Suspension of Entry of Immigrants Who Will Financially Burden the United States Healthcare System, in Order To Protect the Availability of Healthcare Benefits for Americans

 
CONTENT
Federal Register, Volume 84 Issue 196 (Wednesday, October 9, 2019)
[Federal Register Volume 84, Number 196 (Wednesday, October 9, 2019)]
[Presidential Documents]
[Pages 53991-53994]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-22225]
                        Presidential Documents
Federal Register / Vol. 84 , No. 196 / Wednesday, October 9, 2019 /
Presidential Documents
[[Page 53991]]
                Proclamation 9945 of October 4, 2019

Suspension of Entry of Immigrants Who Will
                Financially Burden the United States Healthcare System,
                in Order To Protect the Availability of Healthcare
                Benefits for Americans
                By the President of the United States of America
                A Proclamation
                Healthcare providers and taxpayers bear substantial
                costs in paying for medical expenses incurred by people
                who lack health insurance or the ability to pay for
                their healthcare. Hospitals and other providers often
                administer care to the uninsured without any hope of
                receiving reimbursement from them. The costs associated
                with this care are passed on to the American people in
                the form of higher taxes, higher premiums, and higher
                fees for medical services. In total, uncompensated care
                costs--the overall measure of unreimbursed services
                that hospitals give their patients--have exceeded $35
                billion in each of the last 10 years. These costs
                amount to approximately $7 million on average for each
                hospital in the United States, and can drive hospitals
                into insolvency. Beyond uncompensated care costs, the
                uninsured strain Federal and State government budgets
                through their reliance on publicly funded programs,
                which ultimately are financed by taxpayers.
                Beyond imposing higher costs on hospitals and other
                healthcare infrastructure, uninsured individuals often
                use emergency rooms to seek remedies for a variety of
                non-emergency conditions, causing overcrowding and
                delays for those who truly need emergency services.
                This non-emergency usage places a large burden on
                taxpayers, who reimburse hospitals for a portion of
                their uncompensated emergency care costs.
                While our healthcare system grapples with the
                challenges caused by uncompensated care, the United
                States Government is making the problem worse by
                admitting thousands of aliens who have not demonstrated
                any ability to pay for their healthcare costs. Notably,
                data show that lawful immigrants are about three times
                more likely than United States citizens to lack health
                insurance. Immigrants who enter this country should not
                further saddle our healthcare system, and subsequently
                American taxpayers, with higher costs.
                The United States has a long history of welcoming
                immigrants who come lawfully in search of brighter
                futures. We must continue that tradition while also
                addressing the challenges facing our healthcare system,
                including protecting both it and the American taxpayer
                from the burdens of uncompensated care. Continuing to
                allow entry into the United States of certain
                immigrants who lack health insurance or the
                demonstrated ability to pay for their healthcare would
                be detrimental to these interests.
                NOW, THEREFORE, I, DONALD J. TRUMP, by the authority
                vested in me by the Constitution and the laws of the
                United States of America, including sections 212(f) and
                215(a) of the Immigration and Nationality Act (8 U.S.C.
                1182(f) and 1185(a)) and section 301 of title 3, United
                States Code, hereby find that the unrestricted
                immigrant entry into the United States of persons
                described in section 1 of this proclamation would,
                except as provided for in section 2 of this
                proclamation, be detrimental to the interests of the
                United States, and that their entry should be subject
                to certain restrictions, limitations, and exceptions. I
                therefore hereby proclaim the following:
[[Page 53992]]
                Section 1. Suspension and Limitation on Entry. (a) The
                entry into the United States as immigrants of aliens
                who will financially burden the United States
                healthcare system is hereby suspended and limited
                subject to section 2 of this proclamation. An alien
                will financially burden the United States healthcare
                system unless the alien will be covered by approved
                health insurance, as defined in subsection (b) of this
                section, within 30 days of the alien's entry into the
                United States, or unless the alien possesses the
                financial resources to pay for reasonably foreseeable
                medical costs.
                    (b) Approved health insurance means coverage under
                any of the following plans or programs:
(i) an employer-sponsored plan, including a retiree plan, association
health plan, and coverage provided by the Consolidated Omnibus Budget
Reconciliation Act of 1985;
(ii) an unsubsidized health plan offered in the individual market within a
State;
(iii) a short-term limited duration health policy effective for a minimum
of 364 days--or until the beginning of planned, extended travel outside the
United States;
(iv) a catastrophic plan;
(v) a family member's plan;
(vi) a medical plan under chapter 55 of title 10, United States Code,
including coverage under the TRICARE program;
(vii) a visitor health insurance plan that provides adequate coverage for
medical care for a minimum of 364 days--or until the beginning of planned,
extended travel outside the United States;
(viii) a medical plan under the Medicare program; or
(ix) any other health plan that provides adequate coverage for medical care
as determined by the Secretary of Health and Human Services or his
designee.
                    (c) For persons over the age of 18, approved health
                insurance does not include coverage under the Medicaid
                program.
                Sec. 2. Scope of Suspension and Limitation on Entry.
                (a) Section 1 of this proclamation shall apply only to
                aliens seeking to enter the United States pursuant to
                an immigrant visa.
                    (b) Section 1 of this proclamation shall not apply
                to:
(i) any alien holding a valid immigrant visa issued before the effective
date of this proclamation;
(ii) any alien seeking to enter the United States pursuant to a Special
Immigrant Visa, in either the SI or SQ classification, who is also a
national of Afghanistan or Iraq, or his or her spouse and children, if any;
(iii) any alien who is the child of a United States citizen or who is
seeking to enter the United States pursuant to an IR-2, IR-3, IR-4, IH-3,
or IH-4 visa;
(iv) any alien seeking to enter the United States pursuant to an IR-5 visa,
provided that the alien or the alien's sponsor demonstrates to the
satisfaction of the consular officer that the alien's healthcare will not
impose a substantial burden on the United States healthcare system;
(v) any alien seeking to enter the United States pursuant to a SB-1 visa;
(vi) any alien under the age of 18, except for any alien accompanying a
parent who is also immigrating to the United States and subject to this
proclamation;
(vii) any alien whose entry would further important United States law
enforcement objectives, as determined by the Secretary of State or his
designee based on a recommendation of the Attorney General or his designee;
or
[[Page 53993]]
(viii) any alien whose entry would be in the national interest, as
determined by the Secretary of State or his designee on a case-by-case
basis.
                    (c) Consistent with subsection (a) of this section,
                this proclamation does not affect the entry of aliens
                entering the United States through means other than
                immigrant visas, including lawful permanent residents.
                Further, nothing in this proclamation shall be
                construed to affect any individual's eligibility for
                asylum, refugee status, withholding of removal, or
                protection under the Convention Against Torture and
                Other Cruel, Inhuman or Degrading Treatment or
                Punishment, consistent with the laws and regulations of
                the United States.
                Sec. 3. Implementation and Enforcement. (a) An alien
                subject to this proclamation must establish that he or
                she meets its requirements, to the satisfaction of a
                consular officer, before the adjudication and issuance
                of an immigrant visa. The Secretary of State may
                establish standards and procedures governing such
                determinations.
                    (b) The review required by subsection (a) of this
                section is separate and independent from the review and
                determination required by other statutes, regulations,
                or proclamations in determining the admissibility of an
                alien.
                    (c) An alien who circumvents the application of
                this proclamation through fraud, willful
                misrepresentation of a material fact, or illegal entry
                shall be a priority for removal by the Department of
                Homeland Security.
                Sec. 4. Reports on the Financial Burdens Imposed by
                Immigrants on the Healthcare System. (a) The Secretary
                of State, in consultation with the Secretary of Health
                and Human Services, the Secretary of Homeland Security,
                and the heads of other appropriate agencies, shall
                submit to the President a report regarding:
(i) the continued necessity of and any adjustments that may be warranted to
the suspension and limitation on entry in section 1 of this proclamation;
and
(ii) other measures that may be warranted to protect the integrity of the
United States healthcare system.
                    (b) The report required by subsection (a) of this
                section shall be submitted within 180 days of the
                effective date of this proclamation, with subsequent
                reports submitted annually thereafter throughout the
                effective duration of the suspension and limitation on
                entry set forth in section 1 of this proclamation. If
                the Secretary of State, in consultation with the heads
                of other appropriate executive departments and
                agencies, determines that circumstances no longer
                warrant the continued effectiveness of the suspension
                or limitation on entry set forth in section 1 of this
                proclamation or that circumstances warrant additional
                measures, the Secretary shall immediately so advise the
                President.
                    (c) The Secretary of State and Secretary of Health
                and Human Services shall coordinate any policy
                recommendations associated with the reports described
                in subsection (a) of this section.
                Sec. 5. Severability. It is the policy of the United
                States to enforce this proclamation to the maximum
                extent possible to advance the interests of the United
                States. Accordingly:
                    (a) if any provision of this proclamation, or the
                application of any provision to any person or
                circumstance, is held to be invalid, the remainder of
                the proclamation and the application of its other
                provisions to any other persons or circumstances shall
                not be affected thereby; and
                    (b) if any provision of this proclamation, or the
                application of any provision to any person or
                circumstance, is held to be invalid because of the
                failure to follow certain procedures, the relevant
                executive branch officials shall implement those
                procedural requirements to conform with existing law
                and with any applicable court orders.
                Sec. 6. General Provisions. (a) Nothing in this
                proclamation shall be construed to impair or otherwise
                affect:
[[Page 53994]]
(i) United States Government obligations under applicable international
agreements;
(ii) the authority granted by law to an executive department or agency, or
the head thereof; or
(iii) the functions of the Director of the Office of Management and Budget
relating to budgetary, administrative, or legislative proposals.
                    (b) This proclamation shall be implemented
                consistent with applicable law and subject to the
                availability of appropriations.
                    (c) This proclamation is not intended to, and does
                not, create any right or benefit, substantive or
                procedural, enforceable at law or in equity by any
                party against the United States, its departments,
                agencies, or entities, its officers, employees, or
                agents, or any other person.
                Sec. 7. Effective Date. This proclamation is effective
                at 12:01 a.m. eastern daylight time on November 3,
                2019.
                IN WITNESS WHEREOF, I have hereunto set my hand this
                fourth day of October, in the year of our Lord two
                thousand nineteen, and of the Independence of the
                United States of America the two hundred and forty-
                fourth.


                    (Presidential Sig.)
[FR Doc. 2019-22225
Filed 10-8-19; 8:45 am]
Billing code 3295-F0-P