From clinic to courtroom, fighting for immigrant health care

Reviewed by James Ives, M.Psych. (Editor)Dec 19 2019

Jane Garcia started as an intern at La Clínica de La Raza in the late 1970s, attracted by its mission to provide health care to all — especially immigrants, regardless of their legal status or ability to pay.

Forty years later, Garcia, 66, is the chief executive officer of the organization, which now operates more than 30 clinics in Alameda, Contra Costa and Solano counties and serves about 90,000 patients a year. About 65% of its patients are Latino, many of whom are immigrants.

Garcia, who has Mexican roots, grew up in the border town of El Paso, Texas. Her family frequently visited the Mexican city of Juárez for groceries, gas and haircuts, she recalled.

So advocating for immigrants came naturally to her as an adult, Garcia said, but she hasn't limited her advocacy to the clinics.

In the 1990s, California experienced a paroxysm of anti-immigrant attitudes, similar to those that have manifested elsewhere in the United States today. Then-California Gov. Pete Wilson, a Republican, cracked down on illegal immigration and championed Proposition 187, which denied unauthorized immigrants access to public health care and education. The measure, adopted by voters in 1994, never took effect because it was ruled unconstitutional by a federal court.

Garcia took Wilson's administration to court in 1997 over its attempts to defund prenatal care for unauthorized immigrant women through Medi-Cal, the state's version of the federal Medicaid program for low-income people. She filed the lawsuit on behalf of undocumented immigrant women — and won.

"It was a very brave thing to do back then, to put her clinic in the middle of this fight and be the spokesperson in this lawsuit," said Carmela Castellano-Garcia, CEO of the California Primary Care Association, which represents health clinics. "I just remember being so impressed by her boldness."

Today, La Clínica is the lead plaintiff in one of several lawsuits challenging the Trump administration's attempt to expand the "public charge" rule, which would allow federal immigration officials to more easily deny permanent residency status to those who depend on certain public benefits, such as Medicaid.

Federal judges temporarily blocked the rule from taking effect in mid-October, so Garcia's lawsuit is on hold.

La Clínica de La Raza, though, has a longer history. It was founded in 1971 by students at the University of California-Berkeley who were conscientious objectors to the Vietnam War, Garcia said. Instead of serving in the armed forces, they made a deal with the federal government to set up a free clinic in Oakland's Fruitvale neighborhood, where residents had identified health care access as a main concern.

Garcia spoke with California Healthline's Ana B. Ibarra in her office across the street from the original Fruitvale clinic. Garcia's office is filled with plants, portraits of farmworker activist Cesar Chavez, images of Our Lady of Guadalupe and a framed "Health for All" poster.

The interview has been edited for length and clarity.

Q: Expanding health care access to immigrants has been your mission since Day One. What drew you to this cause?

I grew up in el barrio in El Paso, Texas. My family got many services from public health departments or through schools. Our shots, for example. So, I understood the importance of public health programs.

At the very beginning of my college career I was pre-med, but decided that chemistry and bio were not for me. When I was at Yale as an undergrad, I worked at a community health center as a translator and worked with mostly Puerto Rican families.

Then I got to La Clínica and really loved what they were doing. I just loved what the clinic movement was all about — social justice. And it really called to me.

Q: Why do you believe it's important that everyone has access to comprehensive health care, regardless of immigration status?

Only by providing services to everybody can we have a true impact on the delivery system. When the flu season comes, it doesn't ask your immigration status.

It behooves us all to keep all our communities healthy and to provide access at the most basic level so that we avoid emergency room utilization.

My daughter is an ER nurse and she tells me, "Mom, you don't know how many people come in there using the ER inappropriately." And that's because they don't have access to anything else. That's their primary care.

Q: Beginning in 1986, low-income undocumented immigrant women could get prenatal care through Medi-Cal, but you've spent many years defending that coverage, including in court. Why was this so contentious?

Our focus has always been families, so we really focused on providing access to basic primary care, and prenatal care was a big issue for our communities back then because it was a political lightning rod — you had women who were undocumented seeking services.

We had to fight to make sure that the hospitals we went to to deliver our babies would admit our patients. And that our patients felt comfortable being there. We helped our patients access Medi-Cal or develop payment plans with the hospital. I remember our physicians hearing comments like, "You're turning our hospital into a county facility."

We filed a lawsuit on behalf of some undocumented women in 1997. They were the real soldiers in this. I was just the interface.

Q: Now La Clínica is challenging the Trump administration's attempt to expand the public charge rule. How is this situation similar to your fight in the 1990s?

When this public charge issue came up, it was reminiscent from those days and everything about it reminded me about Prop. 187.

That was just one big period in time that was all about being anti-immigrant. And we are seeing the same things today: parents keeping their children at home and our number of appointments going down. This is round two of the same situation except that I think we have been able to change the narrative somewhat.

Particularly here in California, we don't see the word "illegal" as much, and we see fewer visualizations of people crossing the border like cucarachas [cockroaches]. The messages that we were giving to patients at that time were not very different from the messages that we're giving to patients right now. They are: Continue to get your services here, we're a safe place, and we don't share your information.

Q: Is this where you thought the country would be going into the 2020 election?

As a country, we've definitely taken some steps backward, there's no question about that, but we're not starting from point zero. As advocates, we're way better armed with data and we can show you how much taxes immigrant families pay, we can tell you how significant they are to the workforce.

I think California, whether folks like it or not, is a leader. And with the state's commitment to cover everybody, we will be able to demonstrate that, in the end, that strategy is the way to go in terms of having more healthy communities and a more productive society.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.