Legislating a Public Health Nightmare: The Anti-Immigrant Provisions of the 'Contract with America' Congress

Abstract

The Personal Responsibility and Work Opportunity Reconciliation Act and the Illegal Immigration Reform and Immigrant Responsibility Act, two major products of the Contract With America Congress, have restricted federal funding for immigrant health care to an unprecedented extent. Legally present immigrants are eligible for few government-sponsored services, and undocumented immigrants have even less access to care. The consequences of this public health blunder are difficult to measure because the restrictions on health care access created by the 1996 laws limit investigators' contact with the immigrants who are the targets of the legislation. Public health research demonstrates that denial of care to new and undocumented immigrants has predictable adverse health consequences for all U.S. residents. This article reviews the statutory modifications affecting immigrants' health care access since 1996, their effect on prevention and treatment of communicable disease, prenatal care, and children's health care, recent litigation arising from the 1996 legislation, and the options available for avoiding the threat these restrictions pose to the public's health.

Keywords: Health care, immigrant health, public health

JEL Classification: I1, I3, H5, H7