A federal judge on Saturday blocked a Trump administration rule requiring immigrants to prove they had insurance or could pay for medical care before they can obtain visas, but immigration attorneys and health officials said the block still does not alleviate confusion and uncertainty among existing and would-be immigrants.

U.S. District Judge Michael Simon in Portland, Oregon, issued a temporary restraining order the day before the policy was set to go into effect.

The October proclamation required that prospective immigrants demonstrate they could obtain health insurance within 30 days of arriving in the United States – a demand that immigration and health experts said would be particularly onerous for low-income immigrants who may not be coming to the United States for a job that provides health insurance or who may be unable to pay for foreseeable medical costs. Experts warned that the policy would favor wealthy would-be immigrants.

The proclamation also required that even those who qualified for a federal tax subsidy to help buy health insurance on the Affordable Care Act’s individual market would have to somehow reject that subsidy, for which there is not yet a mechanism on the federal health exchange website, healthcare.gov.

The proclamation came shortly after a wave of legal challenges sought to block Trump’s “public charge” rule, which would have made it more difficult for immigrants to obtain green cards if it seemed they would need federal assistance, such as food stamps or Medicaid. The rule was put on hold last month before it could go into effect.

Yet the temporary blocks on both policies – appeared to have been designed, experts said, to heavily favor wealthy immigrants and prevent many low-income immigrants from coming to the United States – have done little to assuage fear among immigrants in the United States. Some immigrants have sought to disenroll from the federal health insurance they are legally entitled to, health officials said, while others fear they will not be able to bring in family members.


The proclamation particularly sparked fear and confusion among some U.S. citizens who have been planning to apply for visas for their parents and other relatives, said Jesse Bless, director of litigation at the American Immigration Lawyers Association. Other immigrants have expressed concerns that if they leave the country to apply for their visas from the consulates in their home countries, they will be denied reentry because of the proclamation and separated indefinitely from their relatives in the United States, according to Bless.

“People are confused and terrified they will lose the ability to the live in the U.S. with their loved ones,” Bless said.

The Migration Policy Institute estimated that the presidential proclamation could prohibit the entry of about 375,000 immigrants annually, mainly affecting family-based immigrants, who make up the majority of green-card holders.

About 1 in 4 lawfully present immigrants lack health insurance, compared with about 1 in 10 citizens, according to the Kaiser Family Foundation, but citizens still make up the majority of the non-elderly uninsured.

Seven U.S. citizens and the nonprofit Latino Network brought the lawsuit against the administration’s new policy. In his restraining order, Simon wrote that they demonstrated that “they are likely to suffer irreparable harm in the absence of temporary relief, that the balance of hardships tips sharply toward Plaintiffs, and temporary relief is in the public interest.”

The proclamation also has sparked concern among some of the federal officials tasked with implementing it. On a conference call in October to discuss the rules, officials in the Center for Consumer Information and Insurance Oversight raised concerns about the legality and feasibility of implementing the proclamation, according to two government officials on the call, who spoke on the condition of anonymity to share details of a private conversation.


Among the concerns raised on the call were whether the proclamation required federal officials to circumvent the legal rulemaking process, and whether carrying out the order would require officials to overstep their legal authority, the two people said. At least one official raised concerns about how the new order would affect immigrants currently on the health-care exchanges set up by the Affordable Care Act.

One attorney on the call said, “I’m really thinking that in many ways, sticking to the letter of the proclamation will cause us to run afoul of current laws on the book,” according to the two government officials.

Politico reported that officials from the Centers for Medicare and Medicaid Services (CMS) had legal concerns about implementing the order, but details from the internal call have not been reported.

A spokesman for CMS denied that the agency had legal concerns about the president’s proclamation. “The Department has no concerns with implementing the President’s proclamation. Any alleged comments to the contrary are inaccurate,” Johnathan Monroe, a CMS spokesman, said in a statement.

State officials were also left in the lurch, uncertain how or whether the new rules would affect the administration of health care to immigrants in their states because they had not yet received the federal guidance they were awaiting. More than a dozen members of state health-care exchanges held a call Friday to try to resolve confusion over how to comply with the rule, according to an individual on the call who spoke on the condition of anonymity because that person was not authorized to speak about it. Several state health officials submitted comments warning of dire consequences for immigrants if the proclamation went into effect.

The block will remain in place for 28 days, during which the plaintiffs and the government will have time to gather and present evidence to the court.


The White House criticized the restraining order on Sunday afternoon and asserted the president’s right to make such changes to immigration policy.

“It is wrong and unfair for a single district court judge to thwart the policies that the president determined would best protect the United States healthcare system,” press secretary Stephanie Grisham said in a statement. She added: “The Administration looks forward to the opportunity to make its defense in court.”

The organizations involved in the case – the Justice Action Center, the American Immigration Lawyers Association and the Innovation Law Lab, with pro bono assistance from Sidley Austin – celebrated the decision on Saturday but noted that their case was far from concluded.

“Today’s decision highlights the urgency of blocking this health care ban before it causes irreparable damage to our community and those we serve,” Carmen Rubio, executive director of Latino Network, said in a statement.

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