Trump Is Fine With Healthcare Mandates, As Long as They Hurt Immigrants 

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By Doug Rand

Surprise! It turns out that despite his crusade against Obamacare, President Donald Trump is actually a big fan of health-insurance mandates — as long as they’re used to keep immigrants out instead of providing Americans with better health care. That’s the only possible conclusion to draw from his recent executive order denying green cards to applicants who can’t prove they will have health insurance or the money to pay for medical costs once in the United States. 

The new requirement is thankfully on hold after an Oregon judge on Tuesday issued a nationwide restraining order. But it’s too soon to relax: the ruling is only temporary, and the Trump administration is still determined to find a way to implement its plan. 

If they’re successful, the proclamation will affect about half a million people each year, making life harder for green card applicants who simply want to reunite with their loved ones here in America. Moms, dads, and children who have dutifully filled out forms and in many cases spent years waiting in line could now turn up for their final green card interview and be told, on the basis of a quick glance from a U.S. Department of State official, that they don’t look healthy enough to join their families in America. 

That isn’t only cruel, but it’s also pointless. Immigrants already undergo a rigorous medical screening and their sponsor must show they have the resources to support them financially. But the new order dovetails with Trump’s notorious “public charge rule,” which aims to slash legal immigration based on factors such as applicants’ wealth, health, and English proficiency. Between the public charge rule and his new proclamation, Trump is building an invisible wall to exclude lawful immigrants — and unlike his border wall, this regulatory barrier doesn’t require snakes, alligators, or billions of dollars in military funding

This may come as a shock, but Trump’s order isn’t the result of a lengthy period of measured, data-driven consultation with experts and stakeholders. Instead, this sweeping policy change appears to have been cobbled together in an evening by Stephen Miller and his anti-immigrant cronies, then pushed out with no explanation and no clear plan for its implementation, in a move calculated more to spark panic than to improve the immigration system. 

Trump claims his order is necessary because immigrants drive up health costs for Americans. But his order misrepresents the available data on immigrant healthcare expenditures, and provides no evidence that barring immigrants will reduce healthcare costs for Americans. It’s true that immigrants are less likely than native-born citizens to have private health insurance — something that will be exacerbated by this proclamation, which effectively bars immigrants from using Affordable Care Act subsidies. But it’s also clear that immigrants incur remarkably few medical costs, in part because they tend to be significantly healthier than native-born Americans.

While foreign nationals make up 12 percent of the U.S. population, they account for only 8.6 percent of health care spending, with immigrants spending one half to two thirds less per capita than U.S. citizens on healthcare. In fact, immigrants already pay $25 billion a year more in insurance premiums than they claim in medical costs, effectively subsidizing private health insurance for Americans. 

The reality is that far from costing America money, immigrants fuel our economy and keep our health care system afloat. About one in four workers in the health care sector are foreign-born, and immigrant doctors and nurses play a vital role in delivering care in rural areas. More broadly, immigrants pay $405 billion in taxes every year, vastly offsetting the cost of providing medical treatment to the few who require it. 

The obvious truth is that this executive order isn’t intended to lower U.S. healthcare costs. Instead, it’s a conservative two-for-one deal, meant to scare people away from the Affordable Care Act benefits to which they’re legally entitled, while simultaneously slamming America’s door in the face of law-abiding family immigrants.  

President Trump’s proclamation is grounded in the same shaky legal logic as his Muslim travel and asylum bans. In order to defend the country (in this case, the theory goes, from soaring medical costs) Trump is taking a statute traditionally used to deny immigration benefits to foreign adversaries, and using it to reshape immigration law by fiat. 

The Oregon court’s ruling, which found that Trump’s proclamation was “not issued under any properly delegated authority” and tried to claim powers that actually belong to Congress, is a promising sign. Hopefully, other courts will similarly recognize Trump’s order as a partisan stunt intended to appease his base and divert attention from the  impeachment inquiry

In the meantime, though, countless law-abiding immigrants — including the thousands of spouses of U.S. citizens and green card holders we help each year at Boundless — have been left facing unnecessary confusion,  and potentially with yet another obstacle to overcome. If this proclamation is ultimately implemented, many immigrants will be turned away and many U.S. citizens told, heartbreakingly, that they can’t reunite with their loved ones.

Family migration lies at the heart of the American Dream, and that’s what makes Trump’s continuing assaults on what the right has branded “chain migration” so toxic. We should be applauding immigrants who want to settle here, work hard, play by the rules, and eventually bring over their families to build a future in America. Instead, Trump is seeking to block lawful immigrants at every turn, without any concern for what’s best for U.S. families and communities.

Even for this administration, Trump’s health insurance mandate for immigrants is a shockingly transparent attempt to victimize innocent people for short-term political gain. It is unnecessary, unjustified, and likely unlawful — and unless courts continue to reject it as unconstitutional, it will cause untold suffering for countless American families.

Doug Rand is a former Obama White House official and is now co-founder of Boundless Immigration, a company helping immigrants navigate the moving goalposts on obtaining their visas and green cards. 

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