US Immigration: A Shrinking Vision of Belonging and Deserving

On July 6, 2015, then-candidate for president Donald Trump argued that “tremendous infectious disease is pouring across the border. The United States has become a dumping ground for Mexico and, in fact, for many other parts of the world.”¹ Picking up on this new vituperative rhetoric, longtime conservative crusader Phyllis Schlafly warned that unwanted groups of people “invade our country every year, and thereby spread their diseases.”² Others identified Zika virus, tuberculosis, dengue fever, Chagas disease, chikungunya virus, and schistosomiasis as immigrant-borne scourges.

Such stinging invectives following the turn of the 21st century bear a striking semblance in intensity and venom to those uttered following the turn of the 20th century. Despite the continuities, however, there are critical discontinuities public health must weigh.

IMMIGRATION ACT OF 1924

In 1891, Commissioner General of Immigration Terrence Vincent Powderly launched the creation of what would become a vast system of medical and economic inspections of immigrants at major points of entry at all of the nation’s land and sea borders. In a poem describing the immigrant menace, Powderly concluded, “Led to believe that they don’t have to please us/They come with all kinds of contagious diseases.”^3(p26) Powderly’s successor likewise fulminated that the nation was becoming “the ‘dumping ground’ for the diseases and pauperized peoples of Europe.”^3(p30)

Although fewer than one half of one percent of the 25 million immigrants who were examined at the nation’s ports were ever denied entry owing to “loathsome and dangerous contagious diseases,”^3(p34) fears of contagion, disease-related dependency, and genetic degeneration ultimately resulted in passage of the Immigration Act of 1924. This new federal legislation limited immigration and made national origin the basis for admission, effectively cutting off the flow from Southern and Eastern Europe.⁴

But if immigration from one segment of Europe was contained, people from other regions of the world continued to arrive. Tuberculosis provided a potent tool for further exclusion. After 1914, with the influx of Mexican and Filipino farm workers and rising anxiety about influenza and tuberculosis, nativists began to worry that the West was no longer attracting “The Right Kind of People.”^4(p932) In the context of the Great Depression, health officials began the mass repatriation of Mexican and Filipino citizens. Amid growing consensus regarding these individuals’ lack of entitlement to US citizenship, health officials emphasized the economic consequences of tuberculosis as a chronic disease. Mexican repatriation came to an end in 1938, but the status of Filipinos was changed from nationals to “aliens” in 1934. In 1935, federal law allowed for the repatriation of individuals on either public or private relief.⁴

IMMIGRATION ACT OF 1965

The Immigration Act of 1965 eliminated national origins systems, restoring, at the peak of the Civil Rights Movement, what then-president Lyndon Johnson called “the basic principle of American democracy.”^5(p528) Yet, as immigrants entered an expanding welfare state—Medicare and Medicaid were also legislative landmarks of the mid-1960s—the most consequential battlegrounds centered around social welfare policy.

Tensions between belonging and deserving began to mount in the mid-1980s, when the 1986 Immigration Reform and Control Act legalized 2.7 million undocumented immigrants. The AIDS crisis compounded fears of swelling Medicaid rolls and the collapse of the American hospital and medical system. Anxiety soared in 1991 when some 40 000 Haitians fled a bloody army coup by boat. Deemed “economic refugees,” the vast majority of these individuals were intercepted by the Coast Guard and turned back. But after Haitians accepted for asylum by Belize and Honduras tested positive for HIV, the United States began a testing and detainment program on the marine base at Guantanamo Bay, Cuba. By 1993, when a federal district court finally ordered their release to the United States, more than 200 refugees and their families were held behind barbed wire in overcrowded and unsanitary conditions.⁵

IMMIGRATION ACT OF 1996

In the mid-1990s, welfare reform provided the first battleground over questions of immigration, disease, and dependency. The Personal Responsibility and Work Opportunity Act of 1996 barred both documented and undocumented immigrants from a variety of welfare and health services, achieving 44% of its savings over six years at the expense of immigrant health.

The Personal Responsibility Act set the stage for debate over a subsequent 1996 immigration bill. As initially proposed, the immigration bill restricted food stamps for all immigrants and barred the children of undocumented immigrants from public education. Republican Newt Gingrich argued, “It is wrong for us to be the welfare capital of the world.” Limits on welfare would, supporters reasoned, deter illegal immigration. “If kids can’t go to school,” argued Republican presidential candidate Bob Dole, “the parents will go home.”^5(p535)

Hispanic voter backlash ensured that the immigration measure would pass without these severe restrictions. The final legislation also removed disincentives for businesses to hire undocumented workers, making a powerful statement: both legal and illegal immigrants were central to the US economy. Still, coming on the heels of the Personal Responsibility Act, which dramatically limited the social obligations of the nation, the bill clearly defined the terms of inclusion: immigrants entered a social contract in which they were expected to make economic contributions; the nation—during an era in which income inequality was again on the rise—had no reciprocal obligations.⁵

DEFERRED ACTION FOR CHILDHOOD ARRIVALS

With the financial recession of the late 2000s, income inequality grew at a quick pace. Overall inequality between the top 10% and bottom 50% of the population reached levels rivaling that of the Progressive era. The national pretax income of the middle 40% began to fall, along with US life expectancy.⁶

Long-standing trends in immigration enforcement and control changed little with the election of President Barack Obama (Figure 1). The priority for the administration was expansion of the welfare state, achieved in 2010 with the Patient Protection and Affordable Care Act (ACA). Predictably, undocumented immigrants, including those seeking a path to citizenship under the 2012 Deferred Action for Childhood Arrivals (DACA) policy, were excluded from enrolling in the ACA.

FIGURE 1—

Location of Undocumented Individuals at the Border (Border Patrol) and Removal From the Interior (Immigration and Customs Enforcement): United States, 2003–2016

Note. ACA = Patient Protection and Affordable Care Act; DACA = Deferred Action for Childhood Arrivals.

Remarkably, however, although the United States sharply increased efforts to locate “deportable aliens” at the border, Department of Homeland Security Immigration and Customs Enforcement activities in the interior fell off precipitously. In other words, stopping illegal entry took priority over finding already-established undocumented workers. Even as the recession persisted, the lopsided compromise of the 1990s—acceptance into the workforce without entitlements—held.

LOGIC OF EXCLUSION

In 2016, the nation abruptly changed course. The political futures of both the ACA and DACA are in question. Even if DACA is preserved, a multibillion-dollar wall on the Mexican border is likely to dominate policy debates along with high-profile raids to flush out undocumented workers.

Although questions of immigration, which involve decisions about who belongs, are again yoked to questions about entitlements (i.e., questions of who is deserving), the logic of immigration, disease, and dependency is shifting. Distinguishing the current period is a distinct variety of populism that shapes not only public discourse but also public policy. Similar to other scholars, John Judis differentiates “leftwing populists” from “rightwing populists.” The leftwing populist drive is to “champion the people against an elite or establishment.” By contrast, “Rightwing populists champion the people against an elite that they accuse of coddling a third group.”^7(p15)

Anti-immigrant or nativist sentiments and actions often accompanied populist stirrings throughout the 20th century,³ but populism and nativism are not one and the same. It is the political logic of excluding a “third group” of unentitled and unworthy individuals combined with a profound distrust of the welfare state that shrinks America’s current vision of both who belongs and who is deserving.

Given the direction in which inequality is progressing, if public health focuses on policy—whether welfare or immigration—without changing what Judis calls the underlying “political logic” of rightwing populism,⁷ it is the bottom 90% who will lose, citizen and immigrant alike.