President Donald Trump issued a proclamation Friday that will require immigrants to prove they can obtain health insurance before they are issued a visa.  The proclamation says immigrants must demonstrate they will have health insurance within 30 days of entering the country or that they can afford to cover any medical expenses.

What does the new rule say?

The White House touted the proclamation as “protecting health care benefits for American citizens,” arguing that uninsured immigrants create a financial burden for hospitals and doctors, forcing them to charge higher fees for Americans to cover the cost.  The presidential proclamation will not affect refugees, asylum seekers or people on temporary visitor visas. The measure will be effective Nov. 3.

The required insurance can be provided by an employer or be purchased individually, and it can be for catastrophic or short-term coverage.  However, immigrants would not be able to obtain a visa if they use the Affordable Care Act’s subsidies when purchasing coverage. The ACA’s subsidies typically help shoppers save hundreds or thousands of dollars per year when buying health insurance.

What are the implications?

Policy observers say that President Trump’s move is a “classic catch-22″ for low-income immigrants.  “They will need health insurance to be in the country legally [and] the only way they may be able to afford coverage is with ACA subsidies,” said Larry Levitt of the Kaiser Family Foundation.  “But, if they buy insurance with ACA subsidies, it won’t count as insurance under the proclamation.”  Immigrants on Medicaid coverage also would not qualify under Trump’s proclamation.

The rule effectively creates a health insurance mandate for immigrants, just months after Trump and congressional Republicans repealed the Affordable Care Act’s mandate, arguing that its tax penalty was “cruel” and created an unfair burden.

The president’s proclamation also builds on a new rule, issued by the administration in August, that allows federal officials to deny green cards to legal immigrants who have received certain public benefits, like Medicaid, or who are deemed likely to do so in the future.  That “public charge” rule would take effect Oct. 15 but has faced legal challenges.  One in seven adults in immigrant families already reported that they or their families didn’t participate in government programs last year — even before the public charge rule took effect — out of fear of risking their status.