​Summary: Authors wrote this chapter in the Stanford University press book "Immigrant California: Understanding the Past, Present, and Future of U.S. Policy.” The chapter provides the backdrop to the conversations on public charge — defined as being primarily dependent on the government for subsistence (U.S. Department of Homeland Security 2019a) — and health care use by immigrants, beginning with federal health care policies and the inclusion of immigrants in these federal laws, and California’s response to these policies. California has introduced expansive policies to extend and promote health care access to its population, where 27% are foreign-born immigrants. In the particular case of linguistic access in health care settings, California helped form the basis for federal language access laws, including new requirements for language assistance services under the Patient Protection and Affordable Care Act (ACA).

Authors use 2006–2018 California Health Interview Survey data to describe the populations affected by potential new federal polices that present threats to immigrant health. They look specifically at the expansion of the public charge rule published by the U.S. Department of Homeland Security on August 14, 2019, and implemented on February 24, 2020, which expanded the benefits that could be considered in a determination of whether an immigrant seeking permanent residency, also referred to as a public charge. CHIS data provide an opportunity to examine the immigrant communities that remain vulnerable to potential changes in public benefit exclusions and are highly sensitive to an anti-immigrant policy climate.