This commentary is by Andrea Green, MDCM, FAAP, who is an associate professor of pediatrics at the UVM Larner College of Medicine and director of the Pediatric New American Program at the University of Vermont Children’s Hospital Primary Care.

As a pediatrician in Burlington specializing in immigrant health care, I understand how federal government programs help to address children’s most basic needs. I’ve witnessed their successes in my own clinic and cannot imagine what it would mean if these programs were not there for the Vermont families I care for.

Nutritious food is vital to growing children, but right now, 15 percent of Vermont children live in food insecure homes. Recognizing the importance of nutrition and the prevalence of hunger in children, the government has safety net programs like the Supplemental Nutrition Assistance Program, or SNAP.

Children need shelter and a safe environment to live. Over 66 percent of families in Vermont do not earn enough to afford the average fair market rent. For low-income families who qualify, housing costs may be offset by government housing subsidies.

Affordable, quality health care coverage helps children reach their full potential. Over 41 percent of Vermont’s children under age 19 have health insurance through Dr. Dynasaur, Vermont’s Medicaid program. Kids who have access to health care do better in school, are more likely to graduate from college, have higher wage jobs and pay more taxes than those who are uninsured.

All of these programs work to provide Vermont families with essential services, but they also have something else in common: They are on a list of programs that the Department of Homeland Security recently proposed including as part of the “public charge” test, which is used to determine whether someone can become a permanent U.S. resident.

Currently, someone can be deemed a “public charge” if they are primarily dependent on the government for subsistence. Under the new proposal, the government would expand that definition and look at an immigrant’s use of programs like Medicaid, SNAP, and housing assistance.

This could have dangerous consequences for children living in immigrant families. In fact, one in four children in the United States lives in an immigrant family. If public charge were expanded, parents could be forced to choose between accessing vital services or keeping their families together. If children no longer access these programs, their health will suffer. Immigrants often arrive in our country in pursuit of the American dream, with hopes to build a safer and healthier life for their families; this proposal could jeopardize that dream and damage children’s health in the process.

Despite educating the immigrant families in my care about the proposal, “public charge” is still creating anxiety and confusion. Recently, a family shared that they are hoping to bring Grandmother to the United States to join them and help with child care, but now that means forgoing health insurance for the children. They also worry that without housing subsidies for rent, they will become homeless or have to choose between food and rent. No family should have to make these decisions. It is clear that the proposal’s chilling effect is already having real consequences for children and families.

I stand with the American Academy of Pediatrics in opposing any proposal that puts children’s health at risk and will continue to speak out to ensure that all children can be healthy and safe – no matter where they or their parents were born.

We have until Dec. 10 to tell DHS why this public charge proposal would be dangerous for the health of children and families in Vermont and across the country. I will be submitting comments to the proposal and I hope you will consider joining me. We cannot afford to be silent with so much at stake for the children and families in Vermont who may avoid these programs out of fear.

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