The Cruel Public Health Consequences of Anti-Immigrant Rhetoric.

Changes in immigration policy reflect shifts in the relative emphasis placed on each of these priorities. Since the 1980s, Americans' increasingly polarized views on immigration have contributed to Congress's failure to pass comprehensive immigration reform, frequent changes in aspects of immigration policy that can be regulated without Congress, and a system that is increasingly difficult for immigrants to navigate.1 Two articles in this issue of AJPH address one federal immigration policy: the public charge rule. The public charge rule is designed to ensure that immigrants who enter the United States will be able to sustain themselves without relying on the government for financial support.2 In 1999, the public charge rule stated that noncitizens may be denied a green card if they have received general cash assistance or long-term institutionalization funded by the US government or a state, regional, local, or tribal government.2 Immigrants' use of noncash benefits such as Medicaid and certain cash benefits such as childcare subsidies did not impact their green card eligibility.2 In 2017, the Trump administration leaked a draft of a new rule, stating that Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and housing, energy, and childcare assistance would now factor into public charge determinations. IMPLICATIONS FOR PUBLIC HEALTH PRACTICE By deterring immigrants from seeking public benefits and health care, the 2019 public charge rule may have exacerbated the COVID-19 crisis.2 The 2022 final rule is an important step toward addressing the public health consequences of the 2019 rule, but it must be accompanied by outreach so that immigrants feel safer accessing public benefits.3 DHS should disseminate information through communitybased organizations that have already established trust in immigrant communities,8 and medical-legal partnerships could incorporate immigration lawyers who can provide up-to-date guidance on changing policies.3 However, until Congress passes comprehensive immigration reform, public health professionals will face an uphill battle against the misinformation, confusion, mistrust, and fear that currently constrain immigrants' access to health care and public benefits.3 /4JPH CORRESPONDENCE Correspondence should be sent to Chenoa D. Allen, 328 Clark Hall, 701 South Providence Road, Columbia, MO 65211 (e-mail: chenoa.allen@ gmail.com).