Ingrid Ulrey, policy director of Public Health – Seattle & King County, called the proposed rule “inhumane” and said it threatens to exacerbate homelessness, hunger and disease. A coalition of social-service providers and advocacy groups in Washington state, organized to oppose the proposal, urged immigrants not to take immediate action.

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Health officials and advocacy groups are strongly condemning the Trump administration’s proposal to limit legal immigrants’ access to green cards if they use an array of public benefits, including Medicaid, food stamps and federal housing subsidies.

“This is not only bad for the health and well-being of the people most directly affected, it is bad for all of us,” said Dr. Georges Benjamin, head of the American Public Health Association, one of scores of health-care groups to criticize the administration’s proposal.

“We hope that this heartless, punitive public policy will be reversed,” Benjamin said.

Among the major groups nationally calling on the Trump administration to withdraw the so-called public charge proposal – posted Wednesday in the Federal Register – are the American Medical Association, the March of Dimes and the American Hospital Association.

“Many of the patients served by our members almost certainly will avoid needed care from their trusted providers, jeopardizing their own health and that of their communities,” six leading physician groups said in a joint statement.

The groups include the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians and the American Psychiatric Association.

Locally, Ingrid Ulrey, policy director of Public Health – Seattle & King County, called the proposed rule “inhumane” and said it threatens to exacerbate existing problems of homelessness, hunger and disease.

A statewide coalition of social-service providers and advocacy groups, organized to oppose the proposal, urged immigrants not to take immediate action.

“This isn’t happening yet,” said Jorgé Baron, executive director of Northwest Immigrant Rights Project (NWIRP), a member of the coalition. “People shouldn’t be dumping benefits.”

A public comment period runs through Dec. 10, and use of benefits won’t be counted against a green-card application unless and until the proposal is adopted.

The proposal differs from a draft earlier leaked to the press in important respects. The latest version would not penalize immigrants who use the federal program for Women Infants and Children, known as WIC, nor Affordable Care Act subsidies, as the earlier draft did.

The draft also would have taken into account the use of benefits by immigrants’ family members, including children who are U.S. citizens. This version does not.

“Those are really great omissions,” said Dr. Asqual Getaneh, medical director of International Community Health Services, which has a largely immigrant clientele at its clinics in Seattle, Shoreline and Bellevue.

But she said immigrants might refuse those benefits for themselves or their children anyway. “Individuals are very confused and fearful.”

Over the past year, as word of mouth spread about a proposed public-charge rule, the number of women receiving WIC services through her organization has dropped by half, to about 400, she said.

Local food banks and other health organizations say they have also seen people stay away.

“Those seeking to immigrate to the United States must show they can support themselves financially,” Homeland Security Secretary Kirstjen Nielsen said in a statement announcing the proposed rule, adding it would “promote immigrant self-sufficiency and protect finite resources by ensuring that they are not likely to become burdens on American taxpayers.”

The United States for more than two centuries has placed restrictions on immigrants deemed to be a “public charge.”

Yet, said Torrie Hester, an immigration historian at St. Louis University, “there was an understanding that the health of everyone was a public good.”

So while the U.S. Immigration and Naturalization Service in 1999 issued guidance that it would consider immigrants’ use of cash welfare benefits in determining applications for permanent residency, the federal agency specifically indicated that use of Medicaid and the Children’s Health Insurance Program, or CHIP, would not hurt applicants.

The new Trump administration policy would for the first time count Medicaid use as a negative factor, as well as use of food stamps and Section 8 housing subsidies. Other negatives: being of ill health and not of working age (under 18 or over 61).

The policy does not take a position on CHIP but asks for comment on whether that should be included.

Baron, of NWIRP, noted that the policy would not automatically rule people out for using benefits, but instructs immigration officers to consider the “totality of the circumstances.”

That leaves a lot of leeway to individual officers, he said, causing him to worry that “this is going to become an arbitrary system.”

Pediatricians, public health officials and other experts warn that health problems could be substantial if even a fraction of families drop Medicaid or CHIP coverage.

In the proposed regulation, the Trump administration itself acknowledges a host of potentially adverse effects for immigrants such as “worse health outcomes, including increased prevalence of obesity and malnutrition, especially for pregnant or breastfeeding women, infants, or children, and reduced prescription adherence.”

Even skipping regular checkups can be very dangerous for children, said Dr. Lanre Falusi, a Children’s National Medical Center pediatrician who sees patients in a largely immigrant neighborhood of Washington, D.C. She explained that pediatricians use well-child visits to screen children for disease, depression and healthy development.

There are broader public health risks for the general population if immigrant families begin to forgo medical care, warned Dr. Barbara L. McAneny, president of the American Medical Association.

“The potential policy changes will likely reverse the public health gains we have made in the last several decades in areas such as vaccinations (and) control of infectious diseases,” she said.

Public Health’s Ulrey said King County has recently had more cases of flu, mumps, tuberculosis and syphilis, and could suffer worse outbreaks if the policy becomes law.

Hospital leaders also cautioned that if immigrant families do not seek regular medical care, they are more likely to end up in the hospital with more serious and costly illnesses that others would have to pay for.

“It would drive higher levels of uncompensated hospital care and, ultimately, higher costs for insured patients and taxpayers,” said Dr. Bruce Siegel, president of America’s Essential Hospitals, whose members include medical centers that care for largely poor patients.

The Trump administration in its proposed regulation acknowledged the same risks, noting the likelihood of “increased use of emergency rooms and emergent care as a method of primary health care due to delayed treatment” and “increases in uncompensated care in which a treatment or service is not paid for by an insurer or patient.”

Finally, the administration conceded that the rule “could lead to … increased rates of poverty and housing instability; and reduced productivity and educational attainment.”

Seattle Times staff reporter Nina Shapiro and Los Angeles Times reporter Noam Levey contributed to this report.

Editor’s note: A comment thread was erroneously attached to this story when it was first published. It has since been removed, in accordance with our policies on stories of this nature.