Issue link: https://tmcpulse.uberflip.com/i/1111486
9 t m c » p u l s e | m ay 2 0 1 9 "This patchwork of solutions where one state does one thing and one state does another is not fair to the patients and it makes it much more complicated for the health care system to provide care when it's fragmented," Raghavan said. "This is really a national problem … so having some uniform policy makes sense." For now, though, federal policy seems to be moving in the opposite direction. On Oct. 10, 2018, the Trump administration proposed a change to what is known as the "public charge" rule. According to U.S. Citizenship and Immigration Services: "Any individual who is likely at any time to become a public charge is inadmissible to the United States and ineligible to become a legal permanent resident. However, receiving public benefits does not automatically make an individual a public charge." Trump's proposed change adds more pro- grams to be considered when determining if a person is likely to become a public charge, including health care organizations previously considered "off-limits" because of the essential services they provide, such as Medicaid, Medicare Part D, housing assistance and the Supplemental Nutrition Assistance Program (SNAP). Although these changes have yet to be implemented, mis- information and rumors have sent ripples of fear throughout immigrant communities. "People are really afraid. It's created a lot of misconceptions and misunderstanding," said attorney Wafa Abdin, executive director of Houston Volunteer Lawyers, which provides pro bono legal aid. Abdin said she's even seen immi- grants who are excluded from the public charge rule avoid accessing services because of it. "There are families that don't really know how much it will affect them, so they are starting to stop asking for these benefits," Abdin said. Living in fear is the status quo for many undocumented immigrants. "They're not sure when they drop their kids at school whether they'll be able to pick up the kids because every undocumented immigrant has become a priority with the change of priorities as a result of the executive orders," Abdin said. "There is this atmosphere of fear added to those who even have hope of getting some kind of sta- tus. They really don't want to even touch anything that might jeopardize them." For those who work most closely with this population, the current patchwork of solutions and the threat of even more stringent guidelines for aid is devastating, Garcini said. "When you study the context and you learn the story, you realize that the majority of these people are struggling, that they come here with a pur- pose, that they want to work, they want to better their lives," she said. Rajeev Raghavan, M.D., is an associate professor of nephrology at Baylor College of Medicine.