State and local medical providers are noticing a decline in immigrants’ use of health services, which they attribute to Trump administration policies:

Public‐​health officials say a Trump administration policy meant to discourage immigrants from using public‐​health resources is deterring people from getting medical treatment for fear of hurting their immigration status, making it harder to test and treat possible cases of the new coronavirus.

The rule in question, the Department of Homeland Security’s Public Charge Rule, was formally implemented on February 24, 2020. Under the rule, immigrants deemed likely to be dependent on public assistance – evidenced through use of state or local health programs targeted at poor populations – are subject to denial of permanent legal status.

An alien who is likely at any time to become a public charge is generally inadmissible to the United States and ineligible to become a lawful permanent resident. Under the final rule, a public charge is defined as an alien who has received one or more public benefits, as defined in the rule, for more than 12 months within any 36‐​month period.

Healthcare providers are concerned that non‐​citizens, fearing the threat of losing a chance at future permanent legal status, will avoid visiting doctors, thus making COVID-19 more difficult to diagnose, treat, or trace unless the disease progresses to a life‐​threatening stage. United States Citizenship and Immigration Services has since issued new guidance, saying:

USCIS encourages all those, including aliens, with symptoms that resemble Coronavirus Disease 2019 (COVID-19) (fever, cough, shortness of breath) to seek necessary medical treatment or preventive services. Such treatment or preventive services will not negatively affect any alien as part of a future Public Charge analysis.

Non‐​citizens, however, are understandably hesitant to take the revised guidance at face value. According to a Queens‐​based doctor, “people are wary. They believe they are having their names placed in a registry.”

Regardless of one’s views on immigration policies, one must accept that undocumented immigrants will always be present. And if policy treats these immigrants harshly, that might make them more likely to generate externalities for the native population.