A recent Gallup poll found that health care, the economy, and immigration are the top three most important political issues for U.S. voters. Public charge policy—which relates to the admission of noncitizens based on the likelihood that they will not become dependent on the U.S. government for support—lies at the intersection of these three topics. At the same time, immigration and welfare reform are prominent agenda items for the current administration. On October 10, 2018, the Department of Homeland Security (DHS) released a Notice of Proposed Rulemaking that would transform public charge policy that has existed for more than a century.

This essay identifies concern for public health as a factor in the development of public charge policy and demonstrates how the proposed rule abandons this rationale. Part I describes how public charge policy has remained remarkably consistent over time, even when anti-immigrant sentiment and concerns about the costs of providing public benefits to immigrants brought about restrictions on immigrant access to public benefits. Part II demonstrates how the public health rationale has influenced the development of public charge policy. Part III argues that the changes to public charge policy proposed in October 2018 represent a departure from the longstanding incorporation of public health concerns into public charge policy. I argue that the proposed changes are tied to a broader agenda of more generally restricting access to health-supporting public benefits. Finally, I make a normative case for maintaining the current limitations on public charge policy’s consideration of public benefits use by noncitizens.