We asked for workers, but they sent us men (and women, too)

Denying Medicaid-funded prenatal care to undocumented immigrants.

Denying Medicaid-funded prenatal care to undocumented immigrants. Cross-listed at The Century Foundation’s Taking Note section

I happen to be an immigration moderate. It seems a bit crazy to me that we handle birthright citizenship the way that we do, and that we don’t have a credible national ID card system to enforce immigration law. If there is a humane, intellectually coherent, administratively effective, politically feasible pathway to decent immigration policies, I haven’t seen it. One tragedy of the last decade has been the failure of such disparate figures as George W Bush, John McCain, Ted Kennedy, and Barack Obama to forge a sensible compromise.

The enemies of such a sensible policy continue to be an odd combination of hypocrisy across the political spectrum, xenophobia within the Republican base, and employers’ powerful desire to legally or illegally employ compliant and productive low-wage workers. There is also the unstated–but possibly correct–belief held by many people that the human and economic costs of our current muddle would be worsened if our dysfunctional political system now attempted to meet the challenge of comprehensive immigration reform.

Postscript: For further administrative details (including its harmful effects on low-income women legally authorized to be in the country), see Table 7 of this Voices for Children issue brief.

Maybe we’re better off tackling this issue a decade from now, when the Latino vote is more powerful than it is today, and (if we are lucky) the American body politic is less polarized and more accepting of race/ethnic diversity than it is right now.

There’s only one problem with this suggestion: We are making too many good people suffer along the way.

We continue to ask unauthorized residents: Please harvest our fruit, pack our meat, mind our children and our elderly parents, cut our grass, and build our houses. Oh yeah: While you are doing this, please don’t use our emergency rooms if you get hurt. Don’t use our public services that your taxes support. Don’t become an open participant in the civic life of the community in which you may have lived for many years.

One human consequence of such policies was brought home by Nebraska reporter JoAnne Young in the Lincoln Journal Star (h/t Matthew Yglesias and Andrea Nill of Thinkprogress). A year ago, Nebraska eliminated Medicaid funding for about 1,600 low-income pregnant women. About half of the affected women are undocumented.

Because of such policies, many women left uninsured must travel great distances to receive care. The costs of such care is then absorbed by safety-net providers willing to treat them. Many of the affected women receive no prenatal care at all. Several babies have apparently died in this group. I can’t really tell from the story whether the new policy is to blame for these deaths. I can say such bullying policies are a disaster for Nebraska’s maternal and child health system.

During the 1980s, Henry Waxman and other policymakers realized that one couldn’t promote the health and well-being of pregnant women or their children while millions of pregnant women went uninsured. Nor could one have an effective and properly financed maternal and child health system when labor and delivery was the largest single item of uncompensated care.

Prenatal care is the gateway to almost every essential intervention during the relatively short period of pregnancy. When women don’t present for care until very late in pregnancy, perhaps during active labor itself. There is little opportunity to address poor maternal nutrition, gestational diabetes, maternal tobacco use, sexually-transmitted infections, genetic issues, domestic violence, and more. It’s even difficult to carefully plan the logistics of the delivery itself. So many women, their families, and their providers have a more harrowing, sometimes dangerous experience than needs to occur.

Such financial and delivery-system realities led to the Medicaid eligibility expansion of the 1980s and early 1990s, one of the most admirable and successful health policy initiatives in recent decades. Responding to the real and alleged problems associated with undocumented immigrants, and responding to Medicaid budget challenges that affect many states, states such as Nebraska are tarnishing this admirable record by enacting punitive measures.

The infants born less healthy than they could be, under more difficult circumstances than need be, are American citizens. They deserve better. So do their families, who are here contributing to our society and to our economy. Everyone in America deserves better, too. For many practical reasons, these policies are foolish and counterproductive.

More than that, in bullying and mistreating the desperate strangers we have invited here to do difficult and menial work, we diminish ourselves. We are better than that. At least I hope so.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect, tnr.com, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

14 thoughts on “We asked for workers, but they sent us men (and women, too)”

  1. Hypocrisy! You betcha. I think a fruitful way to look at this is the Rich People’s Party versus the Party of the Middle and Working Class. The Rich People’s Party is Nancy Pelosi and Trent Lott and George Bush and Barbra Streisand: they get their lawns mowed and their kids’ butts wiped. The dishes get washed in the restaurants they go to. They like having lots of compliant people to do it, and it’s really even better if those people can’t vote or demand better treatment. The Party of M&WC is African-Americans who used to be able to get day labor jobs in front of the local paint store and now are underbid by illegals, and Tea Party-ists and working people who mow their own lawns but their wages are depressed by competition from illegals.

    Both the Dems and the Reeps have a lot of influence at the top by their rich people – maybe the Dems more than the Reeps, despite rhetoric – and both are dealing with disaffection from their M&WC members.

  2. Dave Schutz,

    The Rich People’s Party is Nancy Pelosi and Trent Lott and George Bush and Barbra Streisand

    Would you say all four of these people and their various well-off ideological allies, are equally likely to endorse Nebraska’s actions? Do you think African-Americans, on the whole, would do so?

  3. Harold: “…It seems a bit crazy to me that we handle birthright citizenship the way that we do,…”

    What’s crazy about it?

  4. Good question Barry. I’m not sure I have a well-defined answer.

    It seems to me that if we were to write the 14th Amendment from scratch in this day and age of easy travel, citizenship would arise from some continuing attachment to American society, something more than being born on U.S. soil. I’m not sure what the standard would be, since we would not want to create a class of stateless persons or a group of people who lived in America their entire lives and were considered noncitizens.

  5. “. . . we would not want to create a class of stateless persons or a group of people who lived in America their entire lives and were considered noncitizens.”

    Are you sure? Maybe, you wouldn’t, but if you think that’s a universal opinion, like, say, the idea that torture is immoral, then, you haven’t been paying attention.

  6. Just a historical note: the 14th amendment was passed, because the U.S. had a large group of people within its borders, who lived their entire lives here, and were considered noncitizens, who had no rights a white man was bound to respect.

  7. I am aware of that history. It may well be a very bad idea to “write the 14th Amendment from scratch in this day and age” given the possibility that we will end up with something very bad. It’s still a bit counterintuitive that someone can fly into LAX from another country, have a baby, and have that baby conferred U.S. citizenship by virtue of being born on U.S. soil.

  8. Just sayin’ but there’s a real problem with denial of prenatal care and the life-begins-at-conception crowd. (Unless you think that’s pretty much a canard for public consumption.)

  9. Harold Pollack says:

    “It’s still a bit counterintuitive American that someone can fly into LAX from another country, have a baby, and have that baby conferred U.S. citizenship by virtue of being born on U.S. soil.”

    Fixed that for ya.

    And you really don’t sound like you are aware of the history of the 14th amendment, or of what can happen in places where citizenship is highly restricted, so that people can be born and grow up in a country, and still not be citizens.

  10. Touche, Barry! That is indeed a distinctively American policy in which we can be proud. Query: any other liberal democracies follow this policy?

  11. Who knows?

    And Harold, are you actually not aware of the current move to disenfranchise as many hispanics as possible right now?

  12. “I happen to be an immigration moderate.”

    When I saw that, I thought, “ha! Poor bast**d.” You know what they say – no good deed goes unpunished. I hope you are wearing a helmet as you get hit from both sides … for the foreseeable future.

    In fact, this whole bipartisanship thing reminds me of that old joke about the guy shoveling a large pile of manure, looking for the pony.

    I am an immigration moderate too. If people want to shut the border, go ahead and shut it. But I don’t want to see *any* enforcement based on racial profiling inside this country, unless the person committed a violent crime. Employer sanctions, well that’s fine. But I have Latino friends (citizens) who got harassed going to *Arizona* from California. [Insert joke about why anyone would ever do that.]

    And that was before 9/11. So I am completely uninterested in giving any more ground to this whole round-them-up insanity. And this is one issue that makes me think seriously about taking a walk on this administration. They are literally worse than the Bushies. So, that’s my version of moderation.

  13. Maybe whats counterintuitive is that people living on one side of an invisible political boundary called a border live under one political system and government with a prevailing standard of living that is so wholly different than that which prevails on the other side of that border. Its all so arbitrary that nothing other than being born here could stand up to rational examination.

  14. I’m a puerto rican american for lack of better description ..and I’m appalled by the outright treason against the constitution..and screw ppl who dont follow our laws as we americans get screwed..screw the dream act.what would happen to you if were caught in another country illegally..especially mexico..they’d ransom you or the embassy wpuld have to intervene..obama is a corporate shill and the democrat party has been hijacked by greenheads and commies…long live the republic…and welfare never helps ppl achieve wealth..

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