The United States is presently experiencing growing restrictionist attitudes toward immigration and illegal aliens.(1) American citizens are becoming furious over what they perceive as a drainage of public funds being used to provide health care and other services to illegal aliens.(2) Because of this fury, measures are being considered that will actually end up being counterproductive in the long run.(3) Denying health benefits and other prevent those immigrants infected with contagious diseases from entering the country.
II. BACKGROUND ON IMMIGRATION
America began as a land open to all, but has since struggled to remain open and preserve the national bounty for those already here.(9) Since 1875, Congress has been placing restrictions on immigration.(10)
Despite this history, the Clinton administration has recently attempted a more moderate immigration policy.(11) In 1993, a new commissioner was appointed to the Immigration and Naturalization Service (INS) who advocated "control with compassion."(12) Recently, the administration passed measures to increase border themselves, rather than waiting to apprehend illegal aliens after they have already entered the country.(18)
Illegal immigrants enter the country in many different ways, including entering without inspection or entering fraudulently or through misrepresentation.(19) There are many different opinions on the actual number of illegal aliens in this country. One study based on the 1980 census and INS records concluded that approximately two million illegal aliens were included in the 1980 census count.(20) Some reports propose that as many as three to eight million illegal aliens currently reside in this country.(21)
Immigrants come to the United States for various reasons. Reasons for immigration have been termed "push-pull" factors.(27) The "push" factors encourage immigratnts to depart their countries of origin, while the "pull" factors attract illegal aliens to the United States.(28) Past public policies, national migrant communities within the United States, and U.S. foreign policy during the Cold War are some factors which played a role in encouraging immigration to the United States.(29) However, as one commentator explains, "there is no broad, or simple, explanation for ... migration."30
The federal government constantly struggles to protect national interests by proposing stricter immigration laws.(31) States may, and do, propose economic regulations which limit aid to immigrants to protect welfare interests.(32) States reserved the police power to protect property and the public's health and welfare.(33)
California's Proposition 187 is one example of such state legislation. Proposition 187 reflects the growing anti-immigrant sentiment across the country.(34) These anti-immigrant attitudes appear to arise mostly from economic factors.(35)
Opinions range from the view that immigrants assist the economy by creating jobs to the opposing views that assert immigrants steal jobs from citizens and soak up social services.(36) For example, in California, a significant portion of the public blames illegal immigrants for state ills such as unemployment, high taxes, urban decay, and crime.(37)
In a speech to the House of Representatives, Representative Barbara Vucanovich of Nevada pleaded for stricter immigration measures with this same anti-immigrant attitude:
Whereas, The United States government social
budget increased from over $778 billion in 1991 to more
than $859 billion in 1992, due largely to the increase in
the number of illegal aliens, thus over-burdening our
national, state and local health, welfare and educational
Whereas, Some immigrants, including illegal
aliens, unlike those of the past, now decline to assimilate,
and demand the right to vote and to have ballots
written in their own language; and
Whereas, our nation, which is experiencing an
increase in terrorism, lacks adequate safeguards insuring
immediate hearings and deportation of immigrants
without proper credentials or documentation, and few
facilities for detention where appropriate or for the
monitoring of undocumented aliens seeking political
Whereas, Admission of immigrants with
communicable diseases, such as tuberculosis and AIDS, result
in health problems of epidemic proportions and the care
of the infected and contagious aliens adds to our disease
control problems and strains the health care
systems . . . .(38)
In 1990 it was estimated that illegal aliens cost taxpayers $5.4 billion in public assistance.(39) Dr. Donald Huddle, an economist from Rice University, completed a study on the costs of immigration.(40) Dr. Huddle concluded that 19.3 million legal and illegal immigrants have settled here since 1970 and have cost $42.5 billion in public assistance in 1992, while only paying $20.2 billion in taxes.(41) Dr. Huddle also estimated that the number of immigrants that have arrived in this country since 1970 will increase to 30.4 million by the year 2002.(42) This increase will cost the public $668.5 billion in 1993 dollars, with an average of $67 billion each year.(43) Dr. Huddle estimated that the 1992 illegal immigrant population of 4.8 million carried public assistance and displacement costs of $11.9 billion net of the taxes they paid.(44) For the decade from 1993 to 2002, he estimated that the net cost for illegal immigrants would be $186.4 billion.(45) Between 1993 and 2002, illegal immigrants will cost $221.5 billion in public assistance and displacement costs.(46) Regarding jobs, Dr. Huddle suggested that in 1992, 2.07 million U.S. workers were displaced from jobs by immigrants, which cost $11.9 billion.(47) He estimated the cost of job displacement for the 1993-2002 decade to be $171.5 billion.(48)
Some see Dr. Huddle's study as radical, but many others come to similar conclusions on the economics of illegal immigrants.(49) Illegal immigrants cost San Diego County $206 million in services, while contributing only $60 million in taxes.(50) In 1997, the state of California asserted that it spent over $2.4 billion providing education and health care to illegal aliens, and on incarcerating illegal aliens who committed crimes within the state.(51)
Many defenders of immigration argue that because illegal immigrants are not qualified to receive many of the social services, they contribute more in taxes than they consume.(52) In facts, some argue that immigrants use less social services than native-born citizen.(53) Some see immigrants as a positive social and economic contribution to this country.(54)
Despite these claims, there remain very strong anti-immigrants attitudes throughout this country. As the late Texas Congresswoman Barbara Jordan observed in April 1994, the "heightened anti-immigrant sentiment . . . is so discernible and identifiable that you can almost smell it."(55) A national survey in 1993 reflected anti-immigrant sentiment by finding that sixty percent of those interviewed perceived immigration negatively while only twenty percent viewed immigration favorably.(56)
III. Legislation Against Providing Health Care
Economic and social hardships in the United States have caused some U.S. citizens to blame immigrants.(57) These anti-immigrant attitudes have in turn led to recent legislation which attempts to eliminate social services to immigrants.(58) This legislation is common ground for immigration advocates and reformists who agree that the federal government is not fulfilling its responsibility of paying for the services being provided.(59)
For example, at common law, in non-emergency situations, patients do not have rights to receive health care.(60) In emergency situations, however, health care provides are required to provide care.(61) Hospitals are also bound by the Hill-Burton Act(62) to treat indigent patients if the hospital receives funding through the Act. (63) More than one-half of the hospitals in the United States received construction funds under the Hill-Burton Act, and therefore are required to provide some care to indigents.(64)
Many states and counties voluntarily elect to provide free health care. States are free to provide these benefits pursuant to Maher v. Roe,(65) but the manner in which the states provide in the benefits remains subject to constitutional limitations.(66) Many states specifically exclude illegal aliens from their free non-emergency health care.(67) However, in the opinion of at least one court of appeals,(68) pregnant low-income illegal aliens are entitled to Medicaid benefits for the prenatal care of their future citizen children.
Providing this health care has put a drain on many states' finances, and several of these states have sued the federal government for reimbursement for services provided to illegal aliens. In 1980, San Diego County sued for the previous three and one-half years.(69) In 1986, El Paso billed the federal government ten million dollars for medical care provided to illegal aliens by its country hospital.(70) Recently Arizona,(71) California,(72) Florida,(73) New Jersey,(74) New York,(75) and Texas(76) sued to force the federal government to pay for the cost of providing health care and other services to illegal aliens. On April 11, 1994, Florida filed a suit against the federal government for reimbursement for providing social services to illegal aliens over the past decade.(77) Governor Lawton Chiles said that "[t]he federal government should bear the financial responsibility for its actions and should pay for the cost of refusing to protect Florida's borders,"(78) San Diego County Supervisor Brian Billbray went so far as to say that the federal government is "the biggest deadbeat dad in the nation when it comes to paying for this problem."(79)
One story epitomizes the reason for the anger that many feel due to the growing problem of illegal immigrants taking advantage of state-provided social services:
An ambulance pulled up outside Sharp Memorial
Hospital in San Diego on Sept. 4, 1991, with a
42-year-old Hispanic man named Hermillo Meave inside.
Despite that he was being transferred with a
chronic heart problem from a hospital in Tijuana,
Mexico, Mr. Meave gave the hospital a San Diego address
and claimed he worked in the area as a gardener with
Since he could produce a California identification
card and a Medi-Cal number that entitled him to
treatment under the California health care system, Mr.
Meave was ruled eligible for admission by a
hospital-based Medi-Cal worker -- meaning that virtually all of
his expenses would be paid by the state.
Me. Meave immediately began an elaborate and
extremely expensive course of treatment. The day after he
was admitted, surgeons implanted a pump to keep his
heart beating until a donor organ could be found. For
five months, Mr. Meave waited on the transplant until a
heart was secured for him.
Despite the suspicions of Medi-Cal fraud
investigators -- that he was not, as he claimed, a U.S.
resident -- Mr. Meave's application for a heart transplant was
approved and in February 1992 he received a new heart.
Then the truth came out. "What Mr. Meave did was
construct an incredibly elaborate fraud .... He had
everybody fooled. ... Then reality of the situation is that
should never have been approved for a transplant."
The bill for Mr. Meave's care: $1 million.(80)
Anti-immigration legislation, like Proposition 187 for example, was specifically initiated to combat these problems of non-reimbursement from the federal government.(81) The people of California felt as though they "have suffered and are suffering economic hardship caused by the presence of illegal aliens in [their] state."(82) The measure was intended to prevent illegal aliens from receiving benefits or public services and to provide a system where illegal aliens could be identified and reported to the federal government.(83)
Under Proposition 187 a person is not to receive public social services until their legal status has been verified as a citizen of the United States, "an alien lawfully admitted as a permanent resident," or an "alien lawfully admitted for a temporary period of time."(84) It also places the responsibility on the provides of social services by requiring:
If any publicly-funded health care facility in this
state form whom a person seeks health care services ...
determines or reasonably suspects, based upon the
information provided to it, that the person is an alien in
the United States in violation of federal law ...
(1) The facility shall not provide the person with
The public service entity instead must notify the alien of his or her illegal status, advise the person that they must either obtain legal status or leave the United States, and notify the State Director of Health Services, the Attorney General of California, and the INS of the person's apparent illegal status.(86) Section 6 of Proposition 187 specifically prohibits publicly-funded health care to illegal aliens, but it recognizes and makes an exception for the emergency medical care that is required by federal law.(87)
California's Proposition 187 was passed by the voters in November of 1994 by a margin of fifty-nine percent to forty-one percent.(88) The measure was a voter-initiated referendum process propelled by a group called "Save Our State."(89) However, immediately after Proposition 187 passed, its opponents obtained an injunction from Federal District Judge Mariana Pfaelzer in Los Angeles, preventing its implementation.(90) Most of the provisions of Proposition 187 were struck down on constitutional grounds, but, as of yet, no higher court decision has been made.(91)
Measures like Proposition 187 have added fuel to the fire of the immigration debate.(92) Some have found such measures to be morally repugnant.(93) Other groups say it encourages discrimination against Hispanics.(94) Twenty-two other states are currently proposing legislation very similar to Proposition 187.(95) A group in Orlando, Florida, in particular, seems to be following in the footsteps of California's Save Our State coalition.(96) The Florida group, also called the Save Our State Committee,(97) was created with the aim of cutting off education, welfare, and other public services to illegal aliens.(98) The group was working on a proposed constitutional amendment so that the issue could be put before voters.(99) Although the Florida Department of State approved the proposed ballot, the committee was required to obtain 43,000 signatures by August 1996.(100) If all signatures had been gathered and approvals obtained, the proposition would have been on the ballot for the November 1996 election. However, the group fell far short of raising the required signatures.(101)
The measure was similar to Proposition 187 in that it would have denied education and government services to illegal aliens, but it was not as harsh because it allowed illegal immigrants children access to non-emergency health care.(102) The measure also would have allowed an eight month grace period to allow illegal immigrants to apply for legal residency status.(103)
Florida is fertile ground for anti-immigrant legislation because it surpasses both California and New York in its percentage of foreign-born Hispanics -- nearly seventy percent.(104) The Florida committee made arguments similar to those of the California Save Our State coalition.(105) In fact, Robert Kiley, a consultant with the California group, worked closely with the Florida group.(106) The group argued that illegal immigrants drain public funds for social services, that immigrant control is not working,(107) and that "[s]tates are paying the price of ineffective enforcement of federal law."(108)
Even though Governor Chiles unsuccessfully sued the federal government for reimbursement of state monies spent on illegal aliens,(109) he did not support California's proposed constitutional amendment.(110) The Governor believed such a measure would be counterproductive, in spite of a study by his administration which revealed that illegal aliens cost Florida $884 million a year for public education, jails, and health care costs.(111) Governor Chiles does not want to curtail public services, but instead wants the federal government to pay for them.(112)
Other states with large illegal alien populations such as Arizona, Florida, New Mexico, and Texas do not seem to be supporting Proposition 187-type measures.(113) For example, an Arizona businessman launched a campaign similar to the Save Out State groups in California and Florida, but it deteriorated after he could not find adequate support.(114) Arguably this lack of support is due to Arizona's hopes of increasing its trade with Mexico.(115) Because support for these Proposition 187-type measures makes trade relationships difficult, the business community refuses to support them.(116) The same is true for communities in Texas where many border towns rely on business with Mexico for their livelihood.(117) The trade relationship between Mexico and Texas, because it has such a long history, has shaped attitudes toward immigration.(118) Some also feel that Texas would never succumb to a Proposition 187-typee measure because Texas does not have the referendum process which could put such a measure before voters.(119) In Texas, such a measure would have to be initiated in the legislature, and because Hispanics make up seventeen percent of the state's senators and almost one-third of its representatives,(120) obtaining support would be difficult.
Still, many others believe that voters in Texas and other states with a large immigrant population would support such measures.(121) These people are concerned that if such legislation can pass in California, then it can also pass in Texas.(122) El Grupo de Apoyo a Immigrantes Latinoamericano (GAILA), a North Texas immigrant-rights organization, called for a boycott in Texas of California products.(123) Texas governor George W. Bush said h does not think Texas needs a measure like Proposition 187.(124)
New Jersey, even though it is not as populated with illegal aliens as California, Texas, and Florida,(125) is also experiencing support for anti-immigrant legislation.(126) State Senator Leonard Connors is sponsoring legislation aimed at cutting off public benefits to illegal immigrants.(127)
California and other states which are considering anti-immigrant legislation are experiencing social and economic turmoil. Citizens of those states have taken desperate measures to deal with the perceived causes of their problems.(128) Communities that are economically stagnate are more vulnerable to anti-immigrant attitudes and this type of legislation.(129) In fact, an initiative co-founder said to the people at an Orange County gathering "[y]ou are the posse ... and [Save Our State] is the rope."(130) They consider the publicly provided benefits of the United States to be one of the "pull" factors influencing illegal immigrants to cross the borders into this country.(131)
The problem is that these anti-immigrant activists are misguided. Proposition 187 and other anti-immigrant measures will not prevent immigrants from coming to this country.(132) According to many immigrants, free education, health care, and other social services are not the factors that "pull" them to this country.(133) Instead, it it the drive to find a job, work hard, and to make a better life for themselves that convinces immigrants to illegally cross the border.(134) Illegal immigrants "come here for job or to escape onerous conditions in their own countries ... [a]nd until we fix that, we're not going to fix our problem."(135) Proposition 187 does not directly address jobs, which are "considered by scholars and other authorities to be the principal lure" for illegal immigrants.(136) Even some proponents of Proposition 187 agree that jobs are the magnet for illegal immigrants.(137)
Fair Florida to All is a group that is countering the actions of the Save Our State Committee in Florida.(138) The group launched a campaign to stop Proposition 187-type legislation and argued to the public that those types of measures are not the way to handle the problem of illegal aliens.(139) Sister Ann Kendrick, a member of the Fair Florida campaign, said that many people do not understand the entire issue of illegal immigrants and the reasons immigrants come here.(140) She stresses that Florida's 187 would not have worked.(141) It would not have addressed control of the border or the lure that jobs create.(142) In her view, immigrants do not arrive or leave because of the presence or lack of public services.(143) A 187-type measure "just punishes poor women and children in an effort to stem immigration."(144)
Wendy Zimmerman, a research associate at the Urban Institute in Washington, agrees that the public does not understand all the factors involved in immigration.(145) Instead, she says people find only a superficial appeal to these measures.(146) Immigrants are striving to reach the U.S. border, regardless of what types of anti-immigrant measures are passed.(147) Their decision to come to this country is usually a result of a personal weighing of the negative factors of their home countries and the positive attractions of the United States.(148) Illegal immigrants are going to stay in this country, and more will continue to pour in; this i not going to change because of anti-immigrant policies.
The passage of Proposition 187 is not causing fear in the minds of U.S.-bound immigrants.(149) Immigrants say the obstacles to immigration lie in crossing Mexico to get to the United States.(150) They say the California proposition pales in comparison to what they must face in their trek to the United States(151) The immigrants disregard Proposition 187 and other similar legislation as deterrents to illegal entry into the United States.(152) In comparison to the threats of Mexican officials and the threats in their own homes, "the prospect of landing in California without free education or health services seems almost laughably acceptable."(153) The people of the United States should not believe that this type of legislation will keep illegal immigrants away.(154) "Nobody cares about 187. You go wherever you can to find work .... You don't risk your life going to the United States just to get free education."(155) Immigrants will continue coming to this country as long as there is a way for them to find work here.(156)
IV. Contagious Diseases in the Immigrant Population
Anti-immigrant measures are the result of the rage over being burdened with having to care for illegal aliens. People recognize that immigrants may come to this country with many needs, and thus they are costly to the states in which they settle.(157) One of the most prevalent and costly factors is the high rate of contagious disease infection among the immigrant population.(158)
Those involved in migratory behavior are often the
poorest, those with the least education, and those with
the highest levels of illiteracy, who must contend with
poor, temporary housing. This forces too many already
stressed and sometimes ill individuals into very close
proximity in an environment that increases the
likelihood of disease transmission .... This population is at
very high risk for health problems.(159)
Immigration is a catalyst to disease like tuberculosis, which spreads easily by air and thrives in urban, overpopulated environments.(160) "Tuberculosis is, around the world, the single largest cause of death from disease today ... and it just keeps getting worse and worse ...."(161) Health officials have seen that many of the tuberculosis patients in the United States originate from third-world countries.(162) As one official said, "[i]n those countries, someone with tuberculosis could be infected as a small child. Only 10 percent of the people who are initially infected go right into active disease. They carry sort of a time bomb in their system."(163)
Los Angeles County, which has a large number of immigrants, also has one of the highest rates of tuberculosis.(164) Sixty-six percent of tuberculosis patients there were found to be foreign-born.(165) In Houston, the INS found that forty percent of the illegal immigrants that were deported tested positive for tuberculosis.(166) Other infectious diseases that have been problematic in the Mexican border areas are rabies, dengue fever, and sexually transmitted disease, including the human immunodeficiency virus (HIV).(167)
The tuberculosis rate among immigrants is almost four times the rate for native residents of the United States.(168) A study performed by several researchers for the Centers for Disease Control and Prevention (CDC) found that the proportion of foreign-born people infected with the disease is on the rise.(169) From 1986 through 1993, 195, 186 persons were diagnosed with tuberculosis and reported to the CDC.(170) In 1986, 21.6 percent of those diagnosed with tuberculosis were foreign-born, and the estimated rate of foreign-born people with tuberculosis was 27.1 per 100,000.(171) In 1993, the rate increased to 29.6 percent of those diagnosed with tuberculosis being foreign born, and the incidence rate of tuberculosis in foreign-born people climbed to 33.6 per 100,000.(172) The rate of infection for U.S.-born people remained constant during the entire eight year study period at about 8.1 per 100,000.(173) From 1986 through 1992, the number of foreign-born cases of tuberculosis increased by 2345, or forty-eight percent, and accounted for sixty percent of the total increase in the number of cases in the United States.(174) Researchers have attributed these increases to the higher rates of tuberculosis infection in the immigrants' countries of birth.(175) States with the greatest increase in tuberculosis cases from 1985 through 1992 were the states with higher immigrant populations: California, Florida, New Jersey, New York, and Texas.(176) The researchers also found that the distributions of increased tuberculosis cases from 1985 through 1992 were closely correlated with reported cases of AIDS.(177)
According to another study, immigrants were found to be a significant factor in causing the increase of new cases of tuberculosis in the United States.(178) Researchers found that of 4840 illegal aliens applying for adjustment status with the INS who were tuberculin skin tested, 2039 (forty-two percent) tested positive.(179)
The U.S. government has recognized that immigrants seeking entry into this country have high rates of tuberculosis and other infectious diseases.(180) Under the Immigration Act,(181) an alien may be denied permanent immigration status if he or she has a communicable disease of public health significance.(182) There are currently eight diseases on this list, including tuberculosis, HIV, leprosy, and syphilis.(183) The INS is authorized to test potential entrants for these communicable diseases before allowing them into the country.(184)
AT least one member of Congress believes that legislation against immigration is not the best way to deal with the problems of AIDS and immigrants.(185) "If we scare [immigrants] away from public health clinics, we are doing no one a public health service."(186) Instead, "scaring them away" from receiving health care may actually exacerbate an already dangerous situation.(187) Public health officials predicted that with the passage of Proposition 187 would also come an increase in cases of tuberculosis, measles, mumps, rubella, polio, and diphtheria.(188)
Anti -immigrant legislation such as Proposition 187 has resulted in illegal aliens not receiving vital health care.(189) Even though a temporary restraining order was immediately placed on Proposition 187,(190) thousand of fearful immigrants have refrained from seeking medical aid and attending their appointments at California clinics.(191) One report stated that hospital outpatient clinics and nonprofit community facilities reported ten to twenty percent declines in patient visits during the weeks after the passage of Proposition 187.(192) Four Los fifty to seventy-five percent during the days immediately after 187 was passed.(193) Some centers even reported a ninety percent drop.(194) It seemed that many illegal immigrants understood that the people of California voted to deport all the illegal aliens.(195) Based on the figures, it is clear that illegal aliens feared being reported to the immigration authorities by their health care providers.
These delays in seeking health care are already having casualties.(196) A pregnant woman scheduled for a prenatal exam would not leave her house for fear that a van outside was on immigration service vehicle.(197) In another case, a grade school boy was afraid enforcement agents would be alerted if his parents took him to a hospital, and he subsequently died of leukemia.(198) Some reports stated that delayed health care has resulted in two leukemia deaths, worsened psychiatic conditions, and untreated pneumonia cases.(199) However, it is those who contract communicable diseases from untreated illegal aliens that are the casualties many Americans find most alarming.(200)
Tuberculosis is one of the contagious diseases that may increase because of policies deterring patients from seeking care.(201) Some health care professional contend that such anti-immigrant measures would increase the number of tuberculosis cases.(202) They conducted a study to see if patients with tuberculosis delay seeking care because of fear of immigration authorities.(203) The results of their study revealed that twenty percent of the tuberculosis patients in the study lacked legal residency documents.(204) Six percent of the symptomatic patients reported that fear of immigration authorities had delayed their care.(205) "More than 47% of those who cited fear of immigration authorities delayed more than 60 days .... Respondents who feared immigration authorities were almost four times as likely ... to delay seeking care."(206) The researchers found that the tuberculosis patients may have exposed themselves to an average of ten contracts during their delay in seeking care.(207) Most of the patients did not know of their tuberculosis infection until they sought care for one of the symptoms.(208) The study concluded by saying: "If future research confirms our findings, any policies that increase undocumented immigrants' fear that health care professionals will report them to immigration authorities may exacerbate the current tuberculosis epidemic."(209)
Even if anti-immigrant legislation allowed for emergency care for illegal aliens, this would not alleviate the problem.(210)
Any increase in the fear of immigration authorities that patients experience when seeking medical care is likely to increase the delay between onset of symptoms and first contact with the medical care system. Because each patient possibly exposes an average of ten contacts to the disease during the course of delaying care, such an increase would spread tuberculosis beyond those who delay.(211)
The Department of Health Services of Los Angeles County observed that illegal immigrants are scared to seek health care and will delay diagnosis and treatment of communicable diseases.(212)
The illegal immigrant most often is fearful of coming to public notice, lives in poverty and substandard, over-crowded and unhygienic living conditions and often, if not always, is economically depressed. All these factors predict not only high disease levels, but also, delayed diagnosis and treatment of those diseases, and when they are communicable, spread to other persons.(213)
The fears illegal aliens have of being reported by health care providers are well-founded in some areas. In Hawaii, for example, the director of health has the duty to assist the U.S. government in the deportation of illegal aliens who are admitted to the state's hospitals.(214)
Physicians and health officials have concluded that one way to attack the tuberculosis epidemic and other disease in the United States is to lower the barriers to health care for immigrants.(215) Prevention is the key to reducing the spread of contagious diseases such as tuberculosis.(216) Illegal aliens must have access to health care so that they may be screened for communicable diseases and treated. In the long run treatment for illegal aliens, will be cost-effective because it will actually halt the spread of disease to others.(217) Spending dollars now to prevent the spread of disease will cost less than treating patients in the future.(218)
In order to combat illegal immigrants' fears of being deported, many hospitals have initiated campaigns to encourage patients to continue receiving the health care to which they are entitled by law. For example, a clinic in Los Angeles posted signs on its doors stating: "No questions asked."(219) Other clinics held news conferences in Spanish to encourage patients to keep their appointments.(220) One announcement urged parents to take their sick children in for treatment and claimed they would not be turned away, while another announcement encouraged pregnant immigrants to seek prenatal care.(221) A San Francisco hospital trained volunteers to act as escorts for immigrants who were apprehensive about presenting themselves for health care.(222) Another San Francisco hospital displayed a banner with hospital employees' signatures saying they would resist Proposition 187.(223) These hospitals were sensitive to the dangers to public health that a lack of care would cause.
Denying care to illegal aliens has been called a "public health nightmare" not just for illegal aliens, but for everyone.(224) Communicable diseases will have to be contended with by all. "Southern California is dependent on the labor of illegal immigrants .... The fact is if those folks get sick, they have contact daily with all of us, and refusing to treat them only makes all of us sicker."(225) Hundreds of thousands of illegal immigrants work in fields and restaurants with the food we eat.(226) Thus, controlling communicable diseases among illegal aliens would be facilitated by immunization and early detection efforts.(227)
Public health benefits were originally maintained regardless of citizenship status because the attempt to head off infectious diseases ultimately costs less by preventing or treating illnesses at early stages, rather than waiting until after the illnesses had already become acute.(228) Because provisions like Proposition 187 prohibit all health care except emergency services, some fear it may put a burden on hospital emergency care.(229) "A medical need that is not responded to early becomes an emergency ...."(230)
One Los Angeles prenatal clinic recognized the drop in clinic visits by illegal aliens and took swift action.(231) A hospital van gave frightened patients door-to-door service, and the clinic distributed ten thousand flyers in Spanish and English that read: "[W]e are open for business as usual. Proposition 187 does not impact our promise to care for all members of the community."(232) When prenatal care is not administered, the result is actually an even bigger strain on the economy.(233)
Dr. Pauline Rosenau, of the University of Texas Health Policy Institute, said it is naive to believe that it is economically efficient to provide emergency care but not preventive care, prenatal care, and regular medical treatment.(234) It will only hurt those financially responsible in the end.(235) Because public health providers know the ramifications of anti-immigrant measures, Dr. Rosenau said they are in favor of providing care, regardless of legality.(236) The problem facing the United States is that these ramifications need to be recognized by the voting public.
The only way to deal with the illegal immigrant problem is to tighten the borders, not to cut off social services. Even proponents of Proposition 187, such as California Governor Pete Wilson, agree that the federal government needs to control the borders in order to solve the problem.(237) Dr. Rosenau said this policy of continuing health care is being held hostage because it is a not political issue.(238) Those voting public does not realize that it is the right position. With simplistic propaganda like: "Those who support illegal immigration are, in effect, anti-American,"(240) it is harder for politicians to explain to their constituents why they supported aid to illegal immigrants rather than why they opposed it.(241) With attitudes like this, the United States will continue to see a rise in cases of communicable diseases and increased costs of emergency care for treatment of immigrants. Medical treatment and disease control for immigrants are actually the most cost-effective actions the United States could take in dealing with illegal immigrants already in this country.(242)
The United States, with the North American Free Trade Agreement (NAFTA),(243) has taken steps to slow migration from Mexico to alleviate the problems with illegal aliens.(244) This has removed a "push" factor.(245) The hope is that Mexican workers will no longer look to the United States for employment opportunities because of increase job opportunities in Mexico.(246)
Some believe, however, that the NAFTA will not reduce the incentives for immigrants coming to the United States, but instead, will exacerbate the situation.(247) The NAFTA accentuates urban, residential areas, and those conditions which increased the likelihood of transmission of infectious diseases.(248) Some argue that a rise in illegal immigrants will result because the NAFTA will increase jobs along the border areas and Mexican workers will see that conditions are better in the United States.(249) Proponents of the NAFTA argue that the stimulation of the Mexican economy resulting from free trade will deter immigrants from coming to the United States.(250) If that is true, public health in the United States will improve, and a decrease in expenditures on health care will result.
It remains clear that denying health care to illegal immigrants is not the way to resolve the problem the United States in facing. Nonetheless, some public officials continue working on anti-immigrant measures.(251) Even with increasing expenditures on health car, politicians are continuing the fight against providing social services to illegal immigrants.(252) The U.S. House of Representatives recently passed a bill curbing court challenges to voter-initiated measures.(253) The bill requires a three-judge panel, rather than a single federal judge, to allow injunctions on state referenda.(254) Because injunctions would bypass the District Courts, the bill speeds up Supreme Court review if an injunction is granted.(255) This demonstrates that measures such as Proposition 187 are not only still alive, but will continue to burden this country.
California's Proposition 187, even though is has been stayed, has shown, and will continue to demonstrate, that cutting off health care to illegal aliens is not the way to handle increasing spending on health care. Such measures will only exacerbate an already threatening situation.
The number of illegal immigrants entering the United States is high and climbing rapidly. These individuals come to the United States for many reasons, but most importantly they come for job opportunities. Health care is not a "pull" factor, nor will the halt of health care "push" immigrants away. As one doctor said, "[t]hose supporting 187 say, 'They shouldn't be here.' But they are here."(256)
It is true that illegal immigrants have cost taxpayers significant amounts of money in social services. Because of the rage many citizens feel over having to pay for services for those illegally in this country, Proposition 187 passed. Furthermore, despite an injunction placed on Proposition 187, at least twenty-two other states are initiating similar measures. What the supporters of these measures do not realize is that preventing health care for illegal aliens hurts everyone. Anti-immigrant legislative proposals affect illegal immigrants by scaring them away from seeking care, even services to which they are allowed.
Immigrants have high rates of contagious diseases, and "[c]ontagious diseases ... do not check for immigration status."(257) These disease will spread to many others, including citizens, if immigrants are not provided adequate treatment. Expenditures on emergency health care and health care for citizen-children will similarly increase without preventive care for illegal immigrants. Ultimately, the protection of the health of all persons living in the United States and a decrease in health care expenditures can be attained by providing health care to illegal immigrants. In the long run, ignoring illegal immigrants' health needs actually fosters the spread of preventable diseases and exacerbates the economic burdens created by public health care needs.
(1.) See Linda S. Bosniak, Membership, Equality, and the Difference that Alienage Makes, 69 N.Y.U. L. Rev. 1047, 1048-49 (1994); Christopher Mitchell, International Migration as an Issue on Today's Inter-American Agenda, J. INTERAM. STUD. & WORLD AFF., Fall 1994, at 93,94.
(2.) See Gayle Hanson, Illegal Aliens Strain an Ailing U.S. System; California Seeks Change in Federal Policies Requiring Health Care, WASH. TIMES, Apr. 12, 1994, at A5 (citing examples where illegal immigrants in California have lied about their status or citizenship to receive medical care): Patrick J. McDonnell, Prop. 187 Heats up the Immigration Debate, L.A. TIMES (Wash. ed.), Aug. 10, 1994, at B1 ("Illegal aliens are killing us in California . . . .")
(3.) See, e.g., Cal. Proposition 187 (1994) (codified as CAL. EDUC. CODE [sections]48215, 66010.8 (West Supp. 1996); CAL. GOV'T CODE [section]53069.65 (West Supp. 1996); CAL. HEALTH & SAFETY CODE [section]130 (West Supp. 1997); CAL. PENAL CODE [sections]113, 114, 834b (West Supp. 1997); CAL. WELF. & INST. CODE [section] 10001.5 (West Supp. 1997)).
(4.) See Matthew T. McKenna et al., The Epidemiology of Tuberculosis Among Foreign-Born Persons in the United States, 1986 to 1993, 332 NEW ENG. J. MED. 1071, 1074 (1995) (stating that the top five countries of origin of immigrants to the United States between 1986 and 1993 were Mexico, the Philippines, Vietnam, China, and Korea and that "the tuberculosis incidence rates in these countries are 10 to 30 times greater than in the United States").
(5.) See id. at 1071 (stating the number of reported cases of tuberculosis in the United States was 14% higher in 1993 than in 1985). But see Malcolm Ritter, Number of New TB Cases Falls to Lowest Level Since the 1950s, HOUS. CHRON., Mar. 25, 1997, at 4A (reporting that new tuberculosis cases dropped to the lowest level since record-keeping began in the 1950's).
(6.) See Sana Loue, Access to Health Care and the Undocumented Alien, 13 J. LEGAL MED. 271, 276 (1992).
(7.) For a discussion of information concerning the legal justifications for providing social services to illegal aliens, see Bosniak, supra note 1 (analyzing the relationship illegal aliens have to the United States, and examining the debate over immigration
(8.) See Note, Unenforced Boundaries: Illegal Immigration and the Limit of Judicial Federalism, 108 HARV. L. REV. 1643, 1644-45 (1995); Hanson, supra note. 2.
(9.) See Peter H. Schuck, The Transformation of Immigration Law, 84 COLUM. L. REV. 1,2-3 (1984); Developments in the Law -- Immigration Policy and the Rights of Aliens, 96 HAVR. L. REV. 1286, 1289 (1983) [hereinafter Developments].
(10.) See Act of March 3, 1875, ch. 141, 18 Stat. 477 (repealed 1974). For a summary of the history of immigration laws as related to this topic, see Cynthia Webb Brooks, Comment, Health Care Reform, Immigration Laws and Federally Mandated Medical Services: Impact of Illegal Immigration, 17 HOUS. J. INTL'L 141, 145-49 (1994).
(11.) See Mitchell, supra note 1, at 101. Recently, however, a hard-line approach has been taken with welfare reform whereby the federal government passed measures limiting services to immigrants, including many health services. See Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub. L. No. 104-193, 110 Stat. 2105 (1997). Congress made the following statements of national policy concerning welfare and immigration:
(1) Self-sufficiency has been a basic principle of United States
immigration law since this country's earliest immigration statutes.
(2) It continues to be the immigration policy of the United States that --
(A) aliens within the Nation's borders not depend on public resources
to meet their needs, but rather rely on their own capabilities and
the resources of their families, their sponsors, and private
(B) the availability of public benefits not constitute an incentive for
immigration to the United States.
(3) Despite the principle of self-sufficiency, aliens have been applying for and receiving public benefits from Federal, State, and local governments at increasing rates.
(4) Current eligibility rules for public assistance and unenforceable financial support agreements have proved wholly incapable of assuring that individual aliens not burden the public benefits system.
(5) It is a compelling government interest to enact new rules for eligibility and sponsorship agreements in order to assure that aliens be self-reliant in accordance with national immigration policy.
(6) It is a compelling government interest to remove the incentive for illegal immigration provided by the availability of public benefits. Id. [section]400, at 2260; see also id. [section]403, at 2265 (placing a five year limit on federal benefits to qualified aliens); id. [section]411, at 2268 (limiting state and local benefits to aliens); id. [section]412, at 2269 (authorizing states to determine eligibility for state public benefits).
(12.) Mitchell, supra note 1, at 101.
(13.) See Illegal Immigration Reform and Immigrant Responsibility Act of 1996, Pub. L. No. 104-208, Div. c, tit. I, 110 Stat. 3009,__ (1997) (to be codified at and amending scattered sections of 8 U.S.C. and 18 U.S.C.); Violent Crime Control and Law Enforcement Act of 1994, Pub. L. No. 103-322, [section] 130006, 108 Stat. 1796, 2028 (to be codified as 8 U.S.C. [section] 1101 note).
(14.) See Illegal Immigration Reform and Immigrant Responsibility Act of 1996 Div. c, secs. 321-334, 110 Stat. at __ (amending scattered sections of 8 U.S.C and 18 U.S.C.); Violent Crime Control and Law Enforcement Act of 1994 [sections] 130002, 130004, 108 Stat. at 2023, 2026 (to be codified as 8 U.S.C. [section] 1252 note and amending 8 U.S.C. [section] 1252a, respectively); see also Immigration and Nationality Technical Corrections Act of 1994, Pub. L. No. 103-416, secs. 223-224, 108 Stat. 4305-24 (amending 8 U.S.C. [section] 1252a).
(15.) See Illegal Immigration Reform and Immigrant Responsibility Act of 1996 Div. c. sec. 604, 110 Stat. at __(amending 8 U.S.C. [section] 1158); Violent Crime Control and Law Enforcement Act of 1994 [section] 130005, 108 Stat. at 2028 (to be codified as 8 U.S.C. [section] 1158 note).
(16.) See Illegal Immigration Reform and Immigrant Responsibility Act of 1996 Div. c., tit. IV, 110 Stat. at__(amending 8 U.S.C. [sections]1324,1304
(17.) See H.R. REP. NO. 103-387, at 3-4 (1993), reprinted fin 1994 U.S.C.C.A.N. 3516, 3516.
(18.) See Mitchell, supra note 1, at 101; see also Brooks, supra note 10, at 152.
(19.) See 8 U.S.C. [section] 1251(a)(1)(B)-(G) (1994) (defining deportable aliens).
(20.) See Loue, supra note 6, at 273.
(21.) See id. at 274, A report by Senator Reid suggests that there are four million aliens permanently residing here illegally. See 139 CONG. REC. S11,997 (daily ed. Sept. 20, 1993).
(22.) See id. There are 3800 border patrol agents employed to enforce the borders but in 1992 alone, the United States had over 500 million enteries. See id. "Thirty-eight hundred people cannot control 500 million. This does not take into consideration much of the other paperwork that the agents have to deal with." Id.
(23.) See Terese Hudson, Cutting Off Care: California's Drastic Reaction to Illegal Immigrants Doesn't Play Well in Other State, HOSP. & HEALTH NETWORKS, June 20, 1995, at 38, 38.
(24.) See id.
(25.) See 139 CONG. REC. h4436 (daily ed. July 1, 1993) (statement of Rep. Burton) (introducing DONALD HUDDLE, THE NET NATIONAL COSTS OF IMMIGRATION (1993) into the record). This study may be obtained from Carrying Capacity Network, 1325 G. Street N.W., Suite 1003, Washington D.C. 20005-3104, (202) 296-454).
(26.) See Doborah Sontag, 3 Governors Take Pleas on Aliens to the Senate, N.Y. TIMES, June 23, 1994, at B7. In 1994, the INS estimated the illegal alien population at 3.85 million. See id.
(27.) See Brooks, supra note 10, at 148.
(28.) See id.
(29.) See Mitchell, supra note 1, at 95.
(31.) See Brooks, supra note 10, at 149-52
(32.) See id. at 152.
(33.) See Medtronic, Inc. v. Lohr, __ U.S. __, 116 S. Ct. 2240, 2245 (1996) ("Throughout our history the several States have exercised their police powers to protect the health and safety of their citizen.").
(34.) See Cal. Proposition 187 sec. 1.
(35.) See Brooks, supra note 10, at 162-64.
(36.) See id. at 155-56.
(37.) See Mitchell, supra note 1, at 99-100.
(38.) 139 CONG. REC. E1896 (daily ed. July 27, 1993).
(39.) See 139 CONG. REC. H4436 (daily ed. July 1, 1993) (statement of Rep. Burton) (citing HUDDLE, supra note 25).
(40.) See Donald HUDDLE, Executive Summary of HUDDLE, supra note 25.
(41.) See id. at 1.
(42.) See id. at 2.
(43.) See id.
(44.) See id. at 1.
(45.) See id. at 4.
(46.) See id. at 2.
(47.) See id. at 5.
(48.) See id.
(49.) See Patrick Lee, Studies Challenge View That Immigrants Harm Economy, L.A. TIMES, Aug. 13, 1993, at A1. But see Huddle, supra note 40, at 5 ("[T]he net impact of immigration is so difficult to calculate that data can be marshaled to support diametrically opposed views.").
(50.) See Lee, supra note 49.
(51.) See California v. United States, 104 F.3d 1086, 1090 (9th Cir. 1997), petition for cert. filed, No. 96-1596 (Apr. 7, 1997). The state asserted that it spent $2.4 billion in education and health care benefits to illegal aliens. See id. at 1090.
(52.) See 136 CONG. REC. H8718 (daily ed. Oct. 3, 1990) (statement of Rep. Miller).
(53.) See id.
(54.) See id.; see also Lee, supra note 49.
(55.) Roberto Suro, New Voice in Immigration Debate, WASH POST, Apr. 13, 1994, at A15.
(56.) See Mitchell, supra notes 1, at 100.
(57.) See supra note 37 and accompanying text.
(58.) See, e.g., Cal. Proposition 187.
(59.) See Lee, supra note 49.
(60.) See Loue, supra note 6, at 278-79.
(61.) See 42 U.S.C. [section] 1395dd (1994).
(62.) Hospital Survey and Construction (Hill-Burton) Act, Pub. L. No. 79-725, 60 Stat. 1040 (1946). This Act operates under the federal government's spending power certain amount of uncompensated care. See Barry R. Furrow et al., Health Law: Cases, Materials and Problems 628-29 (2d ed. 1991).
(63.) See Hospital Survey and Construction Act sec. 622(f).
(64.) See Loue, supra note 6, at 281.
(65.) 432 U.S. 464 (1977) (upholding the State of Connecticut's decision to pay medical expenses incidents to childbirth while providing funding for abortion expenses only when the abortion is "medically necessary").
(66.) See id. at 469-70.
(67.) See Loue, supra note 6, at 295.
(68.) See Lewis v. Grinker, 965 F.2d 1206, 1221 (2d Cir. 1992).
(69.) See County of San Diego v. Castillo, No. 79-0827-GT (S.D. Cal. Feb. 5, 1980).
(70.) See Loue, supra note 6, at 274.
(71.) Arizona v. United States, No. 94-0866 (D. Ariz. Apr. 18, 1995), aff'd, 104 F.3d 1095 (9th Cir. 1997), petition for cert. filed, No. 96-1596 (Apr. 7, 1997).
(72.) California v. United States, No. 94-0674-K (S.D. Cal. Mar. 3, 1995), aff'd 104 F.3d 1086 (9th Cir. 1997), petition for cert. filed, No. 96-1596 (Apr. 7, 1997).
(73.) Chiles v. United States, 874 F.Supp. 1334 (S.D. Fla. 1994), aff'd, 69 F.3d 1094 (11th Cir. 1995), cert. denied, ___ U.S. ___, 116 S. Ct. 1674 (1996).
(74.) New Jersey v. United States, 91 F.3d 463 (1996).
(75.) Padavan v. United States, No. Civ.A.94-CV-1341 (N.D. N.Y. Apr. 18, 1995). aff'd, 82 F.3d 23 (2d Cir. 1996).
(76.) Texas v. United States, No. B-94-228 (S.D. Tex. aug. 7, 1995), aff'd, 106 F.3d 661 (5th Cir. 1997).
(77.) See Chiles, 874 F. Supp. at 1335.
(78.) Hanson, supra note 2.
(80.) Id. (second alternation in original).
(81.) See Cal. Proposition 187 sec. 1.
(83.) See id.
(84.) Id. sec. 5 (codified as Cal. Health & Safety Code [section] 130(b) (West Supp. 1997)).
(85.) Cal. Health & Safety Code [section] 130(c) (West Supp. 1997).
(86.) See id. [section] 130(c)(2)-(3). Proposition 187 also required exclusion of illegal aliens from public elementary and secondary schools, as well as public institutions providing post-secondary education. See Cal. Proposition 187 secs. 7, 8 (codified as Cal. Educ. Code [subsections] 48215(a), 66010.8(a) (West Supp. 1996)). It makes school districts responsible for verifying the legal status of each child upon their enrollment in that school district, the legal status of each child already enrolled in that school district, and the legal status of each parent or guardian of each child enrolled or enrolling in that school district. See Cal. Educ. Code [section] 48215(b)-(d) (West Supp. 1996). The school districts have the responsibility of providing information regarding anyone in violation of federal immigration laws to state and federal authorities. See id. [section] 48215(e). Also, Proposition 187 punishes the manufacture, distribution, or sale of false citizenship or resident alien documents. See Cal. Penal Code [section] 113 (West Supp. 1997).
(87.) See Cal. Proposition 187 sec. 6 (codified as Cal. Health & Safety Code [section] 130(c) (West Supp. 1997)); see also 42 U.S.C. [section] 1395dd (1994).
(88.) See League of United Latin American Citizens v. Wilson. 908 F.Supp. 755, 763 (C.D. Cal. 1995).
(89.) See McDonnell, supra note 2.
(90.) See League of United Latin American Citizens, 908 F.Supp. at 763-64. Judge Pfaelzer struck down the non-emergency health care provision of Proposition 187, but permitted the provision denying care to illegal aliens where the care is funded entirely by the state. See id. at 784-85.
(91.) See id. at 786-87, app. B at 791-94. The fate of Proposition 187 is unclear. For a discussion on the constitutionality of such a measure, see Randall Kyle Hawes, Comment, California Proposition 187: Will the Populist Mandate Survive Constitutional Scrutiny?, 37 S. Tex. L. Rev. 1391 (1996); Dan Stein, Entitlements for Undocumented Aliens -- Is California's Proposition 187 Constitutional? Yes: The Supreme Court Must Re-evaluate Existing Law, A.B.A. J., Feb. 1995, at 42. But cf. Herman Schwartz, Entitlements for Undocumented Aliens -- Is California's Proposition 187 Constitutional? No: The Law Is Clear, Only the Court Has Changed, A.B.A. J., Feb. 1995, at 43.
(92.) See Hudson, supra note 23, at 36, 38 (stating that such proposition are a slap in the face to immigrants because it assumes that those crossing the border come here for the public services, and not to work to make a better life for their families); McDonnell, supra note 2 ("Nationally, the vote may influence immigration discourse initiative have crystallized matters as varied as environmental policy and auto insurance.").
(93.) See Michael Miller, Anti-illegals Law Mired in Court a Year on, Reuters, Nov. 12, 1995, available in LEXIS, News Library, Curnws File.
(94.) See Rex R. Hoggard, Backers File Illegal-Aliens Amendment with State, Orlando Sentinel, May 4, 1995, at C3.
(95.) See Miller, supra note 93. For more discussion on other proposed measures similar to Proposition 187, see Elizabeth Landry, Note & Comment, State as International Law-Breakers: Discrimination Against Immigrants and Welfare Reform, 71 Wash. L. Rev. 1095 (1996).
(96.) See Hoggard, supra note 94.
(97.) See id.
(98.) See id.
(99.) See id.
(100.) See id.
(101.) See Mark Silva, Immigrant Amendment Supporters Aim at '98, Miami Herald, Aug. 9, 1996, at 5B.
(102.) See Hoggard, supra note 94.
(103.) See id.
(104.) See Hudson, supra note 23, at 38.
(105.) See id.
(106.) See Reena Shah Stamets, Groups Seek to Deny Services to Illegal Aliens, St. Petersburg Times, Mar. 4, 1995, at 4B.
(107.) See Hudson, supra note 23, at 38.
(109.) See Chiles v. United States, 874 F.Supp. 1334 (S.D. Fla. 1994), aff'd, 69 F.3d 1094 (11th Cir. 1995), cert. denied, 116 S. Ct. 1674 (1996).
(110.) See Hudson, supra note 23, at 38.
(111.) See id.; Stamets, supra note 106.
(112.) See Hudson, supra note 23, at 38.
(113.) See id. at 36.
(114.) See id.
(115.) See id.
(116.) See id.
(117.) See id. Two-thirds of non-government jobs in El Paso depend on business with the bordering city of Juarez, Mexico. See id. Texas reportedly exports $20 billion worth of goods to Mexico each year -- almost half of all United States-Mexican trade, whereas California only exports six million dollars to Mexico. See id. Texas also has more potential consumers in Mexico than does California. See id. Eight million Mexicans live in the four Mexican states bordering Texas and 64% of all Mexicans live within six hundred miles of Texas, while only two million Mexicans live in the Baja peninsula bordering California. See id. This, some argue, explains the difference in support for 187-type measures. See id.
(118.) See id.
(119.) See id.
(120.) See id.
(121.) See Maria F. Durand, Immigrant Proposal Spurs Memories of Tyler Case, Fort Worth Star-Tel., Nov. 4, 1994, at 1; Thaddeus Herrick, Most Texans Favor Illegal Immigration Laws, Hous, Chron., Nov. 4, 1995, at A29 ("Sixty-one percent of Texans say the state should pass similar legislation, baring undocumented immigrants from public schools, non-emergency health care and social services.").
(122.) See Durand, supra note 121.
(123.) See 2 Texas Groups Urge Boycott of Products from California, Fort Worth Star-Tel., Nov. 18, 1994, at 4.
(124.) See id; see also Herrick, supra note 121.
(125.) See supra notes 25-26 and accompanying text.
(126.) See Michelle Ruess & Kathleen O'Brien, N.J. Senate Oks Denying Benefits to Illegal Aliens. Record (N. N.J.), Oct. 20, 1995, at A1.
(127.) See S. 207-38, 1st Ann. Sess. (N.J. 1996); A.B. 207-1003, 1st Ann. Sess. (N.J. 1996); Ruess & O'Brien, supra note 126.
(128.) See. e.g., Cal. Proposition 187.
(129.) See Hudson, supra note 23, at 38.
(130.) McDonnell, supra note 2.
(131.) See id.
(132.) See Interview with Mark Quangthanh, Immigrant from Vietnam, in Houston, Tex. (Jan. 6, 1995).
(133.) See Tod Robberson, Mexico Denounced As Anti-Migrant, Wash. Post, Dec. 20, 1994, at A1.
(134.) See id.
(135.) Geri Aston, Hospital Join the Fight, AHA News, Jan. 9, 1995 (guoting David Langness, Hospital Council of Southern California spokesman).
(136.) McDonnell, supra note 2.
(137.) See id. Drafters of the proposition say it is the most they could do with California law, and what they really wanted to do with the proposition was just send a message to Capitol Hill and the White House. See id.
(138.) See Hudson, supra note 23, at 38.
(139.) See id.
(140.) See id.
(141.) See id.
(142.) See id.
(143.) See id.
(145.) See id
(146.) See id
(147.) See Robberson, supra note 133.
(148.) See Loue, supra note 6, at 273.
(149.) See Robberson, supra note 133.
(150.) See id.
(151.) See id. It is typical for migrants to suffer from the threat of rape, extortion, and other abuses at the hands of Mexican authorities. See id. One migrant said, "[i]mmigration is like a business to the Mexican." Id. It seems those migrating from Mexico agree that Mexico is the most difficult country to get through. See id.
(152.) See id.
(154.) See id.
(156.) See id.
(157.) See McDonnell, supra note 2.
(158.) See Michael P. Cantwell et al., Epidemiology of Tuberculosis in the United States, 1985 Through 1992, 272 JAMA 535, 536 (1994) ("Twenty-two percent of US [tuberculosis] cases were foreign-born in 1986, increasing to 27% in 1992."); Peter L. Reich, Jurisprudential Tradition and Undocumented Alien Entitlements, 6 Geo. Immigr. L.J. 1, 3 (1992).
(159.) Pauline Vaillancourt Rosenau et al., Health and Health Policy Consequences of Nafta after the Devaluation of the Peso 18-19 (1995) (citation omitted).
(160.) See Ed Timms, Far From Beaten, TB Kills 3 Million People a Year, Times-Picayune, Jan. 1, 1995, at A16.
(161.) Id. (first alteration in original) (quoting Dr. Joseph Bates, President of the American Lung Association).
(162.) See id.
(163.) Id. (quoting Gerry Burgess, a senior Tarrant Country, Texas, health official).
(164.) See id. (stating that in Los Angeles County the per capita tuberculosis rate is double the national average).
(165.) See id.
(166.) See 140 Cong. Rec. S9557 (daily ed. July 22, 1994) (statement of Sen. Hutchison). Ten percent of these cases were active and contagious. See id.
(167.) See Loue, supra note 6, at 276 n.25. The actual status of immigrants entering the United States infected with these diseases is unknown. See id.
(168.) See McKenna et al., supra note 4, at 1072 (stating that the incidence rate for foreign-born persons was 33.6 per 100,000 compared to 8.1 per 100,000 from the period 1990 to 1993).
(169.) See id.
(170.) See id.
(171.) See id.
(172.) See id.
(173.) See id.
(174.) See Cantwell et al., supra note 158, at 536.
(175.) See id. at 537.
(176.) See id. at 537, 538 fig. 4. California has the highest number of reported cases of tuberculosis. See McDonnell, supra note 2.
(177.) See Cantwell et al., supra note 158, at 538.
(178.) See Raymond N. Blum et al., Results of Screening for Tuberculosis in Foreign-born Persons Applying for Adjustment of Immigration Status, 103 Chest 1670, 1670 (1993).
(179.) See id. at 1671 & tbl.1.
(180.) See supra note 166 and accompanying text.
(181.) 8 U.S.C. [subsections] 1101-1525 (1994).
(182.) See id. [sections] 1182(a)(1)(A)(i) (1992).
(183.) See 42 C.F.R. [section] 34.2(b) (1997).
(184.) See 8 C.F.R. [section] 234.2 (1997) (requiring medical examinations for adjustment of status of aliens); see also 42 C.F.R. [subsections] 34.1-34.4 (1997) (describing medical examinations of aliens).
(185.) See 139 Cong. Rec. H1204 9daily ed. Mar. 11, 1993) (statement of Rep. Waxman).
(187.) See, e.g., On the Front Lines, Hosp. & Health Networks, June 20, 1995, at 40, 40 (describing some negative effects Proposition 187 has had in California even before implementation).
(188.) See Illegals in Calif. Avoid Clinics, Com. Appeal (Memphis), Nov. 12, 1994, at 11A [hereinafter Illegals]; McDonnell, supra note 2.
(189.) See Immigrants Wary of Clinic Visits, Wash. Post, Nov. 27, 1994, at A4.
(190.) See supra note 90 and accompanying text.
(191.) See Immigrants Wary of Clinic Visits, supra note 189.
(192.) See id.
(193.) See Illegals, supra note 188.
(194.) See Rebecca Voelker, Impact of Proposition 187 is Difficult to Gauge, 273 JAMA 1641, 1641 (1995).
(195.) See, e.g., Illegals, supra note 188.
(196.) See Katie Leishman, The '187' Voters Only Wanted to Scare You, Star Trib., Nov. 18, 1994, at 25A.
(197.) See id.
(198.) See On the Front Lines, supra note 187, at 40.
(199.) See Voelker, supra note 194, at 1643.
(200.) See Steven Asch et al., Does Fear of Immigration Authorities Deter Tuberculosis Patients from Seeking Care?, 161 W.J. Med. 373, 376 (1994).
(201.) See id.
(202.) See id. at 373 ("Public health authorities and physician groups have expressed concern that legislation requiring providers of publicly funded services to report illegal immigrants to immigration authorities will delay curative care for infectious diseases and exacerbate the tuberculosis epidemic.").
(203.) See id.
(204.) See id. at 374 tbl. 1.
(205.) See id. at 375.
(207.) See id. at 376.
(208.) See id. at 375. Seventy-one percent were diagnosed with tuberculosis when seeking care for a symptom; 15% were diagnosed when they sought care for another medical condition. See id. (209.) Id. at 376. Supporters of Proposition 187 dismissed this report as being "scare tactics."
(210.) See id. at 376.
(212.) See Loue, supra note 6, at 275.
(213.) Testimony of Shirley L. Fannin, M.D., Chief, Acute Communicable Disease Control Preventive/Public Health, Department of Health Services, County of Los Angeles, California, to the Henry A. Waxman Subcommittee on Health and the Environment, Communicable Disease Trends in Los Angeles County (mar. 1981).
(214.) See Haw. Rev. Stat. Ann. [section] 336-1 (Michie 1996).
(215.) See McKenna et al., supra note 4, at 1075.
(216.) See Blum et al., supra note 178, at 1672.
Successful prevention requires access of patients to the health care system, adequacy of the screening tests, and appropriate use of preventive therapy. Screening of the foreign born is a cost-effective program likely to favorably influence tuberculosis morbidity in the future and to aid in achieving the goal of the elimination of tuberculosis.
Id. at 1673 (footnote omitted).
(217.) See id. (discussing isoniazid preventive therapy and its cost).
(218.) See id.; McDonnell, supra note 2; Timms, supra note 160.
(219.) Illegals, supra note 188.
(220.) See id.
(221.) See Aston, supra note 135.
(222.) See id.
(223.) See Voelker, supra note 194, at 1643 caption.
(224.) See Aston, supra note 135.
(225.) Id. (quoting David Langness, spokesman for the Hospital Council of Southern California).
(226.) See McDonnell, supra note 2.
(227.) See Janet M. Calvo, Alien Status Restrictions on Eligibility for Federally Funded Assistance Programs, 16 N.Y.U Rev. L. & Soc. Change 395, 429-30 (1987-88).
(228.) See McDonnell, supra note 2.
(229.) See Aston, supra note 135.
(230.) Id. (quoting Lilly Spitz, assistant general counsel for the California Association of Hospitals and Health Systems, Sacramento). It is bad fiscal policy to provide emergency care as the only avenue of health care to illegal aliens because emergency care is the most expensive and least available form of health care. See id.
(231.) See On the Front Lines, supra note 187, at 40.
(232.) Id. (alternation in original) (italicized in original).
(233.) See id. "[C]onventional wisdom on prenatal care says that every dollar invested saves $3 after birth ...." Id. The health of the children throughout their lives is affected by the prenatal care their mothers receive. See Calvo, supra note 227, at 429. The additional expenditures will be paid for by taxpayers because when the child of the illegal alien is born in the United States, the child is a citizen and thus a charge of this country. See McDonnell, supra note 2. A large amount of public funds are spent providing health care to children of illegal aliens. See Hanson, supra note 2. Forty percent of all publicly funded births are to illegal aliens. See id.
(234.) Telephone Interview with Pauline Villancourt Rosenau, Researcher for the University of Texas-Houston Health Policy Institute (Dec. 17, 1995).
(235.) See id.
(236.) See id.
(237.) See Hanson, supra note 2.
(238.) See Telephone Interview, supra note 234.
(239.) See id.
(240.) McDonnell, supra note 2.
(241.) See Mitchell, supra note 1, at 100.
(242.) See McKenna et al., supra note 4, at 1075.
(243.) Dec. 17, 1992, Can.-Mex.-U.S., 32 I.L.M. 289, 605.
(244.) See Mitchell, supra note 1, at 106-07.
(245.) See Rosenau et al., supra note 159, at 16.
(246.) See Mitchell, supra note 1, at 99, 106-07.
(247.) Rosenau et al., supra note 159, at 21.
(248.) See id. at 19-20.
(249.) See id. at 22.
(250.) See id. at 23.
(251.) See, e.g., Personal Responsibility and Work Opportunity Reconciliation Act of 1996, tit. V; S. 207-38, 1st Ann. Sess. (N.J. 1996); A.B. 207-1003, 1st Ann. Sess. (N.J. 1996).
(252.) See, e.g., id.
(253.) See H.R. 1170, 104th Cong. (1995).
(254.) See id. [section] 1.
(255.) See id.
(256.) On the Front Lines, supra note 187, at 40 (quoting Dr. David Wood).
(257.) Health Care Wars, The Christian Century, Mar. 9, 1994, at 248, 248 (quoting Auxiliary Bishop John Ricard of Baltimore). [dagger] The author would like to thank Dr. Mark Kunik for assistance in choosing this topic.…