In his recent editorial, Dr. Evans [1] discusses the potential effect of the passage of Proposition 187 in California on the health care of immigrants. Although California voters have a legitimate problem with subsidizing health care for large numbers of illegal aliens, the passage of Proposition 187 is remarkably short-sighted. Illegal immigrants stay away from primary care providers because of the fear of having their undocumented status revealed. As Dr. Evans notes, lack of access to prenatal follow-up or to screening tests such as tuberculin testing, could lead to greater long-term expense. Another disquieting implication of Proposition 187 is that it could herald a discriminatory policy directed against Latinos and persons of Asian descent who are legal immigrants or U.S. citizens. Because health care providers or state agencies might inadvertently target certain persons simply because of an ethnic-sounding last name or because of their Latino or Asian appearance, they may demand detailed documentation of immigration status and, therefore, potentially delay delivery or reimbursement of health services, or both. Such practices would tend to reverse many civil rights gains in the United States.

I propose a four-point approach to addressing the problems faced by border states such as California. First, provide access to core medical services such as emergency treatment and pregnancy-related care to all persons, regardless of immigration status. This would avoid potentially discriminatory policy at critical times of seeking health care. Second, insist that all persons, regardless of immigration status, be eligible for screening tests, such as tuberculin testing, Papanicolaou smears, and mammograms, and for pregnancy-related care. Funding for such a program should come from the national and not the state health budget because of the overwhelming public health benefit of covering all persons. Congress and the executive branch will probably be sympathetic to this demand because California and other border states, such as Texas and Florida, command large numbers of elected national representatives and electoral college votes. Third, extend the "parole" system used by the Immigration and Naturalization Service to cover illegal aliens, which is currently in place for persons who have to leave the United States for short periods but who are in "limbo" after having filed for their green cards. Under an expanded parole system, "undocumented" aliens could go home to address nonurgent medical problems without affecting their ultimate immigration status. Fourth, allocate greater resources to securing the relatively porous southern border of the United States.