Several Catholic hospital and community leaders met Oct. 10 and called on people in their networks to oppose a proposed immigration rule change that would make it harder for immigrants to qualify for permanent resident status, and that could decrease immigrants’ access to health care. “This is not a political question,” said Father William Grogan, the cardinal’s delegate for health care. “It’s a moral question. We are driving people to despair if they can’t get access to health care. This is a pro-life issue.” The meeting at Presence St. Joseph Hospital included representatives from Amita Health, which acquired Presence earlier this year; Sinai Health System, which includes Holy Cross Hospital; St. Anthony Hospital, an independent Catholic hospital; and groups such as the HANA Center, which serves the Korean community, and the Centro de Trabajadores Unidos. Auxiliary Bishop Mark Bartosic and U.S. Rep. Jan Schakowsky, a Democrat who represents part of the North Side and north suburbs, also attended. The proposed rule, which was formally published by the Department of Homeland Security the same day as the meeting, would change the way immigration officials determine whether someone who wants to become a permanent resident is likely to be a “public charge” and therefore ineligible for permanent resident status. The rule now is in a 60-day comment period, during which anyone can leave a comment at regulations.gov. Comments must be unique, and they must be in English. Under guidelines in place since 1999, an immigrant is considered a “public charge” only if he or she is likely to become “primarily dependent on the government for subsistence,” said Andrea Kovach, senior attorney for health care justice for the Sargent Shriver National Center on Poverty Law. That definition has been in place since 1882, but no permanent rule as to how to apply it was ever made, so immigration authorities have used a series of guidelines. The benefits that were considered included cash aid, such as Temporary Aid to Needy Families or Supplemental Security Income, or institutionalization for long-term care. The proposed permanent rule expands the definition of “public charge” to mean someone who is likely to receive, at any time in the future, one or more public benefits. Those benefits include: non-emergency Medicaid, Medicare Part D low income subsidy or housing assistance. It’s just as important to understand what the rules do not include, Kovach said. When the rule change was first floated in March, some suggested applying the benefit test not only to the immigrant seeking permanent resident status, but also to their family members, even if those family members were U.S. citizens. That was not included in the final proposal. When it comes to making the public charge determination, immigration officials will look at age (being of working age, or between 18 and 61, is favorable for receiving permanent resident status; being older or younger is not), medical condition, family status and whether the applicant can be self-sufficient; whether the applicant has financial assets and an income of at least 125 percent of the federal poverty level; employment and education history; an “affidavit of support” from a family member or sponsor; and whether the applicant is receiving or has received public benefits in the past three years. However, officials will not be able to look at whether an applicant used public benefits at any time before the rule goes into effect. The rule cannot go into effect until after the 60-day comment period is over. “There is no reason for people to disenroll from benefits programs now,” Kovach said. Yet some families are already dropping out of benefits programs, including Medicaid and education programs, for fear that it will make it more difficult for them to get permanent resident status, according to people attending the meeting. “When you look at the fear and confusion this rule will cause or is already causing, it will lead to a lot of people who are not covered,” Kovach said. “It specifically will hurt children and the elderly, and those with lower levels of education.” “People are afraid,” said Dennis Ryan, vice president of mission effectiveness and external affairs at Holy Cross Hospital. “They are worried.” Carmen Velasquez, who founded the Alivio Medical Center, said rule change is part of a strategy to make people leave the country. “They want to erase us,” she said. “They want us to go away. We are not going to go away and we are going to fight for what is right.” Grogan said Catholic hospitals will bear a disproportionate burden if more poor immigrant families either do not have access to or choose not to sign up for Medicaid. “We care for the largest number of the sick and the vulnerable and the weak in the state of Illinois,” he said. Those who attended the meeting agreed to encourage their employees and volunteers to comment on the proposed rule, and Grogan suggested Catholic parishes, universities and other institutions could also raise awareness before the comment period closes Dec. 10. Even if the comments to not sway DHS’ decision, Kovach said, they could still be important to a potential future lawsuit to prevent the rule from being enforced.