Bruce Lesley is incensed at one dimension of the debate about birthright citizenship that he says is being completely overlooked. "It's in the words: 'birth' right citizenship — this is about babies."
Lesley is the president of First Focus on Children, a bipartisan advocacy group for children and families, which submitted an amicus brief for the case Trump v. Barbara to be argued Wednesday, April 1, before the Supreme Court.
During debate on the potential end to birthright citizenship in recent congressional hearings, Lesley heard about administrative challenges, historical context and political allegiance. "The word 'child' does not cross their lips," he says of the lawmakers and witnesses.
That is a serious oversight, he argues. "This impacts every baby born in America," he says.
What birthright citizenship means for birth
Right now, when a baby is born in an American hospital or birth center, that baby is automatically a citizen with immediate access to a range of support and services.
Pregnant women are eligible for Medicaid coverage in every state regardless of their immigration status. That means prenatal visits, birth and postnatal visits are covered. Medicaid currently pays for 40% of all births in the U.S. Health coverage during pregnancy means the baby has the best possible chance of a healthy start, including automatic eligibility for Medicaid for the first year of life. Despite this safety net coverage, the U.S. has significantly higher maternal and infant mortality rates than peer countries.
An estimated 300,000 babies were born to parents without legal status in 2023. A change to birthright citizenship would affect all children, however, not just those born to immigrant families. All parents would have to prove their own citizenship status in a bureaucratic process that does not yet exist. Federal data show approximately 3.6 million babies are born in the U.S. each year.
The early weeks of a newborn's life are busy, even when the baby is born full term and healthy. "You have well-child visits and immunizations and a lot of appointments to make sure that the child's thriving and developing properly and getting the services and care they need," Lesley says.
For babies born with serious health conditions, the consequences of not having health coverage could be dire. Under the current system, parents and hospitals can be assured that medical treatments will be covered.
Also, hospital staff help families with the paperwork needed for the baby to get a Social Security number, since almost all babies born in the U. S. are citizens and are eligible for one. "They gather that and submit it to Social Security on your behalf," Lesley explains. That Social Security number is required for the baby to be enrolled officially in health insurance, food benefits and any other support services they may need.
The American Hospital Association declined to comment on the case about to be argued before the Supreme Court. The American Medical Association and American Academy of Pediatrics also declined to comment. Both hospitals and doctors would need to change their practices and policies if birthright citizenship were overturned.
A potential burden of proof
Without birthright citizenship, the parents of every baby born in the U.S. would need to establish their citizenship status to have access to these supports. It would mean a break in the continuity of care that currently exists, Lesley says. "If you say, 'Well, we don't know if the baby is a citizen,' it is highly questionable whether babies will then have Medicaid, SNAP, WIC [food benefits], any access to these critical programs at the most vulnerable time in any of our lives," he explains.
The process of establishing a baby as a citizen may be difficult and costly in many cases.
"I believe it's about 10% of birth certificates where the father is listed as unknown," Hannah Steinberg, staff attorney at the ACLU Immigrant Rights Project, said in a press briefing last week. "Children in that situation, where the [unnamed] father is a green card holder or a U.S. citizen — the child is not going to get citizenship" even though they are entitled to it, she says.
She adds that there are also cases where babies are found in the U.S., and the identities of both parents are unknown.
"The law actually says that these children are U.S. citizens, but this executive order just completely strips that away and says, 'No, it matters who your parents are,'" Steinberg says. "Our entire system of law has been set up around this birthright citizenship guarantee — all of our administrative procedures, state laws, local laws."
Lesley adds that babies born to same-sex couples, surrogates or couples who used assisted reproductive technology could also have challenges establishing citizenship for their babies, and so could married, heterosexual, U.S. citizen parents whose documents were lost in a house fire or another disaster.
"That the government [would be] asking for paternity tests and surrogacy documents and whatnot is just crazy," Lesley says.
Births and babies are already affected
Arturo Vargas Bustamante, director of faculty research at the UCLA Latino Policy and Politics Institute, says maternal and infant health is already being affected by the debate over birthright citizenship and other immigration policies of the Trump administration.
"When you have fear and you stop going to the doctor, then in the future there are important consequences" of missing prenatal care, Bustamante says. "Your children are more likely to suffer, for example, low birth weight, and this will ultimately have lifetime consequences."
He points out this has particular implications for the Latino population, since "75% of children of noncitizen parents are Latino," he says. That statistic was included in a recent policy brief he authored on the health and social consequences of ending birthright citizenship.
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