    [United States Statutes at Large, Volume 133, 116th Congress, 1st Session]
    [From the U.S. Government Publishing Office, www.gpo.gov]

    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

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    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:
    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;

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    (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
    (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
    effec

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    tive 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:
    (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.
    DONALD J. TRUMP