[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]


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  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