[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