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Undocumented migration in the United States: An overview of historical and current policy contexts
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Nurs Outlook 63 (2015) 60e67
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Undocumented migration in the United States: An overview of historical and current policy contexts DeAnne K. Hilfinger Messias, PhD, RN, FAANa,*, Marylyn Morris McEwen, PhD, RN, PHCNS-BC, FAANb, Joyceen S. Boyle, PhD, MPH, FAANc,d b
a College of Nursing and Women’s and Gender Studies, University of South Carolina College of Nursing and Mel & Enid Zuckerman College of Public Health, University of Arizona c College of Nursing, Georgia Regents University d College of Nursing, University of Arizona
article info
abstract
Article history: Received 1 June 2014 Revised 6 October 2014 Accepted 15 October 2014 Available online 1 November 2014
The aims of this overview are to provide a brief historical review of federal, state, and local immigration policies and to examine the historical origin and current constructions of the undocumented immigrant. We discuss how past and current policies promote, regulate, restrict, and deter immigration into the United States and access to health services and draw implications for the profession of nursing. Cite this article: Hilfinger Messias, D. K., McEwen, M. M., & Boyle, J. S. (2015, FEBRUARY). Undocumented migration in the United States: An overview of historical and current policy contexts. Nursing Outlook, 63(1), 60-67. http://dx.doi.org/10.1016/j.outlook.2014.10.006.
Keywords: Immigration Policy Undocumentedness
Migration, the process of leaving one location and moving to another with the intent of temporary or permanent settlement, is woven into the fabric of American history and culture. Sometime between 12,000 and 30,000 years ago, humans began migrating from Asia across the Bering Strait to North America (Gugliotta, 2008). As a result of successive migratory waves from Asia and the eventual southern migration through North, Central, and South America, scholars estimate the population of the Americas was somewhere between 2 and 10 million when Christopher Columbus and his crew members set foot on a Caribbean island in 1492 (Ewing, 2012). For 300 years after Columbus’ arrival, the flow of European immigrants to the Americas was undeterred by policies or legislation. Many individuals and families immigrated voluntarily
in search of adventure, land, opportunity, work, wealth, and freedom from various forms of oppression. Others, estimated to be at least 12.5 million, were Africans transported across the Atlantic as human cargo, of whom approximately 10.7 million survived the Middle Passage and became the enslaved workers of the New World (Williford, 2010). From this historical perspective, restriction or regulation of migration and the social and legal construction of the undocumented immigrant are relatively recent phenomena. The millions of global migrants who arrived on American shores through the late 19th century were, to use current terminology, undocumented, given that they traveled and settled without passports or proof of residency or citizenship. Although some were refused admission at the port of
* Corresponding author: DeAnne K. Hilfinger Messias, University of South Carolina, College of Nursing, 1601 Greene Street, Columbia. E-mail address: [email protected] (D.K. Hilfinger Messias). 0029-6554/$ - see front matter Ó 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.outlook.2014.10.006
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entry, primarily because of concerns related to communicable diseases such as tuberculosis, the roles and responsibilities of border agents and immigration officials as we know them today are recent phenomena. In this review, we examine the historical context and the current state of undocumented immigration in the United States, from the early period of open borders through periods of varying levels of promoting, regulating, restricting, and controlling migration; discuss how past and current policies contributed to the construction of undocumented migration; and identify implications for the profession of nursing.
U.S. Immigration Policies and the Construction of Undocumented Immigration The first U.S. legislative initiatives concerning immigration (Table 1) were the Alien and Sedition Acts of 1798, which gave the president the authority to deport foreigners deemed to be a threat, and the Steerage Act of 1819, which required that passenger lists of all arriving ships be submitted to the local customs officials and subsequently reported to the Secretary of State and Congress (Ewing, 2012). During the 19th century, European immigrants were integral to the westward expansion of the country. However, it was not until 1891 that the federal government established the Bureau of Immigration with the power to establish criteria for entrance into the country. The express intent to regulate and control immigration became increasingly evident in federal legislation enacted during the latter half of the 19th century. In 1864, the first comprehensive federal immigration law encouraged the recruitment of immigrant laborers destined for either the east (i.e., Irish and Germans) or the west (i.e., Chinese and Mexicans). Between 1875 and 1920, U.S. immigration policies instituted increasing exclusion and control through quotas based on national origin. Increasing xenophobic and nativist sentiments, particularly against Chinese and Japanese immigrants, culminated in the enactment of the Chinese Exclusion Act of 1882 and a bilateral agreement to limit immigration from Japan in 1908 (Hing, 2004; Ngai, 2004). It was the passage of the Immigration Act of 1921, the Johnson-Reed Immigration Act of 1924, and the Labor Appropriation Act of 1924 that clearly signaled a marked change in immigration policy. Before this time, there were no numeric restrictions on immigration into the United States, with the exception of the Chinese Exclusion Act. The era of open immigration from Europe came to a close with the imposition of restrictive immigration quotas, the elimination of the statue of limitations on deportation, and the establishment of the Border Patrol in 1924 (Ngai, 2004). As federal immigration policies were instituted, the process of gaining approval to enter no longer occurred at U.S. ports (primarily the immigration station at Ellis Island) but moved abroad to U.S. consular offices where
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potential immigrants applied for visas and submitted to medical inspection. These restrictive immigration policies and quotas had an even more fundamental impact on immigrant identity and status: One’s legal status now rested on being in the right place in the queuedif a country has a quota of N, immigrant N is legal but immigrant N þ 1 is illegaldand having the proper documentation, the prized “proper visa.” .In 1924 the Immigration Service terminated line inspection at Ellis Island because medical exclusions were determined abroad. Thus, upon arrival, immigrants’ visas were inspected, not their bodies. The system shifted to a different, more abstract register, which privileged formal status over all else. It is this system that gave birth to what we today call the “undocumented immigrant.” (Ngai, 2004, p. 61) Thus, the construction of the undocumented immigration is embedded in past and present federal, state, and local policies and initiatives. In the following section, we provide a brief overview of federal immigration policies in the 20th century.
The Policy Pendulum: Purposeful Exclusion or Inclusion in the 20th Century U.S. immigration policies reflect conflicted and contradictory tendencies, variously focusing on restricting or encouraging entry and either liberating or eliminating access to resources, employment, education, and services. Exclusion criteria set forth in U.S. immigration law range from literacy, economic status, and national origin to criminal history and sexuality. Resurgent waves of nativist, racist, exclusionary, and restrictive immigration and social policies tend to coincide with periods of economic downturn (Alvarez & Butterfield, 2000; Ewing, 2012; Johnson, 2007). For example, although the United States welcomed Mexican laborers during periods of economic expansion, the tables quickly turned when the economy slowed. Large numbers of Mexicans were deported after the Stock Market Crash of 1929 and as a result of Operation Wetback in the 1950s (Ngai, 2004). However, mass deportation operations did not solve the problem of the presence of unauthorized immigrants or completely stem the tide of continued entry. Federal policies that actively encouraged and incentivized immigrant settlement and incorporation include the 1965 Immigration and Nationality Act, passed on the heels of the Civil Rights Act of 1964, which abolished the discriminatory quota system based on race, ancestry, or national origin. The Refugee Assistance Act of 1975 was a resettlement initiative for refugees from the Vietnam War; the Refugee Act of 1980, in accordance with the 1967 United Nations Protocol on Refugees, formally recognized the
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Table 1 e U.S. Federal Policies Related to Immigration 1798 to 2012 Year
Policy
1798
Alien and Sedition Act
1819
Steerage Act
1864
Immigration Act
1882
Chinese Exclusion Act
1891
Immigration Act
1921
Emergency Quota Law
1924
Johnson Reed Immigration Act
1924 1952
Labor Appropriations Act Immigration and Nationality Act of 1952 (McCarran-Walter Act)
1965
Immigration and Nationality Act (Hart-Cellar Act)
1966
Cuban Adjustment Act
1975
Indochina Migration and Refugee Assistance Act of 1975
1986
Immigration Reform and Control Act (IRCA)
1994
North American Free Trade Act (NAFTA)
1996
Personal Responsibility and Work Opportunity Reconciliation Act
1994
Cuban Migration Agreement
1995
Cuban Migration Agreement
Main Provisions Established presidential authority to deport individuals deemed a threat. Required incoming ships submit passenger lists to port authorities and customs officials. Encouraged immigration to increase available labor force for agricultural and industry. Levied tax on all alien entrants, subjected all entrants to inspection, established criteria for denying entrance (i.e., those deemed unfit or unable to care for self, including convicts and the mentally unstable). Declared certain individuals ineligible for entrance (i.e., individuals with mental illness or contagious diseases and the poor and destitute). Denied citizenship to criminals and polygamists. Established the federal Bureau of Immigration. Temporarily limited numbers of new immigrants by imposing quotas based on country of birth. Restricted immigration through the establishment of a quota system based on a hierarchy of race and national origin. Established the U.S. Border Patrol. Expanded focus of exclusionary criteria from country of origin to undesirable political (i.e., communist), moral, or health characteristics; maintained national origins quotas; ended Japanese and Korean exclusions to citizenship, eliminating racial citizenship bars. Abolished national origins quota system in place since 1924, established preferential system based on immigrant skills or family relationships, restricted issuance of annual immigrant visas to 170,000. Allowed Cuban immigrants special treatment not afforded to other groups. Established resettlement assistance program for refugees from Cambodia and Vietnam; amended in 1976 to include Laotian refugees. Addressed issues of border enforcement and control; increased penalties for transporting undocumented immigrants; established employment regulations and limits on immigrants’ access to government assistance and support; granted amnesty for some undocumented immigrants. Eliminated trade restrictions on flow of capital and goods among the United States, Canada, and Mexico but did not ease restrictions on human migration. Established criteria and restrictions on immigrants’ access to public benefits (e.g., health, education, food assistance, unemployment insurance). Exceptions granted for access of undocumented immigrants to emergency medical care, noncash disaster relief, and public health assistance for immunizations and treatment and testing for communicable diseases. Altered US policy toward Cuban immigrants that had been in place since the 1966 Cuban Adjustment Act. Cubans intercepted at sea were no longer allowed to enter the U.S. Addressed the situation of an estimated 33,000 Cubans and Haitians encamped at Guantanamo Bay Naval Station in Cuba. (continued on next page)
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Table 1 e (Continued ) Year
Policy
2002
Homeland Security Act
2006
Secure Fence Act of 2006
2012
Deferred Action for Childhood Arrivals (DACA)
Main Provisions Established U.S. Department of Homeland Security (DHS). The department’s mission includes preventing terrorism, management of the nation’s borders, administration of immigration laws, and disaster preparedness and response. Invested U.S. Department of Homeland Security with responsibility of achieving and maintaining operational control over international land and maritime borders, with the aim of preventing all unlawful entry into the U.S.; authorized the construction of fencing and improving security along the southern border and a feasibility study of security infrastructure along the northern border. Policy established by the U.S. Citizenship and Immigration Services of the Department of Homeland Security that established provisions to allow certain individuals who entered the U.S. as children and met certain requirements to be eligible for work authorization. However, the provision does not confer legal status or provide a path to citizenship.
Data from Bloemraad (2006); Ngai, (2004); Starkweather (n.d.); U.S. Department of Homeland Security, (n.d.); and Wasem (2009).
international definition of refugee and expanded the domestic refugee resettlement program. These public policies reflected humanitarian values and more welcoming attitudes toward immigrants. The Immigration Reform and Control Act of 1986 (IRCA) provided a pathway for undocumented immigrants residing in the United States to apply for legal status (Ewing, 2012; Ngai, 2004). Often referred to as an amnesty, IRCA signaled a different approach to “the problem of undocumented aliens” (Hing, 2004, p. 161) by providing legal provisions to undocumented immigrants present in the United States before 1982 and agricultural workers who had been in the country for at least 90 days between 1985 and 1986. Certain IRCA provisions constituted, in essence, an official governmental pardon for prior policy violations related to immigration status, such as the use of falsified documentation (i.e., social security cards, driver’s license), and allowed undocumented immigrants to gain legal status as permanent residents and, eventually, apply for citizenship (U.S. Immigration Support, n.d.). On the other hand, IRCA imposed sanctions against employers who knowingly hired undocumented immigrants. In addition, IRCA set in place diversity programs supposedly aimed at assisting immigration from (primarily European) countries that had lower numbers of immigrants as a result of the quota system established by the 1965 Immigration and Nationality Act (Hing, 2004). However, by the mid-1990s, the public policy pendulum had swung back in the direction of overt discrimination and exclusion, with undocumented immigrants from Mexico being the primary target. Several state and federal policies focused on limiting
undocumented immigrants’ access to health, education, and social services. In November 1994, California voters passed Proposition 187, known as the “Save Our State” Initiative. In their analysis of Voter News Service exit poll data from the election, Alvarez and Butterfield (2000) found “voters who perceived the economy as poor, perceived themselves as threatened financially by illegal immigrants, or who lived closer to the immigrant source were more likely to support the initiative” (p. 167). The intent was to deny undocumented immigrants access to publically funded education (kindergarten through college), nonemergency health services (including prenatal care), and cash benefits (such as welfare or food assistance). Furthermore, Proposition 187 would have required publically funded educational institutions and nonemergency providers in publically funded health care institutions to verify residency and legal status of students or individuals seeking health services (“Prop. 187 Approved,” 1994). As a result of various court injunctions and an unconstitutional ruling in 1997, Proposition 187 was never fully implemented. However, its passage clearly reflected very real antiimmigrant and exclusionary sentiments among many California voters (“California: Proposition 187,” 1997). Ten years after instituting the Immigration Reform and Control Act of 1986, Congress passed the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, further restricting immigration qualifications and expanding the grounds for deportation through the adoption of a broader definition of aggravated felony for the purposes of immigration. Also passed in 1996, the Personal Responsibility and Work Opportunity Reconciliation Act restricted access to public
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benefit programs (i.e., Medicaid, food stamps, and Temporary Assistance to Needy Families) among legal permanent residents and barred undocumented immigrants from all public benefit programs. The implementation of these legislative initiatives resulted in reduced access to health care services and public assistance programs, including governmentsponsored or subsidized health insurance for lowincome individuals and families (Brown, Wyn, Yu, Valenzuela, & Dong, 1998; Derose, Escarce, & Lurie, 2007).
U.S. Foreign Policy and Cuban Immigration The influence of U.S. foreign policy on immigration policy is clearly evident in the case of Cuba. For more than 50 years, U.S. immigration laws have afforded Cubans special humanitarian status and provisions, given the travel restrictions imposed on Cuban citizens and the very limited options for legal emigration (Wasem, 2009). From 1959 to 1995, the driving force behind the treatment of Cuban refugees in the United States clearly was the anti-Communist political agenda rather than humanitarian aid or equality (Nackerud, Springer, Larrison, & Issac, 1999). The Cuban Adjustment Act of 1966 provided Cubans special treatment, including the ability to adjust to permanent resident status after presence in the United States for 1 year, at the discretion of the U.S. Attorney General. This policy clearly provided Cubans an opportunity not afforded to any other group or nationality (Wasem, 2009). For 3 decades, there were no adjustments to this preferential treatment for Cubans until the institution of the Cuban Migration Agreements of 1994 and 1995. These policies aimed to stem the mass exodus of Cubans attempting to reach the United States by sea. The 1994 Cuban Migration Agreement distinguished between treatment of immigrants with wet feet (i.e., those intercepted at sea) and those with dry feet (i.e., those who reached U.S. soil). Those with dry feet were allowed to remain in the United States, but those intercepted at sea were either returned to Cuba or sent to a safe haven camp in another country. However, Cuban immigration has not diminished, and the country continues to rank among the top 10 source countries of legal permanent residents in the United States, not far behind Mexico, China, India, and the Philippines (Wasem, 2009).
Post-9/11 Immigration Policies: Federal, State, and Local Initiatives The terrorist attacks of September 11, 2001 resulted in the incorporation of a counterterrorism approach to immigration policies aimed to enhance national security and increase control of foreign nationals entering
and residing in the United States. With the establishment of the Department of Homeland Security, the Immigration and Naturalization Service (which had previously been under the Justice Department) was reconfigured and moved to the Department of Homeland Security and divided into two divisions. The U.S. Citizenship and Immigration Services (USCIS) is the unit responsible for immigrant visas and naturalization, asylum, and refugee applications; the Bureau of Customs and Border Protection and Immigration and Customs Enforcement units are part of the Department of Homeland Security Office of the Undersecretary for Border and Transportation Security (Hing, 2006). Resulting policy initiatives included the National Security Entry-Exit Registration System and the REAL ID Act of 2005 (Ewing, 2012). The National Security EntryExit Registration System is a registration system that targets individuals from specific Arab, Muslim, and South Asian countries. The REAL ID Act is a federal mandate requiring proof of citizenship or legal immigration status from all individuals for state-issued driver’s license; it also requires state-issued identification cards and driver’s licenses to be tamper and fraud resistant. Beginning in the 1990s and intensifying after the terrorist attacks of September 11, 2001, the U.S. Border Patrol adopted the approach of prevention through deterrence in its mission to stop the influx of undocumented immigrants. In addition to deterring undocumented persons from crossing into the United States, the Border Patrol is also charged with impeding traffic of illegal drugs and screening for potential terrorists (U.S. Government Accountability Office, 2009). The initiation of Operation Gatekeeper in 1994 was an example of the aggressive Border Patrol enforcement strategies instituted during the Clinton Administration (Hing, 2010). At the same time, supporters of the 1994 North American Free Trade Agreement (NAFTA) argued that the easing of trade barriers (i.e., tariffs, quotas, special fees, and taxes) would result in economic development within Mexico, which would, in turn, stop the northward flow of undocumented immigrants. From the perspective of immigration theory, NAFTA would counter the existing social and economic factors that were pushing Mexicans to migrate. Critics point out that as an economic policy aimed at reducing undocumented migration, NAFTA “failed miserably” (Hing, 2010, p. 9). Rather than improving economic and employment opportunities for Mexican laborers, the influx of cheap, subsidized U.S. corn damaged Mexican corn production, putting thousands of rural peasants out of work and creating more incentives from within Mexico for northward migration despite the uptake in increased border security. To further physically deter entry of unauthorized persons, the Secure Fence Act of 2006 provided funds for construction of 850 miles of fencing along the U.S.Mexico border. One result of these deterrence policies and strategies was the redirection of undocumented migrant traffic from the more populated Texas-Mexico
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border to more sparsely populated and inhospitable areas of the Arizona border. A recent phenomenon is the increasing number of state and local punitive and exclusionary policies aimed at countering and stopping the migratory flow at the border and denying undocumented immigrants access to housing, employment, and services (Ayo´n, 2006; Kullgren, 2003; Manuel, Feder, & Smith, 2010). In contrast to these recent exclusionary policies, there are examples of state and federal policy initiatives that focus more on immigrant inclusion and incorporation. Some policy initiatives are more welcoming to more highly skilled and educated foreign workers, such as physicians, engineers, and nurses (Immigration Policy Center, American Immigration Council, 2010). Recognizing the public health risks of state policies that deny undocumented immigrants the right to apply for a driver’s license, several states are backpedaling on these initiatives, which forced undocumented immigrants who drove without a license into a situation of double jeopardy. Joining New Mexico, Illinois, and Washington, where undocumented immigrants already had the ability to obtain a driver’s license, in 2013 Colorado, Oregon, and Nevada passed legislation to ensure residents, regardless of immigration status, can legally drive (Moreno, 2013). Some policy makers have more favorable attitudes to certain undocumented immigrant groups, such as children and youth. In June 2012, the Obama administration announced a Deferred Action for Childhood Arrivals (DACA) initiative for unauthorized youth brought to this country as children. This initiative offers a 2-year, renewable reprieve from deportation to those unauthorized immigrants who are under the age of 31; entered the United States before age 16; have lived continuously in the United States for at least 5 years; have not been convicted of a felony, a “significant” misdemeanor, or three other misdemeanors; and are currently in school, graduated from high school, earned a GED, or served in the military (Immigration Equality, n.d.; USCIS, 2014). However, DACA does not confer residency status. Undocumented young immigrants who might qualify for the deferred action initiative are commonly referred to as Dreamers, in reference to the multiple iterations of the Development, Relief, and Education for Alien Minors Act proposed but not passed by Congress (Gonzales, 2010). The Secretary of the Department of Defense recently indicated he had “initiated action” (Preston, 2014, p. 4) to enlist undocumented DACA youth into the military if they have certain skills or speak strategic African and Middle Eastern languages. Over the past several years, numerous state legislatures also have considered proposals dealing with access to higher education for immigrant students. Some initiatives, like Colorado’s Senate Bill 33, signed into law in 2013, guarantees that college students, regardless of immigration status, who meet specified criteria may be eligible for in-state tuition or other
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financial aid. In contrast, a number of recent state legislative proposals aim to prohibit undocumented college students from enrolling or from receiving instate tuition (National Immigration Law Center, 2013). According to some estimates, as many as 1.2 million undocumented immigrants are currently eligible for deportation reprieves (Immigration Equality, n.d.). However, the DACA application requires presentation of specific documents and payment of a $465 filing fee. Because DACA does not provide any path to legal immigration status, the deferred action may, in fact, be nothing more than another stage of being in limbo. Although not without merit, this presidential action does not go far enough to provide meaningful immigration reform that would allow undocumented immigrants meeting certain conditions to attain legal status and eventually citizenship. Furthermore, implementation of this federal policy varies across states. For example, Arizona and Nebraska legislators have refused to issue driver’s licenses to DACA-eligible youth. In a “move some are calling a modern-day scarlet letter,” North Carolina instituted driver’s licenses “marked with a bold ink stripe and the words ‘no lawful status’ printed in red” (Severson, 2013, p. A14). Federal immigration reform proposals currently under consideration reflect a combination of past policies, including the possibility of a pathway to citizenship for undocumented immigrants currently living in the United States and further efforts to secure the southern border to further deter the influx of undocumented immigrants and restrict undocumented immigrants’ access to employment through federal employment eligibility surveillance measures, such as E-Verify (USCIS, n.d.). Support for continued exclusionary policies is evident among individuals and groups who argue immigrants drain local economies and are a burden on health and educational services (Cosman, 2005; Kullgren, 2003). Recent state and local legislation across the country reflect anti-immigrant, xenophobic attitudes, resulting in increased fear, restricted mobility, and decreased access to health and community services among undocumented individuals and their families. In their diverse workplaces, from farms to factories and restaurants and hotels to private homes, undocumented immigrants are the victims of multiple forms of racial and ethnic prejudice, structural violence, and unjust treatment (Holmes, 2006). Reflecting xenophobic fears that undocumented immigrants pose security, economic, and health threats fuel the ongoing militarization of U.S. borders and state policy initiatives often referred to as show me your papers laws; in turn, these contribute to racial profiling, voter identification laws, and fear of communicable diseases such as tuberculosis and HIV/AIDS (Amnesty International, 2012; McEwen & Boyle, 2007). Evidence of a more proactive approach to ensuring access to health care among undocumented immigrants includes policy resolutions by both the American Nurses Association (ANA) and American Medical
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Association. The ANA (2012) Issue Brief, Nursing Beyond Borders: Access to Health Care for Documented and Undocumented Immigrants Living in the US identified various factors that contribute to immigrant health disparities. These include not only individual and family socioeconomic status but policies that directly or indirectly reduce or restrict documented and undocumented immigrants access to health and social services. The ANA House of Delegates reaffirmed the organization’s commitment to the right to health care regardless of immigration status and the need to educate nurses on the “wide-ranging social, economic, and political ramifications of undocumented immigrants’ lack of access to healthcare services” (ANA, 2012, p. 1). The focus of the American Medical Associations’ (2012) resolutions was to signal the organization’s opposition to policies restricting reimbursement for health care services for undocumented immigrants and efforts to criminalize or punish physicians and health care providers who provide services to undocumented immigrants.
Conclusions and Implications for Nursing Despite the fact that migration is an integral component of human history and a hallmark of U.S. history and culture, regulation and control of immigration into the United States is a relatively recent phenomenon. After centuries of essentially open borders without any formal immigration regulation or control, it was not until the latter part of the 19th century that there were any significant federal policy initiatives regulating immigration. Early immigration policies focused primarily on immigrants’ bodies, mental capacity, and economic status, reflected in the line inspections performed at Ellis Island (Mullan, 1917). With the establishment of specific quotas and authorizing visa processes in the 1920s, the inspection of immigrants’ bodies and health status became secondary to the possession of documentation authorizing entry issued at U.S. consulates abroad. Policy initiatives over the past several decades reflect divergent trends, with major initiatives focused on restricting entry and some legislation encouraging and fostering immigration. An important new trend is the increasing role of state and local governments in legislating policies related to immigrants’ rights and access to services and resources. Nurses are well positioned to recognize and respond to the complexities of undocumented immigrant status including the challenges of multistatus families and how they play out in the lives of immigrants (Hilfinger Messias, McEwen, & Clark, 2014). Increased awareness of the impact of past and present immigrant policies on the lives of diverse immigrant groups and the communities where they live will enhance nurses’ ability to tailor care to immigrants’ needs, educate immigrant patients about available resources, and
advocate for humanitarian values in responding to the needs of immigrants whether they are undocumented or documented, refugees fleeing political persecution and violence, or immigrants seeking economic and educational opportunities or family reunification. Furthermore, nurses have the professional responsibility to be actively involved in policy development and implementation at the local, state, and national level to ensure immigrants’ basic rights including access to health care, education, housing, and employment. It is important that nurses and other health care providers understand the impact and implications of immigration policy on the lives of immigrants, their families, and communities and be proactive in ensuring that health care is available and accessible to all regardless of documentation status.
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Retrieved from http://www.huffingtonpost.com/2013/06/05/ immigrant-drivers-license_n_3391941.html. Mullan, E. H. (1917). Mental examination of immigrants: Administration and line inspection at Ellis Island. Public Health Reports (1896-1970), 32(20), pp. 733e746. Retrieved from https:// archive.org/details/jstor-4574515. Nackerud, L., Springer, A., Larrison, C., & Issac, A. (1999). The end of the Cuban contradiction in U.S. refugee policy. International Migration Review, 33(1), 176e192. National Immigration Law Center. (2013, June 19). State bills on access to education for immigrants e 2013. Retrieved from http:// www.nilc.org/statebillsedu.html Ngai, M. (2004). Impossible subjects: Illegal aliens and the making of modern America. Princeton: Princeton University Press. Preston, J. (2014, June 1). Youths with deportation deferrals get chance to enlist. The New York Times, pp. 4. Prop. 187 approved in California. (1994). Migration News, 1(11). Retrieved from http://migration.ucdavis.edu/mn/more.php? id¼492_0_2_0. Severson, K. (2013, March 6). North Carolina to give some immigrants driver’s licenses, with a pink stripe. The New York Times, pp. A14. Starkweather, S. (n.d.). U.S. immigration online. Retrieved from http://library.uwb.edu/guides/usimmigration/ USimmigrationlegislation.html Wasem, R. E. (2009). Cuban migration to the United States: Policy and trends (Report No. R40566). Retrieved from https://fas.org/sgp/ crs/row/R40566.pdf. U.S. Citizenship and Immigration Services. (2014). Consideration of deferred action for childhood arrivals process. Retrieved from http://www.uscis.gov/humanitarian/consideration-deferredaction-childhood-arrivals-process U.S. Citizenship and Immigration Services (n.d.). E-Verify. Retrieved from http://www.uscis.gov/e-verify U.S. Department of Homeland Security. (n.d.). Mission. Retrieved from http://www.dhs.gov/mission U.S. Government Accountability Office (2009). Border Patrol: Checkpoints contribute to border patrol’s mission, but more consistent data collection and performance measurement could improve effectiveness. Retrieved from http://www.azgovernor. gov/documents/BorderSecurity/BorderPatrolCheckpoints_ Report_2009.pdf U.S. Immigration Support. (n.d.) Immigration amnesty for illegal immigrants. Retrieved from http://www.usimmigrationsuppo rt.org/amnesty.html Williford, J. (2010). Gross injustice: The slave trade by the numbers. Humanities, 31(5), 14e43.
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Undocumented migration in the United States: An overview of historical and current policy contexts DeAnne K. Hilfinger Messias, PhD, RN, FAANa,*, Marylyn Morris McEwen, PhD, RN, PHCNS-BC, FAANb, Joyceen S. Boyle, PhD, MPH, FAANc,d b
a College of Nursing and Women’s and Gender Studies, University of South Carolina College of Nursing and Mel & Enid Zuckerman College of Public Health, University of Arizona c College of Nursing, Georgia Regents University d College of Nursing, University of Arizona
article info
abstract
Article history: Received 1 June 2014 Revised 6 October 2014 Accepted 15 October 2014 Available online 1 November 2014
The aims of this overview are to provide a brief historical review of federal, state, and local immigration policies and to examine the historical origin and current constructions of the undocumented immigrant. We discuss how past and current policies promote, regulate, restrict, and deter immigration into the United States and access to health services and draw implications for the profession of nursing. Cite this article: Hilfinger Messias, D. K., McEwen, M. M., & Boyle, J. S. (2015, FEBRUARY). Undocumented migration in the United States: An overview of historical and current policy contexts. Nursing Outlook, 63(1), 60-67. http://dx.doi.org/10.1016/j.outlook.2014.10.006.
Keywords: Immigration Policy Undocumentedness
Migration, the process of leaving one location and moving to another with the intent of temporary or permanent settlement, is woven into the fabric of American history and culture. Sometime between 12,000 and 30,000 years ago, humans began migrating from Asia across the Bering Strait to North America (Gugliotta, 2008). As a result of successive migratory waves from Asia and the eventual southern migration through North, Central, and South America, scholars estimate the population of the Americas was somewhere between 2 and 10 million when Christopher Columbus and his crew members set foot on a Caribbean island in 1492 (Ewing, 2012). For 300 years after Columbus’ arrival, the flow of European immigrants to the Americas was undeterred by policies or legislation. Many individuals and families immigrated voluntarily
in search of adventure, land, opportunity, work, wealth, and freedom from various forms of oppression. Others, estimated to be at least 12.5 million, were Africans transported across the Atlantic as human cargo, of whom approximately 10.7 million survived the Middle Passage and became the enslaved workers of the New World (Williford, 2010). From this historical perspective, restriction or regulation of migration and the social and legal construction of the undocumented immigrant are relatively recent phenomena. The millions of global migrants who arrived on American shores through the late 19th century were, to use current terminology, undocumented, given that they traveled and settled without passports or proof of residency or citizenship. Although some were refused admission at the port of
* Corresponding author: DeAnne K. Hilfinger Messias, University of South Carolina, College of Nursing, 1601 Greene Street, Columbia. E-mail address: [email protected] (D.K. Hilfinger Messias). 0029-6554/$ - see front matter Ó 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.outlook.2014.10.006
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entry, primarily because of concerns related to communicable diseases such as tuberculosis, the roles and responsibilities of border agents and immigration officials as we know them today are recent phenomena. In this review, we examine the historical context and the current state of undocumented immigration in the United States, from the early period of open borders through periods of varying levels of promoting, regulating, restricting, and controlling migration; discuss how past and current policies contributed to the construction of undocumented migration; and identify implications for the profession of nursing.
U.S. Immigration Policies and the Construction of Undocumented Immigration The first U.S. legislative initiatives concerning immigration (Table 1) were the Alien and Sedition Acts of 1798, which gave the president the authority to deport foreigners deemed to be a threat, and the Steerage Act of 1819, which required that passenger lists of all arriving ships be submitted to the local customs officials and subsequently reported to the Secretary of State and Congress (Ewing, 2012). During the 19th century, European immigrants were integral to the westward expansion of the country. However, it was not until 1891 that the federal government established the Bureau of Immigration with the power to establish criteria for entrance into the country. The express intent to regulate and control immigration became increasingly evident in federal legislation enacted during the latter half of the 19th century. In 1864, the first comprehensive federal immigration law encouraged the recruitment of immigrant laborers destined for either the east (i.e., Irish and Germans) or the west (i.e., Chinese and Mexicans). Between 1875 and 1920, U.S. immigration policies instituted increasing exclusion and control through quotas based on national origin. Increasing xenophobic and nativist sentiments, particularly against Chinese and Japanese immigrants, culminated in the enactment of the Chinese Exclusion Act of 1882 and a bilateral agreement to limit immigration from Japan in 1908 (Hing, 2004; Ngai, 2004). It was the passage of the Immigration Act of 1921, the Johnson-Reed Immigration Act of 1924, and the Labor Appropriation Act of 1924 that clearly signaled a marked change in immigration policy. Before this time, there were no numeric restrictions on immigration into the United States, with the exception of the Chinese Exclusion Act. The era of open immigration from Europe came to a close with the imposition of restrictive immigration quotas, the elimination of the statue of limitations on deportation, and the establishment of the Border Patrol in 1924 (Ngai, 2004). As federal immigration policies were instituted, the process of gaining approval to enter no longer occurred at U.S. ports (primarily the immigration station at Ellis Island) but moved abroad to U.S. consular offices where
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potential immigrants applied for visas and submitted to medical inspection. These restrictive immigration policies and quotas had an even more fundamental impact on immigrant identity and status: One’s legal status now rested on being in the right place in the queuedif a country has a quota of N, immigrant N is legal but immigrant N þ 1 is illegaldand having the proper documentation, the prized “proper visa.” .In 1924 the Immigration Service terminated line inspection at Ellis Island because medical exclusions were determined abroad. Thus, upon arrival, immigrants’ visas were inspected, not their bodies. The system shifted to a different, more abstract register, which privileged formal status over all else. It is this system that gave birth to what we today call the “undocumented immigrant.” (Ngai, 2004, p. 61) Thus, the construction of the undocumented immigration is embedded in past and present federal, state, and local policies and initiatives. In the following section, we provide a brief overview of federal immigration policies in the 20th century.
The Policy Pendulum: Purposeful Exclusion or Inclusion in the 20th Century U.S. immigration policies reflect conflicted and contradictory tendencies, variously focusing on restricting or encouraging entry and either liberating or eliminating access to resources, employment, education, and services. Exclusion criteria set forth in U.S. immigration law range from literacy, economic status, and national origin to criminal history and sexuality. Resurgent waves of nativist, racist, exclusionary, and restrictive immigration and social policies tend to coincide with periods of economic downturn (Alvarez & Butterfield, 2000; Ewing, 2012; Johnson, 2007). For example, although the United States welcomed Mexican laborers during periods of economic expansion, the tables quickly turned when the economy slowed. Large numbers of Mexicans were deported after the Stock Market Crash of 1929 and as a result of Operation Wetback in the 1950s (Ngai, 2004). However, mass deportation operations did not solve the problem of the presence of unauthorized immigrants or completely stem the tide of continued entry. Federal policies that actively encouraged and incentivized immigrant settlement and incorporation include the 1965 Immigration and Nationality Act, passed on the heels of the Civil Rights Act of 1964, which abolished the discriminatory quota system based on race, ancestry, or national origin. The Refugee Assistance Act of 1975 was a resettlement initiative for refugees from the Vietnam War; the Refugee Act of 1980, in accordance with the 1967 United Nations Protocol on Refugees, formally recognized the
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Table 1 e U.S. Federal Policies Related to Immigration 1798 to 2012 Year
Policy
1798
Alien and Sedition Act
1819
Steerage Act
1864
Immigration Act
1882
Chinese Exclusion Act
1891
Immigration Act
1921
Emergency Quota Law
1924
Johnson Reed Immigration Act
1924 1952
Labor Appropriations Act Immigration and Nationality Act of 1952 (McCarran-Walter Act)
1965
Immigration and Nationality Act (Hart-Cellar Act)
1966
Cuban Adjustment Act
1975
Indochina Migration and Refugee Assistance Act of 1975
1986
Immigration Reform and Control Act (IRCA)
1994
North American Free Trade Act (NAFTA)
1996
Personal Responsibility and Work Opportunity Reconciliation Act
1994
Cuban Migration Agreement
1995
Cuban Migration Agreement
Main Provisions Established presidential authority to deport individuals deemed a threat. Required incoming ships submit passenger lists to port authorities and customs officials. Encouraged immigration to increase available labor force for agricultural and industry. Levied tax on all alien entrants, subjected all entrants to inspection, established criteria for denying entrance (i.e., those deemed unfit or unable to care for self, including convicts and the mentally unstable). Declared certain individuals ineligible for entrance (i.e., individuals with mental illness or contagious diseases and the poor and destitute). Denied citizenship to criminals and polygamists. Established the federal Bureau of Immigration. Temporarily limited numbers of new immigrants by imposing quotas based on country of birth. Restricted immigration through the establishment of a quota system based on a hierarchy of race and national origin. Established the U.S. Border Patrol. Expanded focus of exclusionary criteria from country of origin to undesirable political (i.e., communist), moral, or health characteristics; maintained national origins quotas; ended Japanese and Korean exclusions to citizenship, eliminating racial citizenship bars. Abolished national origins quota system in place since 1924, established preferential system based on immigrant skills or family relationships, restricted issuance of annual immigrant visas to 170,000. Allowed Cuban immigrants special treatment not afforded to other groups. Established resettlement assistance program for refugees from Cambodia and Vietnam; amended in 1976 to include Laotian refugees. Addressed issues of border enforcement and control; increased penalties for transporting undocumented immigrants; established employment regulations and limits on immigrants’ access to government assistance and support; granted amnesty for some undocumented immigrants. Eliminated trade restrictions on flow of capital and goods among the United States, Canada, and Mexico but did not ease restrictions on human migration. Established criteria and restrictions on immigrants’ access to public benefits (e.g., health, education, food assistance, unemployment insurance). Exceptions granted for access of undocumented immigrants to emergency medical care, noncash disaster relief, and public health assistance for immunizations and treatment and testing for communicable diseases. Altered US policy toward Cuban immigrants that had been in place since the 1966 Cuban Adjustment Act. Cubans intercepted at sea were no longer allowed to enter the U.S. Addressed the situation of an estimated 33,000 Cubans and Haitians encamped at Guantanamo Bay Naval Station in Cuba. (continued on next page)
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Table 1 e (Continued ) Year
Policy
2002
Homeland Security Act
2006
Secure Fence Act of 2006
2012
Deferred Action for Childhood Arrivals (DACA)
Main Provisions Established U.S. Department of Homeland Security (DHS). The department’s mission includes preventing terrorism, management of the nation’s borders, administration of immigration laws, and disaster preparedness and response. Invested U.S. Department of Homeland Security with responsibility of achieving and maintaining operational control over international land and maritime borders, with the aim of preventing all unlawful entry into the U.S.; authorized the construction of fencing and improving security along the southern border and a feasibility study of security infrastructure along the northern border. Policy established by the U.S. Citizenship and Immigration Services of the Department of Homeland Security that established provisions to allow certain individuals who entered the U.S. as children and met certain requirements to be eligible for work authorization. However, the provision does not confer legal status or provide a path to citizenship.
Data from Bloemraad (2006); Ngai, (2004); Starkweather (n.d.); U.S. Department of Homeland Security, (n.d.); and Wasem (2009).
international definition of refugee and expanded the domestic refugee resettlement program. These public policies reflected humanitarian values and more welcoming attitudes toward immigrants. The Immigration Reform and Control Act of 1986 (IRCA) provided a pathway for undocumented immigrants residing in the United States to apply for legal status (Ewing, 2012; Ngai, 2004). Often referred to as an amnesty, IRCA signaled a different approach to “the problem of undocumented aliens” (Hing, 2004, p. 161) by providing legal provisions to undocumented immigrants present in the United States before 1982 and agricultural workers who had been in the country for at least 90 days between 1985 and 1986. Certain IRCA provisions constituted, in essence, an official governmental pardon for prior policy violations related to immigration status, such as the use of falsified documentation (i.e., social security cards, driver’s license), and allowed undocumented immigrants to gain legal status as permanent residents and, eventually, apply for citizenship (U.S. Immigration Support, n.d.). On the other hand, IRCA imposed sanctions against employers who knowingly hired undocumented immigrants. In addition, IRCA set in place diversity programs supposedly aimed at assisting immigration from (primarily European) countries that had lower numbers of immigrants as a result of the quota system established by the 1965 Immigration and Nationality Act (Hing, 2004). However, by the mid-1990s, the public policy pendulum had swung back in the direction of overt discrimination and exclusion, with undocumented immigrants from Mexico being the primary target. Several state and federal policies focused on limiting
undocumented immigrants’ access to health, education, and social services. In November 1994, California voters passed Proposition 187, known as the “Save Our State” Initiative. In their analysis of Voter News Service exit poll data from the election, Alvarez and Butterfield (2000) found “voters who perceived the economy as poor, perceived themselves as threatened financially by illegal immigrants, or who lived closer to the immigrant source were more likely to support the initiative” (p. 167). The intent was to deny undocumented immigrants access to publically funded education (kindergarten through college), nonemergency health services (including prenatal care), and cash benefits (such as welfare or food assistance). Furthermore, Proposition 187 would have required publically funded educational institutions and nonemergency providers in publically funded health care institutions to verify residency and legal status of students or individuals seeking health services (“Prop. 187 Approved,” 1994). As a result of various court injunctions and an unconstitutional ruling in 1997, Proposition 187 was never fully implemented. However, its passage clearly reflected very real antiimmigrant and exclusionary sentiments among many California voters (“California: Proposition 187,” 1997). Ten years after instituting the Immigration Reform and Control Act of 1986, Congress passed the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, further restricting immigration qualifications and expanding the grounds for deportation through the adoption of a broader definition of aggravated felony for the purposes of immigration. Also passed in 1996, the Personal Responsibility and Work Opportunity Reconciliation Act restricted access to public
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benefit programs (i.e., Medicaid, food stamps, and Temporary Assistance to Needy Families) among legal permanent residents and barred undocumented immigrants from all public benefit programs. The implementation of these legislative initiatives resulted in reduced access to health care services and public assistance programs, including governmentsponsored or subsidized health insurance for lowincome individuals and families (Brown, Wyn, Yu, Valenzuela, & Dong, 1998; Derose, Escarce, & Lurie, 2007).
U.S. Foreign Policy and Cuban Immigration The influence of U.S. foreign policy on immigration policy is clearly evident in the case of Cuba. For more than 50 years, U.S. immigration laws have afforded Cubans special humanitarian status and provisions, given the travel restrictions imposed on Cuban citizens and the very limited options for legal emigration (Wasem, 2009). From 1959 to 1995, the driving force behind the treatment of Cuban refugees in the United States clearly was the anti-Communist political agenda rather than humanitarian aid or equality (Nackerud, Springer, Larrison, & Issac, 1999). The Cuban Adjustment Act of 1966 provided Cubans special treatment, including the ability to adjust to permanent resident status after presence in the United States for 1 year, at the discretion of the U.S. Attorney General. This policy clearly provided Cubans an opportunity not afforded to any other group or nationality (Wasem, 2009). For 3 decades, there were no adjustments to this preferential treatment for Cubans until the institution of the Cuban Migration Agreements of 1994 and 1995. These policies aimed to stem the mass exodus of Cubans attempting to reach the United States by sea. The 1994 Cuban Migration Agreement distinguished between treatment of immigrants with wet feet (i.e., those intercepted at sea) and those with dry feet (i.e., those who reached U.S. soil). Those with dry feet were allowed to remain in the United States, but those intercepted at sea were either returned to Cuba or sent to a safe haven camp in another country. However, Cuban immigration has not diminished, and the country continues to rank among the top 10 source countries of legal permanent residents in the United States, not far behind Mexico, China, India, and the Philippines (Wasem, 2009).
Post-9/11 Immigration Policies: Federal, State, and Local Initiatives The terrorist attacks of September 11, 2001 resulted in the incorporation of a counterterrorism approach to immigration policies aimed to enhance national security and increase control of foreign nationals entering
and residing in the United States. With the establishment of the Department of Homeland Security, the Immigration and Naturalization Service (which had previously been under the Justice Department) was reconfigured and moved to the Department of Homeland Security and divided into two divisions. The U.S. Citizenship and Immigration Services (USCIS) is the unit responsible for immigrant visas and naturalization, asylum, and refugee applications; the Bureau of Customs and Border Protection and Immigration and Customs Enforcement units are part of the Department of Homeland Security Office of the Undersecretary for Border and Transportation Security (Hing, 2006). Resulting policy initiatives included the National Security Entry-Exit Registration System and the REAL ID Act of 2005 (Ewing, 2012). The National Security EntryExit Registration System is a registration system that targets individuals from specific Arab, Muslim, and South Asian countries. The REAL ID Act is a federal mandate requiring proof of citizenship or legal immigration status from all individuals for state-issued driver’s license; it also requires state-issued identification cards and driver’s licenses to be tamper and fraud resistant. Beginning in the 1990s and intensifying after the terrorist attacks of September 11, 2001, the U.S. Border Patrol adopted the approach of prevention through deterrence in its mission to stop the influx of undocumented immigrants. In addition to deterring undocumented persons from crossing into the United States, the Border Patrol is also charged with impeding traffic of illegal drugs and screening for potential terrorists (U.S. Government Accountability Office, 2009). The initiation of Operation Gatekeeper in 1994 was an example of the aggressive Border Patrol enforcement strategies instituted during the Clinton Administration (Hing, 2010). At the same time, supporters of the 1994 North American Free Trade Agreement (NAFTA) argued that the easing of trade barriers (i.e., tariffs, quotas, special fees, and taxes) would result in economic development within Mexico, which would, in turn, stop the northward flow of undocumented immigrants. From the perspective of immigration theory, NAFTA would counter the existing social and economic factors that were pushing Mexicans to migrate. Critics point out that as an economic policy aimed at reducing undocumented migration, NAFTA “failed miserably” (Hing, 2010, p. 9). Rather than improving economic and employment opportunities for Mexican laborers, the influx of cheap, subsidized U.S. corn damaged Mexican corn production, putting thousands of rural peasants out of work and creating more incentives from within Mexico for northward migration despite the uptake in increased border security. To further physically deter entry of unauthorized persons, the Secure Fence Act of 2006 provided funds for construction of 850 miles of fencing along the U.S.Mexico border. One result of these deterrence policies and strategies was the redirection of undocumented migrant traffic from the more populated Texas-Mexico
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border to more sparsely populated and inhospitable areas of the Arizona border. A recent phenomenon is the increasing number of state and local punitive and exclusionary policies aimed at countering and stopping the migratory flow at the border and denying undocumented immigrants access to housing, employment, and services (Ayo´n, 2006; Kullgren, 2003; Manuel, Feder, & Smith, 2010). In contrast to these recent exclusionary policies, there are examples of state and federal policy initiatives that focus more on immigrant inclusion and incorporation. Some policy initiatives are more welcoming to more highly skilled and educated foreign workers, such as physicians, engineers, and nurses (Immigration Policy Center, American Immigration Council, 2010). Recognizing the public health risks of state policies that deny undocumented immigrants the right to apply for a driver’s license, several states are backpedaling on these initiatives, which forced undocumented immigrants who drove without a license into a situation of double jeopardy. Joining New Mexico, Illinois, and Washington, where undocumented immigrants already had the ability to obtain a driver’s license, in 2013 Colorado, Oregon, and Nevada passed legislation to ensure residents, regardless of immigration status, can legally drive (Moreno, 2013). Some policy makers have more favorable attitudes to certain undocumented immigrant groups, such as children and youth. In June 2012, the Obama administration announced a Deferred Action for Childhood Arrivals (DACA) initiative for unauthorized youth brought to this country as children. This initiative offers a 2-year, renewable reprieve from deportation to those unauthorized immigrants who are under the age of 31; entered the United States before age 16; have lived continuously in the United States for at least 5 years; have not been convicted of a felony, a “significant” misdemeanor, or three other misdemeanors; and are currently in school, graduated from high school, earned a GED, or served in the military (Immigration Equality, n.d.; USCIS, 2014). However, DACA does not confer residency status. Undocumented young immigrants who might qualify for the deferred action initiative are commonly referred to as Dreamers, in reference to the multiple iterations of the Development, Relief, and Education for Alien Minors Act proposed but not passed by Congress (Gonzales, 2010). The Secretary of the Department of Defense recently indicated he had “initiated action” (Preston, 2014, p. 4) to enlist undocumented DACA youth into the military if they have certain skills or speak strategic African and Middle Eastern languages. Over the past several years, numerous state legislatures also have considered proposals dealing with access to higher education for immigrant students. Some initiatives, like Colorado’s Senate Bill 33, signed into law in 2013, guarantees that college students, regardless of immigration status, who meet specified criteria may be eligible for in-state tuition or other
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financial aid. In contrast, a number of recent state legislative proposals aim to prohibit undocumented college students from enrolling or from receiving instate tuition (National Immigration Law Center, 2013). According to some estimates, as many as 1.2 million undocumented immigrants are currently eligible for deportation reprieves (Immigration Equality, n.d.). However, the DACA application requires presentation of specific documents and payment of a $465 filing fee. Because DACA does not provide any path to legal immigration status, the deferred action may, in fact, be nothing more than another stage of being in limbo. Although not without merit, this presidential action does not go far enough to provide meaningful immigration reform that would allow undocumented immigrants meeting certain conditions to attain legal status and eventually citizenship. Furthermore, implementation of this federal policy varies across states. For example, Arizona and Nebraska legislators have refused to issue driver’s licenses to DACA-eligible youth. In a “move some are calling a modern-day scarlet letter,” North Carolina instituted driver’s licenses “marked with a bold ink stripe and the words ‘no lawful status’ printed in red” (Severson, 2013, p. A14). Federal immigration reform proposals currently under consideration reflect a combination of past policies, including the possibility of a pathway to citizenship for undocumented immigrants currently living in the United States and further efforts to secure the southern border to further deter the influx of undocumented immigrants and restrict undocumented immigrants’ access to employment through federal employment eligibility surveillance measures, such as E-Verify (USCIS, n.d.). Support for continued exclusionary policies is evident among individuals and groups who argue immigrants drain local economies and are a burden on health and educational services (Cosman, 2005; Kullgren, 2003). Recent state and local legislation across the country reflect anti-immigrant, xenophobic attitudes, resulting in increased fear, restricted mobility, and decreased access to health and community services among undocumented individuals and their families. In their diverse workplaces, from farms to factories and restaurants and hotels to private homes, undocumented immigrants are the victims of multiple forms of racial and ethnic prejudice, structural violence, and unjust treatment (Holmes, 2006). Reflecting xenophobic fears that undocumented immigrants pose security, economic, and health threats fuel the ongoing militarization of U.S. borders and state policy initiatives often referred to as show me your papers laws; in turn, these contribute to racial profiling, voter identification laws, and fear of communicable diseases such as tuberculosis and HIV/AIDS (Amnesty International, 2012; McEwen & Boyle, 2007). Evidence of a more proactive approach to ensuring access to health care among undocumented immigrants includes policy resolutions by both the American Nurses Association (ANA) and American Medical
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Association. The ANA (2012) Issue Brief, Nursing Beyond Borders: Access to Health Care for Documented and Undocumented Immigrants Living in the US identified various factors that contribute to immigrant health disparities. These include not only individual and family socioeconomic status but policies that directly or indirectly reduce or restrict documented and undocumented immigrants access to health and social services. The ANA House of Delegates reaffirmed the organization’s commitment to the right to health care regardless of immigration status and the need to educate nurses on the “wide-ranging social, economic, and political ramifications of undocumented immigrants’ lack of access to healthcare services” (ANA, 2012, p. 1). The focus of the American Medical Associations’ (2012) resolutions was to signal the organization’s opposition to policies restricting reimbursement for health care services for undocumented immigrants and efforts to criminalize or punish physicians and health care providers who provide services to undocumented immigrants.
Conclusions and Implications for Nursing Despite the fact that migration is an integral component of human history and a hallmark of U.S. history and culture, regulation and control of immigration into the United States is a relatively recent phenomenon. After centuries of essentially open borders without any formal immigration regulation or control, it was not until the latter part of the 19th century that there were any significant federal policy initiatives regulating immigration. Early immigration policies focused primarily on immigrants’ bodies, mental capacity, and economic status, reflected in the line inspections performed at Ellis Island (Mullan, 1917). With the establishment of specific quotas and authorizing visa processes in the 1920s, the inspection of immigrants’ bodies and health status became secondary to the possession of documentation authorizing entry issued at U.S. consulates abroad. Policy initiatives over the past several decades reflect divergent trends, with major initiatives focused on restricting entry and some legislation encouraging and fostering immigration. An important new trend is the increasing role of state and local governments in legislating policies related to immigrants’ rights and access to services and resources. Nurses are well positioned to recognize and respond to the complexities of undocumented immigrant status including the challenges of multistatus families and how they play out in the lives of immigrants (Hilfinger Messias, McEwen, & Clark, 2014). Increased awareness of the impact of past and present immigrant policies on the lives of diverse immigrant groups and the communities where they live will enhance nurses’ ability to tailor care to immigrants’ needs, educate immigrant patients about available resources, and
advocate for humanitarian values in responding to the needs of immigrants whether they are undocumented or documented, refugees fleeing political persecution and violence, or immigrants seeking economic and educational opportunities or family reunification. Furthermore, nurses have the professional responsibility to be actively involved in policy development and implementation at the local, state, and national level to ensure immigrants’ basic rights including access to health care, education, housing, and employment. It is important that nurses and other health care providers understand the impact and implications of immigration policy on the lives of immigrants, their families, and communities and be proactive in ensuring that health care is available and accessible to all regardless of documentation status.
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