Imagine being forced to choose between seeing a doctor or securing your family’s future in this country. That is the reality the U.S. Department of Homeland Security’s recent proposal could create for immigrant and mixed status families. The plan, quietly released this month, would expand the so-called “public charge” rule to allow DHS to deny permanent residency based on an applicant’s health characteristics or any past or future use of safety net programs. This should alarm anyone who cares about children’s health and our nation’s future.
As a child health researcher at the Boston University School of Public Health and executive director of Children’s HealthWatch, I have spent decades studying how policy decisions ripple through families’ lives. The evidence is unequivocal: threatening immigrant families’ stability and access to basic needs harms children—millions of them.
Today, roughly 18 million children in the U.S. live with at least one immigrant parent—that’s more than 1 in 4. Their families are disproportionately vulnerable to food insecurity and financial instability due to a variety of existing exclusions and barriers to accessing supports—even when eligible. Programs like the Supplemental Nutrition Assistance Program (SNAP) and school meals are proven tools that protect young bodies and minds against these hardships. They lead to better health, stronger educational outcomes and greater ability to afford care throughout a child’s life.
Public charge threats undermine all of this. Even when programs remain legally safe to use, immigrant parents often avoid them—even for eligible U.S. citizen children and family members—out of fear that accessing help could jeopardize their ability to stay in the country, become a permanent resident, or keep their family together. This chilling effect is not hypothetical—it is well-documented.
The scientific evidence is unequivocal: expansions to public charge result in eligible families—including children of U.S. citizens whose involvement in public programs has never been a basis for public charge determination—forgoing essential assistance to which they are lawfully entitled. This is a sad irony. Decades of public health investments are undermined by eligible families’ self-disenrollment from programs, an example of policy violence.
After the 2016 election and proposed changes to the public charge rule, multiple national analyses found alarming declines in participation in nutrition programs among immigrant families: one study found 6 to 7 percentage point declines in the Supplemental Nutrition Assistance Program (SNAP)—our nation’s first defense against food insecurity—and double-digit drops in school meal programs. These numbers are not abstract; they represent real children losing access to the food they need to grow, learn, and thrive.
Health care use also suffered. Multiple studies, including our own, show reductions in preventive care among young children of immigrants following the proposed expansion of public charge and hostile political rhetoric. Children missed their well-child visits, where important vaccinations typically happen—losing out on critical forms of early monitoring and care that prevent illness, developmental delays, and costly emergency care. Pediatricians nationwide saw families quietly disappear from clinics, not because their children were healthy, but because their parents were terrified.
Behind these numbers are real families. Qualitative research we conducted with immigrant mothers saw them describe daily fear: fear of going to the grocery store, fear of taking a sick child to the doctor, fear of venturing into their community. Parents recounted skipping meals so their children could eat, postponing necessary medical visits, and isolating themselves from community resources they once trusted. The stress is relentless, and it affects parents’ and children’s mental and physical health in profound ways. Chronic stress in early childhood is linked to developmental challenges, poorer academic performance, and long-term health risks.
Given this reality, DHS’s proposal is not merely a bureaucratic adjustment. It is an intentional step backward that would inflict real and measurable harm on children who already face significant barriers. More than a quarter of children in this country lives in an immigrant family. Undermining their access to nutrition and health services endangers not only individual families, but also our country’s public health and economic well-being.
As a nation, we benefit when all children—regardless of their parents’ place of birth—have what they need to thrive. Healthy children become healthy adults who participate fully in schools, workplaces and communities. Our long-term prosperity depends on these investments.
DHS should withdraw this damaging proposal and reaffirm a simple, fundamental value: every child in America deserves a fair chance at a healthy life.