Racism in My Experience – Part 14
Immigration
Immigrants to America came in succeeding waves from England, Holland, France, Spain, and Africa, then later from Germany, Ireland, Scotland and Scandinavia, from Eastern and Southern Europe, from China and Japan, from Vietnam and Korea, from Central and South America, from Ethiopia and Somalia, from the Philippines and El Salvador. They have created and recreated, woven and rewoven our nation’s fabric. They brought their languages, religions, cultures, skills and communities and enriched our own. German Catholic and German Jewish and Irish Catholic immigrants played key roles in the development and culture of Cincinnati where I grew up.
We have a national ethos, a guiding myth and vision about welcoming the tired, the poor and hungry from all over the world, yearning to breathe free. We have a proud history of welcoming those fleeing religious and political repression. We have not always been true to our principles, see the voyage of the St. Louis (Voyage of the Damned) trying to bring Jewish immigrants to the US just before World War Two. Despite our important national myth, virtually none were welcomed by the dominant group upon their arrival, and all -- from the Irish and German Catholics, to the Russian and Lithuanian Jews, from the Catholic Poles and Italians, to the Chinese and Japanese Buddhists, and most recently Middle Eastern Jews and Muslims – had to develop survival skills to protect themselves and their communities in the face of nativist hostility which too often met them.
Our immigration laws, which were adopted in the 1920’s, favored immigration by those of Northern European ancestry and barred many others on explicitly racist grounds, particularly those seeking to immigrate from China, Japan and other Asian communities. That immigration preference for Aryan dominance ended for good during the 60’s when immigration policies were changed to emphasize skills-based immigration and family reunification.
Candidate, now President Trump and his Administration ran on an explicitly anti-immigrant and racist platform in 2016 and has done all that he can to advance these views and turn them into policy and practice. He would like to return to a policy favoring immigration of Northern European, high skilled immigrants and preventing family reunification immigration. Immigrants have been the engine of our economic growth, not a drag on it. https://knowledge.wharton.upenn.edu/article/economic-debate-immigration-reform/
Immigrants from Belgium and France were among my friends when I grew up in Cincinnati. We had students from Latin America in my high school and from Europe and Africa during college years. I was unaware that they experienced any forms of discrimination; in fact to me, they seemed welcomed into the community.
As a young lawyer, I first represented Haitian immigrants during the early 70’s. Haiti may have been the country of origin for some of my ancestors. As I spoke reasonably good French at the time, they came to me to understand and decipher their legal documents and American law, both of which they were totally unfamiliar with, making them easy prey for the unscrupulous. They came to the US fleeing the murderous Papa Doc Duvalier regime, supported by the US. They are now a very successful immigrant population. http://www.bostonplans.org/getattachment/63cf049b-f2b8-47a6-a81c-8a63dc8ca40b More recently 50,000 Haitian immigrants arrived after the devastating earthquake of 2010. President Trump is seeking to end their temporary or provisional refugee status and return them to Haiti, a nation, which he characterizes as a shithole country. https://www.migrationpolicy.org/article/haitian-immigrants-united-states-2018
I represented a wonderful young family who had fled a bloody Civil War in Africa, where their family and tribe had been targeted. They needed temporary assistance because the wife was sick and unable to continue her work as a nurse while she recovered. The local services office was of the opinion that as immigrants, they could not qualify for any help. I learned the ins and outs of the intersections between immigration and public coverage as we got their case resolved. We all became friends, and I learned of the great love and appreciation they had for our nation that had given them shelter from death in their homeland, and of the huge void of missing and longing they felt for family, village, tribe and their nation of origin (which was then in such murderous turmoil).
An American citizen who had previously lived in Peru for many years came to my office. She was taking care of her daughter in Boston and preparing to donate an organ to save her daughter’s life. The local hospital wanted $100,000 to perform the surgery unless she was eligible for the state’s Medicaid program. The local social services office had denied her coverage; they were of the opinion she was not a lawful resident of Massachusetts. The Supreme Court in Shapiro v. Thompson almost a decade earlier told states that the requisite residency for these programs was physical presence with intent to reside. After we got involved, she got the needed coverage.
In 1986, President Reagan signed immigration reform packages, known as IRCA and OBRA. IRCA provided a path to citizenship for long time undocumented residents of the US; OBRA provided federal funding and mandatory Medicaid coverage of emergency care and deliveries for undocumented otherwise eligible for Medicaid, but for their citizenship. In the fight for their implementation in California, we were able to increase covered benefits for prenatal care and for long-term care in nursing homes in addition to emergency care of the undocumented. About one million undocumented, low income, working families are now covered in California.
During the 90’s Congressional Republicans under the leadership of Newt Gingrich embraced a series of initiatives directed at minorities, women, and immigrants under the umbrella of tough on crime, tough on immigration, tough on reproductive rights, and tough on welfare. In 1996, President Clinton signed a welfare block grant bill https://en.wikipedia.org/wiki/Personal_Responsibility_and_Work_Opportunity_Act and an immigration reform package of legislation. https://www.law.cornell.edu/wex/illegal_immigration_reform_and_immigration_responsibility_act Earlier he signed a criminal justice measure with much tougher sentencing requirements for crimes involving drugs among many other provisions. https://en.wikipedia.org/wiki/Violent_Crime_Control_and_Law_Enforcement_Act and https://www.vox.com/2016/4/28/11515132/iirira-clinton-immigration
California’s then Governor Pete Wilson fathered three strikes laws for lifetime imprisonment, state ballot initiatives to deny education, health care and other publicly funded services for immigrants, a ban on affirmative action and the end of bi-lingual education as he positioned himself for a Presidential run in 1996 – a campaign that led with attacks on immigrants but never really got off the ground. https://www.motherjones.com/politics/1995/11/california-schemer-what-you-need-know-about-pete-wilson/ While this approach went nowhere for Pete Wilson’s presidential campaign and may have damaged Republican branding in California; it proved a golden path for Candidate Trump thirty years later.
In implementing the new welfare reform and immigrant care measures during the state legislative process, Governor Wilson had to compromise with Democratic legislative leaders. In California, the MediCal (Medicaid) program was significantly improved for the working poor and for legal immigrants, as it shifted from welfare program based eligibility to income based eligibility, and the five year waiting periods for full scope eligibility of legal immigrants were rejected. The federal courts enjoined implementation of Prop 187, holding that immigration is the purview of the federal government, not the states. https://www.aclu.org/press-releases/cas-anti-immigrant-proposition-187-voided-ending-states-five-year-battle-aclu-rights?tab=case&redirect=immigrants-rights/cas-anti-immigrant-proposition-187-voided-ending-states-five-year-battle-aclu-righ
At the very same time, Los Angeles County was deeply in the red and proposing to close some of its public hospitals and clinics to meet its very large budget deficits. LA was both the epicenter of the nation’s uninsured, and operated one of the largest public hospital systems in the nation, open to the poor regardless of their immigration status. It operated three large trauma centers, five emergency rooms, six comprehensive health centers, six hospitals and about thirty health clinics. About 1/3rd of the public hospital patients were uninsured and about 2/3rds of the public outpatient clinics’ patients were uninsured. An estimated 15-20% of the system’s uninsured outpatient clinic patients were undocumented working families. So if you are LA County, what facilities do you close? Those serving low income African Americans, those serving low income Latinos, or those taking care of the most severely disabled? Congressional Republicans were on a mission of destruction for any funding of care to the undocumented, and the Wilson Administration would not contribute any new funds. Working with the Clinton Administration, we found a new way to thread the financing needle and keep the county hospitals intact, using a §1115 waiver to pay for outpatient care to the uninsured and shifting management of the clinics away from the county to the non-profit community clinics. https://www.urban.org/sites/default/files/publication/61626/410295-Medicaid-Demonstration-Project-in-Los-Angeles-County---.PDF
A county hospital in the High Desert was transformed into a specialty outpatient center. The nationally renowned rehabilitation center for those with severe injuries was designated for sale to a non-profit; that never happened. The county was supposed to increase its outpatient services to keep people out of hospital emergency rooms; that also never happened. The takeover of the county clinics by the community clinics was a major improvement in timely access to appropriate care and cost efficiency. Several years later the MLK hospital, located in the heart of the African American community, was closed by the federal government as the conditions at the hospital had become too dangerous for patient safety. It was rebuilt as a not for profit community hospital, and so far it has improved care, conditions and safety for the low-income patients being served. An earthquake badly damaged the County-USC hospital, located in the center of the Latino community. After much controversy about the size of the replacement facility, it was rebuilt as a much smaller facility with a very large ER and trauma center. The new facility also improved care to the surrounding minority community. Was there racism involved in these decisions? I didn’t and still don’t think so, and I think the care to the community substantially improved by taking some decision-making authority away from the County Board of Supervisors and the LA County Department of Health and shifting it to community-based non-profits. The experience highlights the critical role public hospitals play in poor communities and the lack of adequate alternatives. Many of the large, financially strong, highly respected hospitals in the Los Angeles region were simply not that interested in expanding their services into poor immigrant communities. Further south in Orange and San Diego, the counties were explicit in denying coverage to undocumented workers and their families; the UC hospitals, which had earlier been public hospitals, were expanding their care to the privately insured and burnishing their credentials as academic medical centers; they were not interested at the time in developing better systems of care for immigrants.
The state of California began to shift its delivery system for low-income MediCal patients from a fee for service structure, just like Medicare. Each county negotiated with the state for the design of its new system. Counties with county hospitals preferred to operate their own public managed care plans. So the big question was what would happen to the minority doctors in these new systems. Would they be welcomed in the for-profit health plans like Blue Cross and Health Net? Would these plans open up their networks to the poor, the minorities, the immigrants? Would the facilities like UCLA or Cedars Sinai enthusiastically participate in or shun MediCal managed care. Would it destabilize the community clinics and community hospitals that saw and treated large volumes of minority patients, causing them to close their doors? How would the managed care plans, accustomed to the privately insured, respond to the large numbers of minority patients, how would they deal with immigrants, with those not conversant with the US medical system, with those whose primary language was other than English.
There were certainly many glitches and battles along the way and, while others will differ, I have felt it was a vast improvement. Many of the health plans, using their own financial resources, developed coverage for undocumented children. Some developed innovative cross-border coverage for Mexican immigrants working seasonally in California agriculture. Others developed pilots for mixed status immigrant families. There were no state legislative requirements or financial incentives for them to do so. In fact when we sought state funding for these initiatives, it took over 15 years of persistent advocacy before the California state legislature and Governor agreed to expand coverage for undocumented children and young adults. Over time and with pressure from advocates and the state legislature, the health plans developed better access to primary care, more translation services, and more culturally relevant and appropriate care for immigrant communities.
Over time in the early 2000s, the Bay Area counties, led by Alameda, San Francisco and Santa Clara developed better new models of care for the uninsured, explicitly including the undocumented. Under the leadership of Mitch Katz, Los Angeles County eventually followed the pioneers of the Bay Area. Finally in 2015-16, California government began to develop coverage that included the undocumented, uninsured – first children, then young adults.
Prepared by: Lucien Wulsin
Dated: 9/19/20