LATINOPIA BOOK REVIEW LUIS TORRES ON “BORDERS OF CARE”

Immigrants, undocumented or not, seek and receive less medical attention than any other population in the country. A new book explains why.

The current hostility toward immigrants in the United States is pernicious and shameful. But it’s nothing new.  It began in ominous earnest early in the 19^th and 20^th centuries and it persists. We are reminded of that reality in a compelling new book written by historian Beatrix Hoffman, “Borders of Care” (University of Chicago Press). Others have covered the subject and illuminated the social, political and economic issues at the heart of the phenomenon. Here Hoffman uses an intriguing prism through which to view and analyze discrimination and malevolence which immigrants have long suffered in the United States – presumably a “land of immigrants.” They have not always been welcomed. The prism at work here is how immigrants were (are) discriminated against by the attitudes and policies that denied them access to health care.

It didn’t certainly didn’t start with this year’s Trump-promulgated Big Beautiful Baloney Bill which, among other things, dramatically cuts health care to poor folks, including “legal” immigrants. Medicaid (known as Medi-Cal in California) is being slashed, leaving millions of families with extremely limited access to medical care. No, it didn’t start with that malicious bill championed by Trump and passed by a spineless, acquiescent Republican Congress. Denying health care to poor people and immigrants has a long history in this country. Think Ellis Island. Think Angel Island. Think “teeming masses” of immigrant Jews, Irish, Asians and Mexicans heading into this country going back some two-hundred years. Discrimination comes in many forms, doesn’t it?

In “Borders of Care” historian Hoffman methodically charts the patterns, policies, attitudes and –ultimately—government actions that systematically denied health care to immigrants. They were regarded as “disease ridden” and “likely to become a public charge.” Those attitudes served, in part, as justification for not providing care. For example, immigrants in New York City’s lower Eastside in the late nineteenth century and beyond were crammed together in fetid neighborhoods where the claims about disease-carrying immigrants inevitably became a bizarre form of self-fulfilling prophecy.

Jews arriving from Europe in steerage (third class) were often quarantined in crowded, barely sanitary conditions on Ellis Island during cholera epidemics, thereby making them vulnerable to the types of diseases they presumably would contaminate the country with. Wacky. But that kind of thinking drove health care – or the lack of it – for immigrants. The treatment of Italian immigrants was comparable to what Jews experienced. And the Irish as well.

 

It’s generally well known that between 1845 and 1850 a terrible blight basically destroyed Ireland’s potato crop. Because of British-imposed dictates there was an over-reliance on a single agricultural crop. The blight created economic chaos and a resultant frantic diaspora. Many of those who fled Ireland headed to the United States. Hostility and a lack of access to health care awaited them. In that era an estimated two-million Irish arrived in the U.S. That’s a big chunk of the population of Ireland. Those who arrived in the U.S. did not find a welcome mat laid out for them. Hoffman writes: “Many of the Irish newcomers arrived sick. They were already weakened by famine, and the crowded and perilous ocean voyage subjected them to outbreaks of contagious disease aboard the ship. Although the vast majority survived their journeys, the vessels crammed with poor immigrants became known as Coffin Ships because of their association with disease and death.” When it came to access to health care, the Irish – like other immigrants – found nothing like a picnic. Like other immigrants, from the Chinese to the Mexicans, they were stigmatized as inherent carriers of disease. Their sickness was blamed on their behavior or inherent racial tendencies, not the conditions of poverty, famine or overcrowding that they encountered. When hundreds of Irish immigrants died in one of the cholera epidemics in nineteenth century New York City, the Board of Health attributed their illness to their “intemperance and lack of cleanliness,” writes Hoffman. They became associated with cholera and other infectious diseases. That seemed to justify another reason to despise the Irish, who were already under suspicion for being Catholic, which some regarded as “a Satanic cult.”  Welcome to America.

The Irish, like other immigrants in the United States faced an uphill battle finding a benevolent environment that led to decent health care. Politics and policies made access to health care particularly difficult for Chinese, Japanese and, most assuredly, for Mexicans in this country. For Mexicans, it began when they woke up and found that they were no longer in Mexico, but in this new jurisdiction called the United States. The hostility persists to this day.

The Treaty of Guadalupe Hidalgo codified the end of the war between Mexico and the U.S. It presumably made Mexicans in what’s now the Southwest United States citizens. But they became foreigners in their own land. Hoffman writes: “Ideas about health and medicine played an important role in this transformation of longtime residents into foreigners. The Anglo colonizers focused on how Mexicans and then Mexican Americans were medically different due to shortages of medical services or poverty. As historians have powerfully shown, their supposed medical difference imprinted people of Mexican origin as racially distinct and inferior.” Racism and political oppression made robust access to medical care difficult for raza into the 20^th and 21^st centuries. Cholera and tuberculosis raged in Mexican communities, whether in copper mining towns in Arizona or cities in California, but the powers-that-be essentially looked the other way. White authorities blamed “indolence” and “dirtiness” among Mexican communities for the spread of disease and the presumed futility of working to help those communities. Those attitudes continue today. The moronic Donald Trump views all Latinos as immigrants – and “illegal” immigrants at that. Any surprise federal funds for medical care are being slashed today?

The phenomenon of medical care and the immigrant community has a long history, and not just regarding Mexicans and other Latinos. When the so-called Gold Rush began in 1848 thousands of newcomers poured into California, which became a state in 1850. Among those who came were thousands of Chinese. They became miners and became a valuable, if under- appreciated, labor force. We all know they were essential in building the railroads. The white, dominant society had little regard for the Chinese as human beings. Racial discrimination fueled a vicious cycle in which segregated Chinese communities increasingly suffered from overcrowding, poor sanitation and lack of access to medical services. Hoffman recounts that the Chinese were condemned by whites as “filthy, uncivilized and a threat to public health.” Those stereotypes were used as justification for denying medical care and other resources to Chinese men, women and children.

This overall hostility was capped by the nefarious Chinese Exclusion Act of 1882. No more Chinese were admitted into the United States. It made all Chinese already in the country ineligible for U.S. citizenship. Interestingly enough, as a sidebar to history, among the consequences of the Exclusion Act was the creation of “illegal” entry by migrants at the U.S.-Mexico border. Among the first migrants crossing at the southern border were Chinese nationals. They weren’t allowed to arrive in San Francisco or Los Angeles by ship, so they sailed to Mexico and eventually crossed the border where California meets Mexico. That’s why there are huge and thriving Chinese communities in Mexico, straddling the border. Today, the best Chinese restaurants in the Western hemisphere are in Mexicali.

Racial discrimination against immigrants – of all stripes – had severe consequences, not the least of which was the denial of health care and medical services, from local and national sources. That goes along with injustices in the realm of voting rights, legal protections and political participation. It becomes a sick game: how do we oppress immigrants? Pick a poison.

Looking at all this through the prism of access to health care for immigrants is a valuable perspective. Immigrants have long been regarded as carriers of disease and threats to become “a public charge” and, in general, a potential plague on the country. The Pendejo-in-Chief Donald Trump has boisterously claimed that “immigrants are poisoning the blood of our country.” Adolf Schicklgrubber couldn’t have said it better.

Beatrix Hoffman summarizes the essence of her important book thusly: “I argue that health care in the U.S. is organized around exclusions. Instead of providing access for all, the country has rationed care and coverage based on factors like employment, income, race, location and age. As well as letting many people fall through the cracks, the American way of rationing continually reinforces the idea that not everyone is deserving of inclusion of good health. Immigration status provides another category for rationing.” Hard to argue with that.

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Copyright 2025 by Luis Torres is a veteran journalist and writer. He lives in Pasadena, California. “Borders of Care: Immigrants, and the Fight for Health Care in the United States” is available from University of Chicago Press. Cover of book used under “fair use” proviso of the copyright law. All other photos in this blog are in the public domain.