My parents raised my sisters and me here in the U.S., with security and opportunity we could never have in Sudan. Yet, the cruel irony is that my parents would have loved nothing more than to see us grow up on our ancestral lands. Instead, compelled by economic and political unrest, they left their loved ones behind and immigrated to northern Virginia, a move that they never would have been able to make if a new Trump immigration rule had been in effect.

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The new policy, which would expand the existing public charge rule, would require most immigrants seeking green cards to show they have a middle-class income and that they have not (and will never) receive government benefits, including Medicaid and Medicare Part D, the Supplemental Nutrition Assistance Program (SNAP, formerly known as food stamps), or housing assistance programs. It would radically rewrite our immigration system to explicitly favor white, wealthy, and non-disabled immigrant applicants.

Most abhorrent of all, it threatens immigrants’ livelihoods by punishing them for using the public benefits they need to survive, just as the U.S. contributed to the disruption of their livelihoods abroad through militarism and unchecked state violence.

In 1998, not long after my parents moved to the U.S., they had to watch their new country attack the homeland they were forced to leave only years before. The American military, under orders from President Bill Clinton, bombed the Al-Shifa pharmaceutical plant in Khartoum, Sudan, leveling the only factory in the country producing cheap medicine for tuberculosis or veterinary needs. (Sudan’s economy was primarily based on agriculture.)

The bombing of Al-Shifa, which represented at least 50 percent of total domestic pharmaceutical production, devastated the already strained Sudanese medical system. The Clinton administration justified the attack by claiming it had evidence showing the plant was being used by Al Qaeda to manufacture chemical weapons — evidence that later proved untrue.

Twenty years later, my extended family in Sudan is still managing electricity and water cut offs, gas shortages, and economic insecurity. The U.S. trade embargo, imposed after Sudan was designated as a state sponsor of terror, has served only to deepen wealth inequality in Sudan while empowering Al-Bashir’s brutally repressive military regime to hoard the nation’s wealth and operate with total impunity.

Since 2000, more than 360,000 Sudanese people have immigrated to the United States, like my parents did. Many people arriving at our borders today have been directly impacted by U.S. foreign policy.

Only a few years after the bombing of the Al-Shifa pharmaceutical plant, the administration of President George W. Bush launched the catastrophic “War on Terror.” In the years since 9/11, some half a million people have been killed as a consequence of U.S. wars in Afghanistan, Iraq, and Pakistan alone. Another 21 million people in Afghanistan, Iraq, Pakistan, and Syria have become displaced. Today, the U.S.-led “War on Terror” spans 76 countries.

Iraq remains one of the top 10 countries of origin for permanent immigrants to the U.S. annually. In fact, seven of those 10 countries have been subject to violent foreign intervention by the U.S. or crushing economic blockades and sanctions, including Cuba, the Philippines, Vietnam, and El Salvador. Nevertheless, if the public charge rule is implemented in its current form, 60 percent of Central American immigrants and 34 percent of African immigrants would be at high risk of denial.

This is not an accident — it is part of the plan to base our immigration system on white supremacy. The president has made that explicit in his language, and in his broader immigration policies.

Consider what happened with Trump’s very first immigration policy. In January 2017, the administration issued its infamous Muslim Ban, temporarily banning entry of immigrants from my parents’ homeland of Sudan, along with six other majority-Muslim nations. Every country on that list had been subject to violent foreign intervention by the U.S., a fact first pointed out by Sen. Chris Murphy (D-CT).

Shortly after the ban went into effect, I hurried to Dulles International Airport to provide translation for those impacted. Within an hour, I was approached by a Sudanese father and his young family. I learned that they had been granted an opportunity to immigrate to the U.S. through the Diversity Visa Program, the same program my parents had used in the 1980s (and which the Trump administration has also tried to get rid of).

The father was afraid for his family and asked me to help him arrange their flight back. If they left, they would almost certainly never be able to return, so I pleaded with him to stay and seek legal support. But as he looked around at the chaotic scene unfolding in the airport, this young father of two remained unconvinced. He gripped his wife’s hand and left.

I never learned what became of him, but I still remember his parting words: “I can’t bring my family to a country that doesn’t want us.”

Immigration policy that ties admissibility solely to a person’s perceived economic and social worth is inherently violent. We cannot at once claim to be the world’s moral authority, while entrenching ableism and white supremacy through exclusionary policies at home and imperialist violence abroad. My family has carried the weight of these policies for decades, and millions more will be devastated if the Trump administration has its way.

The rule proposed by the United States Citizenship and Immigration Services would require most immigrants seeking green cards to show that they have a middle-class income: specifically, more than 250 percent of the federal poverty line (about $62,750 for a family of four). Immigrants could also fail the test if they have received government benefits, including Medicaid and Medicare Part D, in the past or if officials feel they are likely to receive them at any point in the future. The test would also penalize use of the Supplemental Nutrition Assistance Program (SNAP, formerly known as food stamps) and housing assistance programs.

Researchers at the consulting firm Manatt found the proposed changes could drive disenrollment from Medicaid, even for people who are lawfully in the United States, eligible for coverage, and wouldn’t be subject to the public charge rule, because they fear running afoul of the new requirements. Similar fears are already pushing eligible immigrant families off SNAP, especially those in “mixed status” households that include lawful residents, citizens, and/or undocumented people.

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Overall, the researchers estimate public charge could affect 13.2 million immigrants on Medicaid, including 7.6 million children, who consume nearly $70 billion in Medicaid and Children’s Health Insurance Program services annually.

When people begin to unenroll from Medicaid, the rise in uninsured people who still need health care will lead to fewer Medicaid reimbursements and a corresponding increase in uncompensated care costs. That will be particularly hard on rural hospitals, in part because rural communities rely more heavily on Medicaid coverage than their urban counterparts due to the lower number of other insurance options and high poverty rates.

While the majority of immigrants in the United States live in urban areas, they are making up an increasing share of rural communities. When rural hospitals experience even a relatively small drop in income from losing these patients, Manatt researcher April Grady notes that it “can have an outsized impact.”

Texas, California, and Nevada could see particularly acute chilling effects for their immigrant residents in both urban and rural areas if the public charge rule is approved, thanks to their large immigrant communities. Texas is already struggling with hospital closures, where changes to Medicaid policy, along with the state’s refusal to expand the program, have hit rural facilities hard.

Sharita Thomas, a research associate with the North Carolina Rural Health Research Program (NCRHRP), observed that there have been 90 rural hospital closures since 2010, many in the South, with more on the horizon. 68 percent of rural hospitals vulnerable to full closure are Critical Access Hospitals, which are facilities that are at least 35 miles away from other hospitals, maintain 24/7 emergency care, and meet several other criteria to receive unique benefits designed to make them more financially stable, including cost-based Medicare and in some cases Medicaid reimbursement.

When the sole hospital in a rural community closes, it forces patients to search further afield for care, a particular concern with obstetrical and emergency treatment. It also has a wider negative economic impact. “In rural communities,” said George Pink, Deputy Director of the NCRHRP, “the hospital is the largest or second-largest employer in the region. When that source of employment goes away, there are often ripple effects.” This can extend to companies considering relocation but reluctant to do business in an area that lacks a hospital or doesn’t provide sufficient hospital services, depriving rural regions of economic opportunities.

Even if hospitals facing budget constraints don’t close, they could start cutting programs, with labor and delivery a frequent early target. When cuts fail to achieve the desired goal and get more drastic, a floundering hospital may ponder a merger with another health care entity. Hospital mergers in urban and rural areas alike are rapidly accelerating, with 102 in 2016 alone and a comparable number in 2017. Many of the hospital chains gobbling up smaller competitors are Christian, with the Catholic hospital system in particular expanding rapidly and cutting off access to reproductive health services in the process.

Public charge could have another unintended consequence on rural hospitals, where physicians from immigrant backgrounds make up an important component of health care access. Many rural communities are counting on immigrants to meet health care provider shortages, offering incentives to those willing to work in underserved communities. Physicians have already warned that the executive order restricting entry from majority-Muslim countries is detrimental to health care access in the U.S. and this rule could be another deterrent.

Determining the impact of public charge on rural hospitals “really is a bit of a numbers game,” said Grady, but it’s a game that the federal government has been unwilling to play. She added that while the proposed rule hints at issues like people being afraid to seek emergency care and mixed-status households withdrawing from benefits, it declined to provide estimated fiscal and social impacts.

“There’s administration hurdles that are not fully explored in the proposed rule,” she said.