The New Public Charge Standard Will No Longer Penalize Medicaid and SNAP Recipients

Old & New Immigrants: Their Rights The New Public Charge Standard Will No Longer Penalize Medicaid and SNAP Recipients

BY WALTER EWING

The Department of Homeland Security (DHS) issued a Notice of Proposed Rulemaking to clarify the meaning of the “public charge ground of inadmissibility” on February 24. The new guidance will be welcome news for immigrants as well as state governments and immigrant-serving organizations across the country that have worked to combat fear and misinformation around public charge. Under current law, immigrants applying for admission to the United States or those already here and seeking a green card must prove they are not “likely to become a public charge.” Although changes were implemented during the Trump administration, since 1999 immigrants have been required to prove that they would not become “primarily dependent” on certain cash welfare programs.

Changes to Public Charge Under Trump The Trump administration attempted to change this standard by implementing its own version of the public charge rule in 2019, but its application was halted in March 2021 due to litigation. Since then, DHS has applied “the public charge inadmissibility statute consistent with the 1999 Interim Field Guidance.” Once finalized, the Biden administration’s proposed rule would replace both. The Supreme Court is, however, still deciding whether to allow several states to continue the fight to save Trump’s version of the public charge rule. State and local governments have had a difficult time keeping up with continuously shifting guidance over the last three years. California was forced to commit substantial resources toward multilingual guides for residents, while social service agencies in Maryland and Michigan dedicated significant resources to multiple rounds of guidance for frontline civil servants. But issues with the Trumpera public charge rule didn’t stop there. A group of 21 Attorneys General told DHS that the Trump administration’s 2019 Final Rule caused many immigrants to either not enroll in or disenroll from public benefit programs not even covered by the rule. The public charge inadmissibility formula in the rule was so complex and difficult to understand that many immigrants and service providers simply avoided benefits rather than risk making a mistake. In fact, the rule may have led to a decrease of 260,000 enrollees in child Medicaid and 21,000 enrollees in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)—even though neither of these programs was targeted by the rule.

New Public Charge Guidance Under Biden The Biden administration’s proposed rule defines someone who is “likely to become a public charge” as someone who is “likely at any time to become primarily dependent on the government for subsistence, as demonstrated by either the receipt of public cash assistance for income maintenance or long-term institutionalization at government expense.” DHS is clear that, as in 1999, “institutionalization” does not include immigration detention or the serving of a penal sentence. Contrary to the standard imposed by the Trump administration, DHS will no longer consider “receipt of Medicaid, public housing, or Supplemental Nutrition Assistance Program (SNAP) benefits as part of the public charge inadmissibility determination.” The proposed rule will “provide fair and humane treatment for noncitizens requesting admission to the United States or applying for lawful permanent continued on page 18

Alabama Amazon Workers File Precedent Setting ULP Charges Against Amazon for Misconduct in Re-Run Election

The Retail, Wholesale and Department Store Union (RWDSU) this week filed Unfair Labor Practice charges (ULPs) against Amazon claiming that it has engaged in misconduct during the re-run union election in Bessemer, Alabama. This is the second set of ULP charges by the Union, showing a continuance of the company’s conduct aimed at interfering with the right of employees to organize. This rerun election is the result of the company’s objectionable conduct under the National Labor Relations Act (NLRA) during the first election, conduct which the National Labor Relations Board (NLRB) concluded interfered with employees’ rights to a free and fair election. All the charges highlight examples of Amazon’s continued efforts to undermine and suppress workers’ right to a free and fair election. Despite the adversity, workers of the BAmazon Union continue to fight to ensure their democratic rights at work are respected and Amazon is held accountable for its outrageous behavior. One of the filed ULPs seeks to challenge the current caselaw precedent around captive audience meetings, which has for too long allowed employers to compel attendance to anti-union meetings. These aptly named “Captive-Audience” meetings are coercive and workers should have the right, as is already protected under the law in Section 8, to not engage in them. p residence from within the United States.” In addition, the proposed rule will formally exempt several categories of noncitizens from public charge, including “refugees, asylees, noncitizens applying for or re-registering for Temporary Protected Status (TPS), special immigration juveniles, T and U nonimmigrants, and self-petitioners under the Violence Against Women Act (VAWA).” Nor will DHS consider “vaccines or public benefits specifically related to the coronavirus (COVID-19) pandemic” when making public charge determinations. “The 2019 public charge rule was not consistent with our nation’s values,” said Homeland Security Secretary Alejandro N. Mayorkas. “Under this proposed rule, we will return to the historical understanding of the term ‘public charge’ and individuals will not be penalized for choosing to access the health benefits and other supplemental government services available to them.” The administration will accept comments from the public on the new proposed rule until April 25, 2022, and a final rule could be unveiled soon afterward. This proposed rule is an important step in creating a more fair and efficient immigration system because it will provide a greater level of flexibility and certainty to noncitizens who seek to obtain or maintain immigration benefits in the United States.p

NEW YORK, NY - FEBRUARY 20, 2021: Protestors hold signs and march on a picket line across from Amazon's Whole Foods Market in solidarity with the unionizing Amazon workers in Bessemer, Alabama. Editorial credit: Ron Adar / Shutterstock.com Public Charge/continued from page 17

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February 2022 19 Love, Health & Travel The Safety Sandwich – Setting Boundaries

BY SARAH O’LEARY, ESTESTHERAPY.COM

It is common to worry that setting boundaries will cause a relationship to suffer and hurt the feelings of the other person. Knowing the purpose of asserting your limits is essential: setting boundaries brings clarity and safety to relationships. While boundary setting can be uncomfortable and sometimes incite conflicts, it can help your relationships grow and will help you stand up for what matters to you. Nothing kills a relationship like resentment; without boundaries, resentment thrives like a weed. What brings couples closer together is the ability of each person to take responsibility for his or her own feelings, thoughts, and behaviors. The Safety Sandwich is a great tool for setting boundaries.

Safety Sandwiches If you can “sandwich” your boundary between two positive safety statements, you can provide an assurance of connection while articulating your needs. You need to make it clear that this boundary is important to you as well as the person with whom you are setting boundaries. Think of the safety statements as the 2 slices of bread, and the boundary as the filling or the meat of the issue. Here are a few examples to get started: Feelings: “I love sharing what’s going on with you…” (Safety statement) “…but I really need to process this by myself right now…” (Boundary) “…Thank you for supporting me.” (Safety statement)

Thoughts: “I appreciate getting to hear your point of view…” (Safety statement) “… I have different thoughts on the topic. I think we’ll just go in circles trying to convince each other. Let’s put a pin in it…” (Boundary) “…Thank you for sharing with me and giving me another perspective.” (Safety statement)

Behaviors: “I really love talking on the phone with you…” (Safety statement) “…but I’m not able to talk every day…” (Boundary) “…maybe we can set up a time every Wednesday to talk instead.” (Safety statement) While you cannot control the reaction of another person, your efforts to maintain connection while protecting your needs are your responsibility. If their response is inflammatory, try to hear where the pain is coming from. Perhaps they need a little more assurance that the relationship and your connection are okay. Otherwise, they may need their own time and space to process. It is a great idea to process both successful and unsuccessful attempts at boundaries with your therapist. p Sarah O’Leary, AMFT#123449 is captivated most by the importance of relationships and emotions and how they impact our everyday lives. She beleives that, "relationship" doesn't just mean partner, but rather connections of all kinds. This article was supervised byNicole Asencio, PsyD, LMFT#99795.

How Long Does Protective Immunity against COVID-19 Last after Infection or Vaccination?

BY PRAKASH NAGARKATTI & MITZI NAGARKATTI THE CONVERSATION

As the omicron variant of SARS-CoV-2 took hold across the globe in late 2021, it became readily apparent that the pandemic had entered a new phase. Having experienced a previous COVID-19 infection or being vaccinated still left many people wondering how vulnerable they were to the virus. Some 4.9 billion people – or 63.9% of the world’s population – have received at least one dose of the COVID-19 vaccine as of late February 2022. And more than 430 million cases of COVID-19 have been confirmed since the start of the pandemic. So with the majority of the world population being either immunized against COVID-19 or having recovered from infection, people have rightly begun to ask: How long will the immunity triggered by either vaccination, an active infection or a combination of both provide immune protection? This is a challenging question because the virus is relatively new and novel variants have continuously emerged. However, researchers are beginning to better understand how existing immunity protects against reinfection and the prevention of severe COVID-19 that can lead to hospitalization and death. As immunologists studying inflammatory and infectious diseases, including COVID-19, we are interested in understanding the nature of such protective immunity.

The role of antibodies and ‘killer’ T cells Upon vaccination or infection with COVID-19, your body produces two types of protective immune responses. The first type involves B cells, which produce antibodies. Antibodies are Y-shaped proteins that form the first line of defense against an infection or perceived invader, such as a vaccine. Much like a lock and key, antibodies can directly bind to a virus – or to the spike protein of COVID19, in the case of the mRNA vaccines – and prevent it from gaining entry into cells. However, once a virus successfully enters the cells, antibodies are no longer effective. The virus begins replicating in the infected cells and spreading to other cells. This is when the immune system calls into action another type of immune cell known as killer T cells, which act as the second line of defense. Unlike antibodies, killer T cells cannot directly “see” the virus and thus cannot prevent a virus from entering cells. However, the killer T cells can recognize a virus-infected cell and immediately destroy the cell before the virus gets a chance to replicate. In this way, killer T cells can help prevent a virus from multiplying and spreading. Throughout the COVID-19 pandemic, the public has widely and mistakenly believed that antibodies provide the bulk of protective immunity, while not recognizing the important role of killer T cells. This is in part because antibodies are easy to detect, whereas killer T-cell detection is complex and involves advanced technology. When antibodies fail, it is the killer T cells that are responsible for preventing the more severe outcomes of COVID-19, such as hospitalization and death.

Memory is key to long-term protective immunity Then come the real veterans of the immune system, which can provide long-lived and strong immunity against an infection based on their past experience. After performing their tasks of clearing the infection or the spike protein of the virus, the antibody-producing B cells and killer T cells get converted into what are called memory cells. When these cells encounter the same protein from the virus, they recognize the threat immediately and mount a robust response that helps prevent an infection. This explains why multiple doses of COVID-19 vaccines that increase the number of memory B cells prevent reinfection – or breakthrough infections – better when compared with a single dose. And a similar increase in memory killer T cells prevents severe disease and hospitalization. Memory cells can remain in the immune system for long periods – sometimes even up to 75 years. This explains why people develop lifelong protective immunity in certain cases, such as after measles vaccination or smallpox infection. The trick, however, is that memory cells are highly specific. If new strains or variants of a virus emerge, as has been the case numerous times during the COVID-19 pandemic, memory cells may not be as effective. This raises the question: When do these different key players of the immune system emerge after infection, and how long do they last?

Duration and longevity of immunity against COVID-19 Antibodies begin mobilizing within the first few days following an infection with COVID-19 or after receiving the vaccine. They steadily increase in concentration for weeks and months thereafter. So by three months following infection, people have a robust antibody response. This is why the Centers for Disease Control and Prevention has long held that people who have had a confirmed COVID19 infection in the past 90 days do not need to quarantine when they come into contact with someone with COVID-19. But by about six months, antibodies start declining. This is what led to the so-called “waning immunity” that researchers observed in the fall of 2021, months after many people had been fully vaccinated. However, immunity is far more complex and nuanced, and antibodies only tell part of the story. Some B cells are long-lived, and they continue to produce antibodies against a virus. For this reason, antibodies against SARS-CoV-2 have been detected even a year after an infection. Similarly, memory B cells can be detected for at least eight months, and memory killer T cells have been observed for close to two years following COVID-19 infection. In general, vaccines have also been shown to trigger an immune memory similar to that of natural infection. However, long-term studies of the comparison do not yet exist. Nonetheless, a recent study that is not yet peer-reviewed showed that a third dose of vaccine increases memory B cell diversity, which leads to better protection even against variants like omicron. But the mere detection of an immune response does not translate to full protection against COVID-19. Based on the limited amount of time and research that researchers like us have been able to study COVID-19, it is difficult to precisely correlate the levels of antibodies and killer T cells with the degree of protection they offer. So while it is becoming clear that some form of immune response against the virus can be detected for more than a year after COVID-19 infection, their levels may not be enough to provide full protection against reinfection.

Immunity from vaccination versus infection One recent study from the U.K. Health Security Agency showed that protection against infection from two doses of vaccine may last for up to six months. Similarly, another

Researchers are working to develop vaccines that provide long-term immune protection from COVID-19. study showed that the mRNA vaccines were highly protective at two months, but that their effectiveness decreased by seven months – in part due to the emergence of the delta variant. In both studies, the vaccines were found to be better at preventing hospitalization and death than in preventing infection over time. There are contradictory reports on whether the protective immunity triggered following an active infection is better than that induced by the current vaccines. This may have resulted from the emergence of different variants of the virus during the study. nnnHowever, the broad consensus is that COVID-19 infection can give rise to protection comparable to that from the vaccines, as shown in a recent study that has not yet been peer-reviewed.

Hybrid immunity Researchers have also found that the protective immunity acquired from the combination of a COVID-19 infection followed by vaccination – called hybrid immunity – is very potent and remains effective for more than a year after infection with COVID-19. Interestingly, hybrid immunity triggers a very strong antibody response over an extended period. Such studies show how important it is for even people who have been previously infected with COVID-19 to get vaccinated to ensure the most robust protection against COVID-19. With the growing knowledge that both vaccines and active infections can trigger a strong and sustained killer T cell response that protects against hospitalization and death, immunologists are now researching how to develop vaccines that can trigger a similar sustained long-term antibody response to prevent reinfections. Hybrid immunity from those who are vaccinated and have experienced COVID-19 infection may offer some useful clues.p

Prakash Nagarkatti is a Professor of Pathology, Microbiology and Immunology, University of South Carolina. Mitzi Nagarkatti is a Professor of Pathology, Microbiology and Immunology, University of South Carolina

Americans are Returning to the Labor Force at a Quickening Rate – Do They Just Really Need the Work?

BY CHRISTOPHER DECKER THE CONVERSATION

The U.S. economy surprised analysts by adding 467,000 jobs in January, overcoming omicron concerns and continuing a long streak of gains, the Bureau of Labor Statistics reported on Feb. 4, 2022. Yet at the same time, the unemployment rate ticked up a notch, from 3.9% to 4%. Confused? Shouldn’t a large increase in jobs drive joblessness lower? Usually, the main culprit behind these types of conflicting results is an increase in the number of people rejoining the labor market. I believe that must be the case here – and recent data show a clear trend in this direction – even though the BLS has adjusted its latest data in a way that makes it harder to see what’s going on or make historical comparisons. The share of working-age Americans either in work or looking for work – known as the labor participation rate –dropped steeply at the beginning of the pandemic. But there are signs that labor participation may finally be turning around. From a low of 60.2% in April 2020, it has slowly risen since. And the latest report showed it reached 62.2% in December and January, the highest since the depths of the pandemic in mid-2020. The 2.2 percentage point gain since April 2020 may not seem huge, but it equates to about 5.8 million people rejoining the workforce. As an economist who has been following the labor market closely for the past year, I think people are being both encouraged and forced back into looking for work. My interpretation of the evidence suggests that those who quit and held off getting back into the labor force are now finding job opportunities that are too valuable to pass up. For one thing, wages continue to increase – they grew rapidly in January 2022, with average hourly wages up 5.6% from a year earlier. At the same time, it appears that many businesses are responding to workers’ desires

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for some flexibility in scheduling and a better work/life balance. Greater job flexibility can be seen in the jump in the number of Americans working remotely. The number of employees working from home because of the pandemic increased to 15.4% of the workforce in January, as the omicron variant spread and staffers were given the option to work from home. But it isn’t just employer-driven factors behind the increase in labor participation. For those without a job and stable income, personal resources can get depleted over time. Some people who left the workforce early on in the pandemic may have been able to get by and cover essential spending such as housing and groceries by relying on personal savings, support from family members or generous pandemic-related government benefits. Those resources are not infinite, however. The number of long-term unemployed Americans declined in January, following a trend observed throughout 2021, suggesting that a growing number are returning to the workforce. Moreover, the cost of living is soaring at the fastest pace in 40 years. And for households that had been relying on a single income during the pandemic, the problem is made worse by the fact that wages are lagging behind, putting pressure on families. In other words, job holdouts might not be able out hold out much longer if inflation continues to outpace wage increases. But even with the recent uptick in the labor participation rate, the U.S. economy still has a long way to go before the ongoing labor shortages hammering companies end and the job markets return to pre-pandemic levels. p

Editor’s note: This article was updated on Feb. 7, 2022 to take into account the U.S. Bureau of Labor Statistics’ revised statistics for December.

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