| ANNOTATIONS
Dave Lesher; Dan Morain, Care
for Disabled Illegal Immigrants Periled Health: due to Federal
Welfare Reform Bill, State is Set to Cut Off Government Aid For
These Nursing Home Patients in 30 to 60 Days. Wilson Aides Hope
to Find Alternative Public or Private Funding, Los Angeles Times,
Sept. 4, 1996.
About 200 illegal immigrants lost their nursing home care
because of the new welfare reform. Governor Wilson tried to
protect his reputation by trying to provide for these elderly
immigrants. However, Wilson's plans backfired because of
Proposition 187. The other alternative the Governor proposed was
to have the nursing homes absorb the cost. If not, then he
suggested that these immigrants be transferred to public
hospitals as emergency cases because the welfare reform did not
eliminate emergency services. It is ironic that the one bill that
the Governor proposed and signed is the very bill that was a
barrier to helping the immigrants. [Back]
Donna M. Greenspan, Florida's
Official English Amendment, 18 Nova L. Rev. 891, (1994).
Greenspan's article assists the reader in understanding what a
state's English-only law is like and what the implications are by
providing a historical background of the passing of the
amendment. Florida passed such an Amendment in 1988 with an
overwhelming majority; however, it has not been enforce. As a
matter of fact, the unenforcement is such that Dade County
repealed is 1980 English-only ordinance. Florida's English-only
Amendment was found constitutional, passing the strict scrutiny
test because it "lacks the requirement of de jure
discrimination." The author, however, points out that
despite its constitutionality, the Florida English-only Amendment
may cause serious problems in enforcement. Some of the possible
problems may conflict with the Equal Protection provision of the
14th Amendment, the First, Amendment, the 1964 Civil Rights Act,
an the 1965 Voting Rights Act. [Back]
Elizabeth Ellen Chilton,
Ensuring Effective Communication: The Duty of Health Care
Providers to Supply Sign Language Interpreters For Deaf Patients,
47 Hastings L.J. 871, (1996).
Title II of the Americans with Disabilities Act and Section
504 of the Rehabilitation Act "require recipients of federal
funds and operators of public accommodations to ensure 'effective
communication' with those whom they serve by providing
appropriate auxiliary aids and services, including qualified sign
language interpreters, to individuals with hearing
impairments." Even though this article does not deal with
Spanish-speaking or Chinese-speaking patients, but deals with
patients who "speak" American Sign Language, this
article is valuable for its in-depth look of the effect on health
care that inadequate communication may have. Like the deaf,
Non-English speaking patients should be able to have interpreters
available to them because their quality of care is similarly
impacted. Effective communication is key, regardless of the
language that constitutes the barrier to that communication. [Back]
Eric Bailey, Services
Not Key For Latinas in U.S. Illegally, Study Shows Immigrants:
Few Rely on Public Assistance, and Most Are Here to Stay.
Proposition 187
This is a very interesting article of it dissipates the myth
that illegal immigrants are coming to the \united States because
of the subsidized social services. The UC Irvine study has found
that the "use of public assistance ad preventive health
services was low. Furthermore, the study exposes indirectly the
antagonist attitude toward non-English speaking people as
evidence by the following quotes by Ezell who tries to discredit
the UC Irvine study. Ezell says that Leo Chavez, who conducted
the study "has obviously never been to any of the emergency
rooms in Orange County to see who's using them--it's
non-English-speaking young people with babies." He further
"added that if illegal immigrants 'really want to feel part
of the community, they ought to learn to speak English."
Ironically, the research showed that only 18% of undocumented
Latinas use government-sponsored medical program and that 84% of
them said "they felt part of a community in the United
States." Finally, "those with a regular source of
health care were 65% less likely than those without it to intend
to stay, a finding Chavez said might reflect a dissatisfaction
with the quality of care, language difficulties and uncovered
costs that prove a financial frustration." Once again, this
is an article that indicates that English-only laws would be a
disservice to this country as a whole. [Back]
Health Care Curbs Softened in
Immigration Compromise, Health Legis. & Reg. Wkly. (Pg.
Unavail. Online), Oct. 2, 1996.
It is not enough for Government to take basically all of the
benefits from illegal immigrants. Now, the Government, through
"a sweeping immigration policy overhaul" which became
law as of September 30, 1996 as "part of the FY 97 omnibus
spending bill" is also taking away benefits from legal
immigrants. As proposed, the bill was to apply retroactively and
not allow for costs to be picked up by Medicaid if treatment and
testing was done for conditions related to AIDS. Although the
final bill reached a compromise which did away with the
retroactivity aspect and with the non-payment of AIDS related
treatment and testing, legal immigrants are openly being
discriminated against. It is my personal belief that this
discrimination cannot be based on anything but language, because
working legal immigrants pay taxes just like "normal
Americans," if not more; they should be entitled to the same
benefits. [Back]
Joseph Perkins, Question:
Who Pays for the Immigrant Services? The San Diego Union-
Tribune, Sept. 6, 1996.
Californians have subsidized their state's 2 million illegal
immigrants are looking forward to be relieved of this burden by
the welfare system reform. According to the reform,
"illegals living within California's borders may no longer
receive taxpayer-subsidized welfare benefits, college aid,
nonemergency health care, retirement benefits, public-housing
assistance, unemployment checks, food, stamps, disability
payments, government grants, contracts and loans, and
professional and commercial licenses." Is this just a
political move by the legislature or is it open discrimination
with the stamp of approval of the President and the Courts? This
particular reform is limited to illegal immigrants; however,
although illegal, they are still human beings. If one believes in
natural law and the inherent rights of the human being, whether
one is illegal or not, whether one speaks English or not, he or
she should be able to have at a minimum access to health care. By
cutting back on these services, America is showing its
discriminatory side just to put a few extra dollars in the
pockets of those who can already afford to work and to have
access to care. [Back]
Leslie J. Blackhall, et al, Ethnicity
and Attitude toward Patient Autonomy, JAMA, Vol. 274, No. 10
(1995).
As this article demonstrates, language alone is not the only
barrier to access and quality of health care. Western medical and
bioethical communities reflect a cultural bias for they do not
take into consideration other values and cultures. This article
is a research which surveys "800 Korean-American,
Mexican-American, African-American, and white (European-American)
subjects as a part of a larger study examining the attitude of
older American of varying ethnicities toward health care and
medical decision making." This article is a true eye-opener.
Most of us take so many things for granted that we are not aware
that what we do and expect to have done under the umbrella of
quality health care may be more damaging than beneficial to
ethnic patients. [Back]
Lynne Lamberg, Nationwide
Study of Health and Coping Among Immigrant Children and
Families, JAMA, Vol. 276, NO. 18, (1996).
Each year the United Sates receives "about 800,000 legal
immigrants and perhaps 300,000 illegal immigrants." Many of
these immigrants undoubtedly have children who need to learn
English, go to schools, be immunized, and receive other general
health care services. "Newcomers must learn how to
communicate with an alien culture, and the alien culture also
must learn their ways." In New York alone, "more than
100 languages are spoken by children in the school systems."
With this vast diversity of culture and language, one can
conclude that English-only laws are not the solution to the
health and educational needs of these immigrant children. Besides
the language problem, the author mentions that a barrier to the
well being of these immigrant children is the warfare among
agencies. He advocates an "integrated system of care for all
American children, only some of whom are immigrants." [Back]
Martina Stewart, English-Only
Laws, Informational Interests, and the Meaning of the
First Amendment in a Pluralistic Society, 31 Harv. C.R.-C.L. L.
Rev. 539, (1996).
Proponents of English-only laws have been heard saying that
"[n]o one is asking anyone to give up their heritage, just
to respect the language and culture of the host country to
accompany their voluntary decision to become a part of it."
On its face, it seems like a logical and reasonable statement,
but its underlying message is one that may be violative of Equal
Protection.
The article by Stewart analyzes the Court's handling of the
case of Yniguez v. Arizonans for Official English, 69 F.3d 920
(9th Cir. 1995) (en banc), cert granted, 113 S. Ct. 1316 (1996).
In this case, Yniguez, a bilingual employee for the Arizona
Department of Administrations, stopped servicing her
Spanish-speaking clients in Spanish because of the English-only
law that had recently been passed; she feared being disciplined.
She sued on First Amendment ground and won. The Ninth circuit
found the law facially broad and violative of the First
Amendment. Although Equal Protection was not directly addressed
by either the plaintiff or the court, that issue is nonetheless
addressed implicitly. Stewart also analyzes six other opinions
which resulted from the First Amendment issue. [Back]
Michele Arington, English Only Laws and Direct Legislation:
The Battle in the States Over Language Minority Rights, 7
J.L. & Pol. 325, (1991).
English-Only Laws have gained much popularity in the last
decade. Some say they are merely an attempt to maintain
linguistic unity in this country. An English Language Amendment
has been proposed but has been rejected, so where the
English-Only Laws exist, they exist as a result of efforts by the
states and municipalities. Critics of these laws are afraid that
they may threaten the rights of certain minority groups because
"language proficiency might be used as a precondition to the
enjoyment of many benefits and rights under the law."
These laws have touched areas such as voting rights,
education, employment, equal protection, and the first amendment.
The author does not discuss what effect these English-Only Laws
would have in the health care field, but the reader may rest
assured that Non-English speaking patients do not to wait for a
law to suffer the impact of the effects of English-Only practice
which certainly already exists. [Back]
Note, The
Impact of Managed Care on Doctors Who Serve Poor and Minority
Patients, 108 Harv. L. Rev. 1625, (1995).
This Note shows how affecting access to health care to
immigrants affects more than a governor's re-election campaign
and the immigrants dire plight. Doctors who serve poor and
minority patients are also being affected by legislation that
undermines the infra-structure for the poor and minority. Now,
instead of Medicaid being the culprit of the problem, the
restructuring of "the health care industry toward managed
care" is putting a strain on doctors who serve the
population unable to pay, to communicate, to have access, and
ultimately to have their needs meet.
This Note shows not only how managed care is excluding
provider who serve poor communities, but it also shows what
impact this exclusion has. It further attempts to analyze how the
legislature is responding to this problem. [Back]
Patrick J. McDonnell, 'I Don't
Know What I Could Do For My Mother Now' Welfare: Illegal
Immigrants Face Eviction From Nursing Homes, Los Angeles Times,
Sept. 15, 1996.
Eviction of illegal immigrants from nursing homes due to
Medicaid cuts is affecting not only the elderly immigrants who
are being evicted but is having a ripple effect and affecting the
nursing homes and the families of these immigrants. First, the
nursing homes will lose the revenue from the Medicaid funds, and,
as if that were not enough, they may have to absorb the cost of
having these illegal immigrants as nursing home residents.
Second, the families of these illegal immigrants, are not
necessarily illegal themselves and are suffering the
discrimination themselves. Besides, if the nursing homes do not
take on the cost, many of these families will probably lose all
of their assets by paying for nursing home treatment for family
members on the verge of being evicted. What aggravates the
situation is that "many of the relatives are unaware of
their rights. Language difficulties and a lack of understanding
of the details of benefits law compound matters." [Back]
Patrick McDonnell, LA
Ahead of the Curve the Great Social Laboratory with a Vast
Immigrant and Poor Population, LA County Faces as Severe a Test
Under Welfare Reform as any Place in the U.S. Both Newcomers and
People Already Here--even legally--are Affected, Los Angeles
Times, Dec. 10, 1996.
Like his article above, McDonnell discusses the effects of the
new welfare reform bill. However, in this article, his specific
focus is on Los Angeles County. It seems that by eliminating
assistance to immigrants, the government is shooting itself on
the foot as this article shows that Los Angeles County alone
stands to lose $532 million in revenue as a result of the
"termination of SSI/SSP payments and food stamps for legal
immigrants." [Back]
Raphael Metzger, Hispanics,
Health Care, and Title VI of the Civil Rights Act of 1964,
3-WTR Kan. J.L. & Pub. Pol'y 31, (1993/1994).
Metzger's law review article is an excellent, detailed,
on-point analysis of how language and culture affect the quality
and access of health care for the growing Hispanic population in
the United States. Metzger provides several interesting
statistics, and he also shows that there is a direct link between
the poor health status of Hispanics and the barrier "that
are related to language use and culture." In his study of
Title VI of the Civil Rights Act of 1964, Metzger becomes a
strong advocate and believer that Title VI indeed "compels
linguistic and/or cultural accommodation for a significant number
of Hispanic health care consumers." [Back]
Robert Pear, Under New Law, Nursing
Homes May Reject Legal Immigrants / IMMIGRATION: Patients Who
Have Never Become Citizens May Face the Loss of Care--and a Place
to Live, The Orange County Register, Oct. 13, 1996.
"The federal government and the states share the cost of
Medicaid." President Clinton's signing of the welfare reform
bill is removing its share of the costs. So, now, the states see
themselves faced with the burden of picking up the federal
government's slacks. This open discrimination against immigrants
is simply a game of shifting the cost. States have limited
budgets and some discretion, but their resources are definitely
not infinite. Some of the nursing homes that are being affected
by this cut in Medicaid funds will lose much of its business. As
William J. Pascocello, and administrator for the Nightingale
Health Center in New York City stated that Nightingale has
"a whole floor of Chinese-speaking residents." As the
reader can see, the ramifications of cutting Medicaid funds to
immigrants, whether legal or not, are numerous. They affect the
whole floors of nursing homes, whole groups of non-English
speaking people, and so on. This also affects access to care
because according to Edward J. Stafford, executive director of
the new York State Health Facilities Association, "Nursing
homes right now are very hesitant to admit anyone if they're not
sure he or she is a U.S. citizen." [Back]
Robin Elizabeth Margolis, Healthtrends,
11 No.1 HealthSpan 25, (1994).
Healthtrends provides reviews of recent health care studies.
At the release of this article in 1994, the Hispanic population
constituted 9% of the U.S. population, totaling 22 million
people. But in the year 2010, it is estimated that Hispanics will
be the largest ethnic group in America. Only 32% of Hispanics do
not have any health insurance. This growth of the Hispanic
population will definitely affect the budge due to non-insurance,
but it will also severely affect providers who will have to learn
how "to speak Spanish, ad be sensitive to cultural nuances
that often lead to misunderstanding between patients and the
health care system." [Back]
Sana Loue, Access
to Health Care and the Undocumented Alien, 13 J. Legal Med. 271,
(1992).
Loue examines the problem of access to health care for
undocumented aliens from an outsiders' point-of-view. She
analyzes the undocumented alien community, the availability of
care, the need for care, current mechanisms to obtain care, and
barriers to care. To assist her in her research, Loue used a
group of HIV infected undocumented individuals as a case study.
In her article, she includes suggestions on how to remedy the
current situation and possible alternatives. It was interesting
to learn that almost half of all the immigrant population lives
in California, with New York, Texas, Illinois, and Florida
sharing the other large portion of that burden. In her study,
Loue notes that the "[p]ublic outcries regarding the
widespread and voracious consumption of resources by undocumented
aliens appear misplaced, in view of the substantial personal and
systemic obstacles that hinder their access to care." This
too, for me was something new, though not at all surprising and
unexpected. [Back]
Sidney W. Watson, Reinvigorating
Title VI: Defending Health Care Discrimination --It
Shouldn't Be Easy, 58 Fordham L. Rev. 939, (1990).
This article discusses how Title VI of the 1964 Civil Rights
Act was an effort on the part of government to prohibit
"programs and activities that receive federal financial
assistance from discriminating on the basis of race." The
article, however, goes on to show that "[w]hile enactment of
Title VI ended the most blatant forms of health care
discrimination, subtle barriers still prevent minorities from
gaining full access to federally funded hospitals and other
health care facilities." This is a thorough article, for its
analysis begins with the development of Title VI, its
implementation, the Supreme Court's involvement, and its
connection to Title VII. [Back]
Vernellia R. Randall, Does
Clinton's Health Care Reform Proposal Ensured [E]qual[ity] of
Health Care For Ethnic Americans and the Poor? 60 Brook. L. Rev.
167, (1994).
I have chosen to include this article in the annotated
bibliography because ethnic Americans and the poor group may very
well be made up of at least a few hundred thousand legal and
illegal immigrants who do not speak English. Professor Randall,
in her law review article, makes a thorough evaluation of the
Health Security Act, its flaws, and its perpetuation of
discrimination in the health care field. Against popular belief,
economic access is not the only barrier to health care, according
to Randall. The Health Security Act, even though it attempts to
address many of the current problems, is inadequate in achieving
its goals and becomes itself another barrier to access and
quality health care to all human beings, irrespective of color,
race, language, or nationality. [Back]
42 USCA Section 2000d
The few lines which make-up this section simply read: "§
2000d. Prohibition against exclusion from participation in,
denial of benefits of , and discrimination under Federally
assisted programs on ground of race, color, or national origin:
No person in the United States shall, on the ground of race,
color, or national origin, be excluded form participation in, be
denied the benefits of, or be subjected to discrimination under
any program or activity receiving Federal financial
assistance." This section is added to this annotated
bibliography to stimulate the reader to further research the
implications of this section in conjunction with the new welfare
reform bill and legislations such as proposition 187.
[Back]
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