Entitled to Nothing: The Struggle for Immigrant Health Care in the Age of Welfare Reform

2 The Health of the Welfare State

31 chapter 2 The Health of the Welfare State Especially since the 1970s, the norms of good citizenship in advanced liberal democracies have shifted from an emphasis on duties and obligations to the nation to a stress on becoming autonomous , responsible choice-making subjects who can serve the nation best by becoming “entrepreneurs of the self.” —Aihwa Ong1 Creating “Entrepreneurs of the Self”2 The massive economic restructuring of the 1970s was pivotal to the development of global capitalism. This economic transformation, driven by a ferocious faith in a global market free of barriers to facilitate the flow of capital, fueled a parallel demand for transnational labor migration.3 In fact, Saskia Sassen argues that immigration is largely a result of the economic , political, and social conditions of the receiving country. She states, “Immigration flows may take a while to adjust to changes in levels of labor demand or to saturation of opportunities, but eventually they always have tended to adjust to the conditions in receiving counties, even if these adjustments are imperfect.”4 At the same time, the Hart-Celler Act of 1965 not only rearranged which and how many persons could enter the United States but also the entire process by which these decisions were made.5 The new category of “family unification” helped to alter the composition 32 The Health of the Welfare State of the immigrant population to comprise approximately 40 percent from Latin America and another 40 percent from Asia. In a stunning turnaround , European admissions fell to less than 20 percent during the 1970s. Thus, the 1970s brought in a new wave of large-scale immigration from what were, at the time, nontraditional sending nations. Subsequently, the number of Latino/as surpassed the African American population to become the largest racial minority group in the United States today. In addition , Asian immigrant communities also experienced significant population increases—so much so that Asian Americans became the fastest growing minority group. The decade of the 1970s was also an historic era of civil rights legislation . Consequently, particular forms of discrimination, including racism, were legally prohibited. Here, we see the impact of the civil rights movement in opening access to welfare benefits to African Americans. In 1939, when AFDC was created (Aid to Families with Dependent Children), the major welfare program for poor families, 89 percent of the recipients were white and 61 percent were widows.6 These numbers began to change in the 1960s as black women and other welfare rights advocates collectively won greater access to AFDC by contesting the exclusion of certain industries from coverage under the programs and discriminatory practices of state agencies that administered the programs.7 However, by the mid-1970s, retrenchment of the welfare state was institutionalized through a concerted political attack on the acceptability of entitlement. Teresa Amott describes this coordinated process as follows: Starting in California, a movement to limit state taxes was able to mobilize the concerns of moderate income citizens over their stagnating earnings. Fundamentalist Christians focused on the erosion of “family values” and the rise in divorce and out-of-wedlock births. Corporations facing falling profit rates sought to impose labor discipline through cutbacks in government programs, sophisticated anti-union campaigns, and demands for deregulation. At the state level, these movements combined to sharply limit the never-strong political support for AFDC.8 As the U.S. economy began to stagnate in the 1970s and neoliberal political and economic doctrines took root, the concept of entitlement underwent severe scrutiny as age-old moral fitness arguments were reinstated The Health of the Welfare State 33 to question the “deservingness” of Black mothers. Gwendolyn Mink observes that welfare, as a maternalist innovation, was once understood as a “Mother’s pension,” but it became “discursively transformed into a ‘way of life’ by the late 1960s, and the worth and rights of single mothers were displaced by the icon of the Black ‘welfare mother.’”9 Mink describes today ’s postmaternalist welfare policy as pathologizing women’s dependency to justify punishing mothers who do not conform to legislated morality— a “shape-up-in-the-home or ship-out-to-work” principle: “Today’s welfare reform . . . rejects the idea that the poverty of mothers and children is a social concern and seeks to privatize economic uplift: hence the notion of coercive work requirements.”10 By 1990, Linda Gordon writes, In two generations the meaning of “welfare” has reversed...