November 28, 1996
There is a California proposal to cut off state-funded assistance to prenatal care for illegal immigrants. Jeffrey Kaye of KCET-Los Angeles has our report.
JEFFREY KAYE: Norma Floris's recent medical check-up went well. The mother-to-be seemed reassured hearing the heartbeat of the baby growing inside her. But for many, the sight of a pregnant illegal immigrant getting a government-funded examination is less than heartwarming. And California's governor, Pete Wilson, is determined to put a halt to such services. In August, the governor, acting under the new federal welfare law, told California agencies to move toward a cut-off of social services to illegal immigrants. He said first to be cut would prenatal care.
GOV. PETE WILSON, California: (August) Yes. Our question is not whether prenatal care is beneficial. The question is whether or not the United States should discard its immigration laws, throw open its borders, and simply say we will take all comers, whether they are citizens or not. We cannot afford to do that.
JEFFREY KAYE: The state of California spends $69.3 million a year providing prenatal care to some 70,000 illegal immigrant women, according to officials. But the new welfare law signed by the President makes illegal immigrants ineligible for most federal, state, and local public benefits, with the exception of emergency health care, disaster relief, and immunizations. Under the legislation, states may pass their own laws to make illegal immigrants eligible for state and local assistance. The new federal law overturns a 1987 California statute providing prenatal care to illegal immigrants under Medicaid. The nonprofit Community Health Foundation of East Los Angeles operates three clinics which offer Medicaid finance services. Applicants for prenatal care under Medicaid, known as Medical in California, are required to declare their immigration status on a government form. Rodolfo Diaz is the foundation's executive director.
JEFFREY KAYE: What do they have to do, to show on this form?
RODOLFO DIAZ, Community Health Foundation: Basically, it's a self-declaration of their eligibility for medical services under the Medical program.
JEFFREY KAYE: A self-declaration, meaning what?
RODOLFO DIAZ: That they are undocumented, they'll declare that they're not eligible for aid under any other category, and they are undocumented, therefore, eligible for prenatal care only.
JEFFREY KAYE: And if they're undocumented, they can get whatever would be available to anyone, documented or not.
RODOLFO DIAZ: For prenatal care, yes.
JEFFREY KAYE: Because the state already has a process to identify pregnant illegal immigrants who apply for aid, Governor Wilson is acting rapidly to cut off prenatal care. He issued an emergency regulation that would have eliminated prenatal care to illegal immigrants by December 1st. But civil rights groups, along with the city and county of San Francisco, sued. On Tuesday, a state judge said prenatal care could not be cut without public hearings. Los Angeles County supervisor Gloria Molina believes her county will continue prenatal care no matter what.
GLORIA MOLINA, L.A. County Supervisor: And what I anticipate is that the county, more than likely, is going to continue its prenatal care and is going to try and make the legal argument with the governor and the legislature about the responsibility of prenatal care, since we're going to be delivering these children, and it is better that they have the preventive or the prenatal care beforehand, as it has proven to be a much, much cheaper approach to providing--or providing for healthy babies.
JEFFREY KAYE: These children are U.S. citizens.
GLORIA MOLINA: Absolutely. When they're born here, they become U.S. citizens, and they're entitled to all the benefits.
JEFFREY KAYE: The Community Health Foundation provides prenatal care to about 1500 illegal immigrant women a year. Rodolfo Diaz said continuing the care is a matter of conscience.
RODOLFO DIAZ: We're doing what's humanitarianly correct for the population. It would be against the edict of the health center if people in the health professions deny service or become enforcers of a political policy at the access level to our patients. And, yes, there would be civil disobedience.
JEFFREY KAYE: Here now to debate the issue is California State Senator Diane Watson, a Democrat who chairs the Health & Human Services Committee of the State Senate, and Kim Belshe, the director of the Department of Health Services for California. Her agency administers the state Medicaid program. Welcome both of you. First, Ms. Belshe, why should prenatal care be denied to illegal immigrants?
KIM BELSHE, California Health Services Department: First, I think it's important to emphasize that from a medical perspective, there is no question that prenatal care is very important, very beneficial to the mother, and to the baby. If an individual is pregnant, they need to do everything they can to get early and ongoing prenatal care. The real issue here, however, is whether or not the taxpayers should be paying for prenatal care services and other services for illegal immigrants. Congress and President Clinton, when they enacted federal welfare reform this past summer, answered that question no, and, in fact, directed states to terminate state-funded programs currently being provided--providing services to illegal immigrants. Governor Wilson agrees with that direction. In fact, he, for many years, has stated that he's very concerned with the idea of rewarding people who've entered the country illegally with the provision of taxpayer services, particularly when our legal residents and citizens are going without. So California has begun the process of coming into compliance with the new federal welfare reform bill. We have begun initially to focus on prenatal care because that's one of only two programs that clearly falls within the requirements of the new federal law. But I would note that we are also reviewing hundreds of other programs which we anticipate will also be affected by the new federal welfare reform bill.
JEFFREY KAYE: All right. Sen. Watson, staying on the prenatal care issue, why should the government pay for prenatal care for people who are in this country illegally?
DIANE WATSON, California State Senator: (Los Angeles) It doesn't make any difference whether they're here legally or illegally, they are taxpayers, they're here working. Somebody is employing them. What is my real concern is that mother and that child, because if that child is born here, that child is a citizen. It's cynical to me that the governor would want to move out ahead of the federal regulations and ahead of the policies that will come out of the legislature. We have been working on welfare reform since August, and what we want is a thoughtful process that we can review where the public can have the input and advise the governor and the Department of Health Services to implement a program that takes into consideration the health of the mother and the health of the child.
JEFFREY KAYE: And so are you saying that the government should continue, the State of California, to provide health care, prenatal care for illegal immigrants?
DIANE WATSON: If it were left up to me, children need to be taken care of. Mothers, who are the bearers of those children, need prenatal care. If we don't invest somewhere around $1500 per pregnancy on the average, then we end up having to invest through emergency services and other programs later on. And it's short-sighted to say we can just cut people off, when we know they're going to be here.
JEFFREY KAYE: When you're saying this later on, you mean if the baby needs the care?
DIANE WATSON: Born at low birth weight, born addicted to a substance, born with alcohol, born with other diseases, the conditions that would be identified if there were prenatal care. And we can prevent these conditions if the care is adequate.
JEFFREY KAYE: Ms. Belshe, what about that?
KIM BELSHE: Well, again, I don't think anyone would dispute--and I certainly as a health official wouldn't dispute the importance of prenatal care. Prenatal care is very beneficial to the mother and the child. Pete Wilson has been one of the chief proponents of promoting the affordability and the availability of prenatal care in California, and, indeed, I would argue has a stronger record than any other governor in the nation on this. But, again, the question is really who is going to pay for these services, is it appropriate, is it legal now for taxpayers to be paying for these services to illegal immigrants? That really is the question. And Congress made it very clear, that there's a compelling government interest in reversing the incentives provided by the availability of public benefits for illegal immigration. That really is the broad policy that was established by Congress. That's the broad policy that was governing our actions, and I think in response to the issue of the importance of prenatal care, I certainly as a state health director would say to a pregnant--any pregnant individual you have got to get prenatal care early and ongoing throughout your pregnancy. But if that person is illegal, I cannot tell that person that the taxpayers of California are going to pay for that care. I'm going to have to say to that person, you're going to need to pay for it yourself, you're going to need to rely upon a charitable organization or a charitable provider, or you're going to have to return to your country of origin to receive those services. Legally, the taxpayers of California, under federal law, will not be--
DIANE WATSON: Our difference here--
KIM BELSHE: --able to provide those services.
JEFFREY KAYE: Yes.
DIANE WATSON: Our difference here is why does the governor want to push this by December 1, when we have not yet started to deliberate the issue. We might agree on maybe 75 percent of what you're putting forth, but we need to debate it, we need to understand that just because we cut off a person from prenatal care, we do not see that person or that infant and another program later on down the line. So what we need to do in terms of policy is to logically and in some orderly fashion come up with a policy to deal with the legal and illegal immigrants in the state of California.
JEFFREY KAYE: Ms. Belshe, could you address that question that others have put this way to suggest that it's penny wise and pound foolish, as Sen. Watson said, that it might cost the state more money down the line.
KIM BELSHE: Well, again, it's a question of what was the policy addressed by Congress when they enacted welfare reform.
DIANE WATSON: They really don't know. They're asking for us to tell them.
KIM BELSHE: Well, I would suggest, Senator, that the Congress and the President were really quite clear when they stated very explicitly that as a matter of policy, there is a government interest in reversing the incentive to illegal immigration that the availability of public benefits broadly provides.
DIANE WATSON: But then they say--
KIM BELSHE: If I may--regardless of the merits of a particular service, regardless of the cost effectiveness of a particular service, that was the broad policy that was established. They did not single out specific services, really, with the exception of immunizations. So from a policy perspective, that is now the law, and that's why California has been moving ahead, because we feel not only is the law clear in terms of our now being required to terminate existing services being provided to illegal immigrants, but secondly, that prenatal care, which is one of only two 100 percent state-funded programs clearly is affected by this law. And as a matter of equity, when we have tens of thousands of legal residents and citizens who are not able to access the very same services that are now available to illegal immigrants, the Wilson administration feels that's a significant equity problem, we need to move ahead expeditiously.
JEFFREY KAYE: Is it an equity problem, what about that?
DIANE WATSON: Well, I don't see that as the biggest problem. Let me tell you what the problem is right now. The governor, through executive order, through letters to all the directors in the 58 counties, the social services, says I want the cutoff as of December 1. What we are trying to say is that we need to take time to look at the issue, we need to take time to find out what the feds really meant, and what they wanted us to do was tell them how we would fix it for the state of California.
JEFFREY KAYE: Ms. Belshe, a state judge yesterday told the governor apparently he couldn't make this cutoff by December 1st, correct? What are you planning on doing?
KIM BELSHE: Well, the judge spoke to the process by which the administration had proposed to move forward with implementing the new federal law. The judge also acknowledged, though, that the federal law was very clear, that pregnant or soon-to-be pregnant illegal immigrant women who want prenatal care will no longer be eligible for those services under the new federal law. So it's really a question not so much of what the law says. It's a question of what's the process for moving forward. Again, the administration feels the law is very clear on this matter. States have been directed to terminate programs that are funded with state dollars being provided to illegal immigrants. It is very clear in California that prenatal care is one of only two programs that meets those definitions. So that's why we had proposed to move ahead.
JEFFREY KAYE: Finally, Senator Watson, the legislature under the federal welfare law could override this if it wanted to.
DIANE WATSON: Absolutely.
JEFFREY KAYE: Do you believe the legislature, that California should adopt a law that would override this policy?
DIANE WATSON: I absolutely do. Let me tell you something about the illegal immigrants in the state of California. They come here to work. People employ them. They buy homes. They pay taxes. They contribute to the economy. Their children that they bear while here are citizens, and I don't understand how a Department of Health Services director and a governor would want to push them off altogether, without considering the bigger picture. And all I'm asking is that they slow the process down, they allow us a chance to get the input from the community and those who will be cut off. That's the human way to handle it. That's the logical way to handle it. That's the reasonable way to handle it. If we cut 70,000 women off December 1, as the governor wanted to do, then where do these people go, what happens to their offspring?
JEFFREY KAYE: Let me get Ms. Belshe's response to that. What is the rush?
KIM BELSHE: Well, I think there really is--responding to Sen. Watson--I think the governor really is looking at the bigger picture. And the bigger picture is consistent with federal welfare reform provisions, is the array of services that are provided to undocumented immigrants, which taken together do provide an incentive for people to come here illegally to access our services at the very time that we have tens of thousands of legal residents and citizens who are going without the very same services, in this case prenatal care, that illegal immigrants are able to access. So there is an equity issue. There is an incentive issue. It is that broad perspective that the governor is bringing to this issue, not necessarily specific to the merits, or the cost-effectiveness of a particular service. But what incentives are we establishing through our policies to encourage people to come here illegally? And I think it's that broader policy picture that will govern the governor's consideration of any legislation that the Senator and her colleagues may wish to consider.
JEFFREY KAYE: All right. Kim Belshe, Sen. Watson, thank you very much.