To Whom It May Concern:
Empower Missouri is a non-profit, nonpartisan anti-poverty organization that has worked for more than 120 years to improve the health and economic stability of Missouri families. We submit this comment to strongly oppose the proposed changes to the public charge rule. Experience from the first Trump administration already showed that such policies harm U.S. citizen children, worsen public health outcomes, and increase preventable costs for states, hospitals, and taxpayers. Repeating these policies again would directly undermine national efforts to improve affordability and Make America Healthy Again.
When the public charge rule was last expanded in 2019, families became afraid to seek the basic support services that their children were qualified to receive. One of the clearest findings from that period is that Medicaid and CHIP enrollment fell twice as fast for citizen children with an immigrant parent as it did for other children. Families did not withdraw because they no longer needed help; they withdrew because they feared immigration consequences, even when their children were legally eligible. Today, the same pattern is already reemerging. Even the proposal of tightening public charge standards has caused many immigrant families to avoid programs that provide food, housing, and health care, long before any rule takes effect. In Missouri, 274,000 children live in families that rely on SNAP, and Medicaid covers more than 36 percent of all Missouri children. These are exactly the children who stand to lose the most when fear silences access to essential supports.
U.S. citizen children in immigrant families are Americans who will sustain our economy, pay taxes, and support the nation’s long-term growth. When fear drives these children away from health care, nutrition, or stable housing, their lifelong potential is reduced, and the nation loses the contributions they would otherwise have made. Missouri is home to more than 256,000 immigrants, and 97 percent are engaged in the workforce. As a result, many of their U.S. citizen children will again be pushed out of the programs they depend on to remain healthy enough to learn, grow, and eventually participate fully in the American economy. Research shows that children who receive basic supports early in life are more likely to succeed in school, earn higher wages as adults, and avoid chronic disease or disability. Public charge policies interrupt this progress and instead create future costs that all Americans bear. Protecting children’s access to care is not only the right thing to do; it is a practical investment in America’s economic future. The consequences extend into the present-day health and economic systems. When children lose Medicaid or CHIP, they do not stop needing health care. They receive care later and at a higher cost, often in emergency settings. Hospitals face higher uncompensated care, states face higher emergency Medicaid expenses, and privately insured families face higher premiums as costs shift into the commercial market. Similar harms occur when families avoid SNAP or housing assistance, increasing food insecurity, school absences, health complications, and developmental delays. These outcomes directly contradict efforts to Make America Healthy Again, because no public health strategy can succeed when families are afraid to access preventive care and basic supports.
The evidence from the first Trump administration makes one conclusion unavoidable: public charge policies do not promote self-sufficiency. They make U.S. citizen children sicker, destabilize families, and increase avoidable costs for taxpayers, states, and health systems. The federal government has already seen these impacts once. Reinstating a rule known to create widespread harm would again place children at risk and weaken the nation’s long-term health and economic strength.
For these reasons, Empower Missouri urges the administration to withdraw the proposed public charge rule. A healthy and economically strong America depends on ensuring that all eligible children, regardless of their parents’ immigration status, can safely access the care and support they need to thrive.
Atentamente,
Empoderar a Missouri
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