The Health Care Safety Net in a Post-Reform World

Chapter 4 Applying Lessons from Social Psychology to Repair the Health Care Safety Net for Undocumented Immigrants

“Our history tells us that immigration in the American story has always been controversial—associated always with both benefits and costs. . . . For native populations, European immigration meant death by disease, warfare, and social disorganization, a virtual genocide in which their populations fell by 90 percent by 1600. . . . When these death-bringing European immigrants became Americans by birth, their own response to further immigration was mixed. Industrious immigrants were indispensable in expanding colonial populations, and they were welcomed in the abstract and upon arrival. However, the quality of immigrants . . . was [and remains] a constant issue of concern.” —Otis L. Graham (2001) “[Immigrants’] search for a better life is one of the most basic desires of human beings. Many undocumented workers have walked mile after mile, through the heat of the day and the cold of night. Some have risked their lives in dangerous desert border crossings, or entrusted their lives to the brutal rings of heartless human smugglers. Workers who seek only to earn a living end up in the shadows of American life—fearful, often abused and exploited.” —President George W. Bush (January 7, 2004) This chapter offers a new tool to advance the discussion about how the law should respond to the presence of undocumented immigrants in America. Applying Lessons from Social Psychology to Repair the Health Care Safety Net for Undocumented Immigrants Chapter 4 91 Dayna Bowen Matthew The Common Group Identity Model, formulated by social psychologists, explains the process of social categorization by which human beings naturally organize themselves into in-groups and out-groups and thus develop social perceptions to reinforce intergroup conflict. However, where group identities can be realigned, conflict can be reduced. This realignment, called “recategorization ,” introduces members of two previously separate groups of people to the recognition of their membership in an altogether different, single, inclusive , superordinate group. The result is that members of the two groups change their attitudes and behavior as they become involved in shared causes defined by the new in-group. Social psychologists have empirically shown it is possible to create new in-groups and improve intergroup relations by the deliberate exercise of recategorization (Dovidio et al. 2005). This chapter proposes that immigration policymakers consciously employ the lessons learned from the Common Group Identity Model to reform immigration law. My thesis is that the problems arising from social categorization—prejudice, stereotyping , discrimination, hatred, conflict, and violence—can be reversed by the process of what social psychologists call recategorization; therefore, state lawmakers may strengthen the health care safety net by applying recategorization theory to shape immigration law and policy. I apply the Common Group Identity Model to the question of whether public funds should be spent to extend the health care safety net to undocumented immigrants. This is a question that the US Congress as well as a number of state and local legislative bodies have recently addressed by enacting a wave of statutes that limit the access undocumented immigrants have to publicly funded benefits. The generally restrictive trend in these laws that deny most health care benefits to the estimated twelve million noncitizens living in America has created what one commentator has described as a public health “nightmare” (Costich 2001). To date, most legal analysts have focused on the civil and human rights issues or the national safety concerns that these laws raise or address. I believe social psychologists might better explain the reasons underlying public benefit restrictions than lawyers. Moreover, social psychologists might also offer lawmakers the understanding they need to write a better law. Undocumented immigrants are known to experience both high fertility rates and a higher incidence of communicable diseases. Noncitizens are frequently employed in jobs such as food service and preparation, domestic household employment, and agriculture where they will come into close contact with the larger population of citizens (Passel and Cohn 2009). Oddly, the current legal policy regime responds to these obvious public health concerns by legislatively restricting access by undocumented immigrants to all publicly 92 Dayna Bowen Matthew supported services except emergency and basic public health care. Notwithstanding the threat these laws may present to the community’s overall health and safety, the intent of these statutes is to discourage noncitizens from overburdening public resources. On its face, such a policy saves public benefit money. But closer inspection reveals these laws also increase the threat of disease spreading throughout the entire population...