing food assistance and medical benefits now more than ever.

“In many of these hourly jobs, there’s no paid sick time off, there’s no paid family leave,” she said. “It’s absolutely insane to keep them from using benefits.”

Now more than ever, the policy feels insulting, said Garcia, a farmworker. “We are the people that provide produce for your home,” she said. “We are doing some of the hardest jobs in the world.”

“We don’t consider ourselves a public burden,” added Patricia. “We are human beings.”