Marcus Maldonado, Wake Forest University School of Law JD ’24
She loved to watch her grandchildren fight and laugh. It always seemed like one or the other. She considered herself a rich woman, surrounded by family and those she loved. In this respect, at least, she was. In others, not so much. She had immigrated to the United States with her husband when they were both full of vigor and life. Nothing could stop them: not the scalding desert heat, not the foreign language spoken on the other side of the fence, nor the fact they were dirt poor. Trifles.
They had built a beautiful home together, literally with their bare hands. He was a renowned mechanic in their native city in Mexico and had dutifully opened up shop and catered to the residents there in McFarland, California. She was an amazing cook and had started her own little kitchen of sorts, feeding breakfast and lunch to the various laborers in the fruit and vegetable fields nearby. She loved him, and he loved her. They built a life, started a family, and soon came to be pillars of their community. But he wouldn’t stop smoking. Being a mechanic is a stressful job and sometimes sheer will isn’t enough to stop the nerves or relax the body. But cigarettes were. Soon, they turned into a reward, an after-supper treat, and then just plain addiction. He wasn’t even able to make it through a night’s sleep without getting up for a drag.
She accepted it.
She accepted it up until the day that lung cancer claimed her beautiful husband as its own. All that was left then were the memories. She remembered him being too weak to walk from the kitchen to the mechanic shop they had built on their land. She remembered when that awful cough had set in and wouldn’t leave. She remembered when blood started to accompany those coughing fits. She remembered staying up with him at night, dousing him with holy water from head to foot and saying prayer after prayer over him. She remembered him begging her for a cigarette because he couldn’t get his heart to stop beating at a thunderous rate. She remembered telling him no, that it was killing him. Finally, she remembered that fateful trip to the emergency room, and the doctor telling her that the cancer was everywhere at this point and that he had maybe a month left. She had let him have his cigarette then.
They were undocumented immigrants, despite having lived in this country longer than the last. He had believed in the American dream and wouldn’t let anyone call him a thief either. He had made sure that they filed taxes each year on their income, as if that somehow would matter in the eyes of the outside world. It had mattered to him.
She had been left alone to raise four children. Now, they were all grown and had lives of their own. They had been born in this country and enjoyed the full benefits of that status. They had all begged her to adjust her status, fought with her, insulted her, and finally tried begging again. Each time she declined. Her beautiful chimney of a husband had not adjusted, and neither would she. They would be equals in all things, even in this. Then her kidneys started to fail. She knew her body well, had been able to accurately predict when she had gotten pregnant all four times. She knew she was sick when the first wave of pain in the right renal area started occurring. High voltages of pain would shoot up her right leg, leaving her unable to get up or feed her hungry customers. She knew when the first traces of blood started to appear in her urine.
As her condition progressed her children begged her to go to the doctor, to seek some form of treatment. Hospitals, they said, were mandated to treat anyone if it was an emergency. She would get treatment, they said. She was too proud. Deep down, however, she was also afraid. She had heard the stories: ICE officers turning up at the bedside of a sick patient to inform them that they were aware of the patient’s legal status and upon release they would be deported. She couldn’t really remember Mexico anymore. What would she do there? No, she would risk her condition here as her husband had.
Yet just like him, she too was rushed to the hospital when she couldn’t get herself out of bed one day. The doctors and nursing staff confirmed that her kidneys were indeed failing and that she needed hemodialysis done, that the treatment took about four to five hours, and that she could possibly go without dialysis for maybe eleven days max. She accepted that as a challenge. If anyone could make it that long without dialysis, she could. But that was in the beginning, before her condition had worsened. The trips to the ER became more frequent. Since then, she knew the staff by name, how many children they had, what their hopes and dreams were. She brought them her own delicious cooking when possible—the only type of payment she could afford. Soon, the meals for the staff stopped. She was losing her battle the same way that her husband had.
She had resigned herself to this sad reality, had finally made peace with it when her son broke the news to her. She was sitting on her front porch, watching her grandchildren fight and play when he came running outside through the front door. He wasn’t as in shape as he had been back in his youth—too many carne asada tacos and not enough cardio. After what seemed like an eternity, he finally caught his breath and delivered the only ray of hope she’d had in this entire ordeal: Governor Newsom had passed legislation that starting in May 2022, public health care would be available to all residents of California above fifty years of age regardless of legal status. This new plan was to go into effect immediately and would be based on income alone, meaning that if she fell within one of the prescribed income brackets then she would be eligible for care.
Dios mio, she thought.
****
Change was in the air. The whole state could feel it. For too long, California had been in the news feeds for all the wrong reasons. From the corruption of their law enforcement and police departments, wildfires, and of course the introduction of gluten free everything, California wasn’t doing so hot. Eventually, however, there is a respite from the crap storm.
California’s big break came in the guise of immigration reform of all things. You see, there are about 2.2 million undocumented immigrants in the entire state, comprising about 20 percent of their total immigrant population, and 6 percent of the entire Californian population. That’s a lot of people, and those people get sick just like everyone else. The only exception is that these people worry that going to the doctor might mean that they get better, but on the other side of the border. When put like that, they would rather take their chances with the common cold, or the flu, or even COVID.
These people’s saving grace had been The Emergency Medical Treatment and Labor Act, or EMTALA for short. This act dictated that anyone who came to the emergency room, regardless of legal status, should be treated to the best of the ability of the hospital in question. If that hospital did not have the ability to treat the patient in question, they were to be transferred to a location that could. Marvelous.
Yet as was always the case, the bill came due, and when it did the undocumented individual didn’t have the money to pay. Not to worry; the federal government had the answer. It came in the form of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA for short). This act directed funds from the federal government to pay physicians, hospitals, and ambulance companies that provided care to undocumented individuals. States
were allocated anywhere within the vicinity of 250 million dollars, sometimes more, depending on the population of undocumented immigrants in the state. California took the cake. Any ideas as to where this money came from? You guessed it, the American taxpayer. Not the most flattering piece of information, nor the most endearing. This had seemed to only fuel the fire that immigrants were costing the average American citizen money they didn’t have. But all of that was about to change.
The governor’s new proposal for legislation had gone through. It would finally put California back on the map for something other than the latest rehab stint of whatever actor/actress who was too detached from reality. It would mean that California would be the first state in the Union to grant access to public health care to all regardless of status. And to put the cherry on top, it would be based on individual income. It would allow these undocumented individuals to pull some of their weight. This was great for California. However, being the first and only means just that: No one else is doing it at all.
****
She hadn’t shed a tear since the day they put her husband in the ground. She wouldn’t allow herself. In her culture, the mourning period was short, the celebration of life longer. Oh, how they celebrated afterwards. It was his dying wish that it be so. She hated how easily she had always given in to him and his demands. Even as he lay dying in front of her, an emaciated husk of the man he had been, the light still danced in his eyes.
“When I’m gone, cariño, don’t mourn me. No llores por mi, ” he had commanded. And so, it was. No tears, no anger, no hate towards God or the universe for taking the great love of her life away from her. Instead, only gratitude for the time they had had together. She had lived her life in a stoically grateful manner, always choosing to see the best in every situation. Even now, with her body betraying her, she chose to see the good: she would be with her husband soon. She had consigned herself to the fact that she would not watch her grandchildren grow up, fall in love, get their hearts broken, and start lives of their own. It was okay. She believed in the Divine Economy as well: a life for a life. If her and her husband’s deaths meant that their future generations were guaranteed freedom from the hardships they had faced, so be it. Acceptance was the path she had always chosen.
But all of that changed the day her son broke the news to her about the governor’s legislation passing. All the dams she had constructed since her beloved’s passing seemed to break and the tears flowed like twin rivers down her cheeks. They were good tears, a healing balm that she let dissolve the hurt and the pain that had accumulated over the years. She had a chance, and she was determined to take it, to live like her querido had bidden her.
There were still boxes to check off. While she qualified based on her age, the new law stated that for single individuals to qualify, they needed to earn less than $17, 609. It had to be proven, the law said, through tax records or pay stubs. When she learned of this requirement, it was all she could do to keep from bursting into tears again. After years of poking fun at her husband’s borderline fanatical obsession with paying taxes on their income, she had decided that it was a practice worth continuing. She wouldn’t let anyone call them thieves either. He had taught her how to file taxes, knowing she was much better with numbers than him. She had become the official bookkeeper for their respective businesses: the mechanic shop for him and the impromptu kitchen for her.
She had kept the kitchen up over the years, had provided phone orders for when COVID hit. Not even a pandemic could stop her legions of hungry and loyal customers. Year after year, at the start of tax season, she would sit to do her taxes with a bottle of tequila. Of course, she would always pour a shot out for the amazing teacher she had had. It became tradition, another way to honor the dead. She was thriving, until her kidneys started to fail. She finally understood what the old saying of the “spirit is willing, but the flesh is weak” meant. Business dropped considerably but not enough to put her below the minimum tax threshold; therefore, she continued to file her taxes. As her husband had said all those years ago, it would matter in the end.
He proved to be a prophet on all counts. She had never been to any American doctors or healthcare facilities that weren’t located in emergency rooms. In a sense, all she knew was the chaos of the ER. The sea of sick patients waiting to be treated, the physically and mentally strained orderlies and nurses who looked no better than the people they were trying to help. She was completely unprepared for the scene awaiting her when she walked into her new provider’s office. It was clean, small, and above all, quiet. She clung to her son’s arm with a vice grip. In the sea of people in the ER, one could hide in plain sight. Chaos breeds anonymity, but there was none to be found here. There were maybe five people total in that small lobby. She felt exposed, naked almost. How was she to hide from the ICE officers that were surely bearing down on the small office now? Her heart started to race. She felt like the pounding alone would lure the immigration officers to her location.
Her son, sensing her sudden anxiety, squeezed her hand and said, “No te preocupes, Ama. They can’t touch you here.” He sounded so much like his father; she couldn’t help but trust him. She relaxed and started to fill out the required paperwork. Soon, her name was called, and she nervously, yet determinedly, shuffled through the door into a new future.
****
She was watching her grandchildren fight and laugh from her favorite spot on that old porch. Those sounds no longer had the ring of finality to them that they once did. She had just finished her round of home dialysis for the day and was taking a little time before she got back to cooking. Her customers could be so impatient, but those beautiful sounds were worth risking their discontent. It had been six months since her fateful trip to that little clinic. She still felt like she was living a dream, an alternate reality where people like her got to live happily ever after. Dreams and fantasies, it seemed, were not too far removed from reality anymore.
In her dreams at night her beautiful husband would still visit her. Always with that twinkle in his eye, that silly lopsided grin that had so enchanted her from the start. He would always ask the same question: “Mi reina, is it time for you to come with me yet?” She found that she did have the strength to resist this one request of his at least. “Todavia no, mi amor. Todavia no.”
****
Note from the Author
These stories represent the millions of people across this nation who live in a state of desperation every day. They have nowhere to turn, and no one in whom to confide. They are not criminals, but are, in many instances, law abiding citizens content to keep their heads down. Their fatal flaw, so to speak, is that they are undocumented immigrants.
At the moment that this paper is being written, two states in the entire Union have passed legislation to alleviate the stress on hospital emergency rooms as well as the undocumented plight of not having any sort of public healthcare available. California is one of those states, as is Illinois. It makes sense, seeing as how California has the largest undocumented immigrant population in the country. Arizona, which may not have the same staggering numbers as California, also experiences heavy undocumented traffic and has been at the center for controversial practices against these individuals. The truth is that this country is now at a crossroads. As was mentioned above, the passing of EMTALA has mandated that all hospitals across the United States treat anyone who crosses through their doors, if it is within that particular hospital’s ability to do so. As an incentive, MMA was also passed, allowing the federal government to reimburse these hospitals, doctors, and private ambulance companies for their service.
This generation of immigrants are getting older, however. Their needs are increasing and although these monumental changes are great for California and Illinois, this means that there are forty-eight other states that have not acted in any way to help themselves. The truth of the matter is that because the only recourse that has been available to undocumented individuals is the emergency room, states are accumulating debt that needs to be paid off. This money comes straight from the average taxpayer’s pocket. This does nothing to dispel the pernicious stigma that undocumented aliens are a burden on society.
Petitions to local governments to change the laws of the states should be what is strived for. Under the Constitution of this country, the states have police powers over health, welfare morality, and safety. It is unquestionable that health care falls under this category. State officials need to hear from their constituency about issues of this magnitude. Most undocumented immigrants are terrified of going to the doctor. Yet when no other options are available, it should come as no surprise that this is their destination. This option is proving to be a weight too great for the average taxpayer to bear. The debts that the hospitals accrue are being paid for by MMA straight from the average citizen’s pockets. This is not sustainable.
By petitioning state officials to change the laws to allow public healthcare based on income for all, regardless of legal status, the American taxpayer is not only showing some modicum of goodwill towards undocumented individuals, but also helping themselves to not be the well from which this wave of debt draws from. This legislation in California and Illinois is recent and still in its infant state. It needs to be monitored closely to see what the successes are, as well as the failures. Many states do not experience the same amount of undocumented traffic or problems as California or Arizona. Yet the truth is that these funds used to pay hospitals and physicians for treating undocumented immigrants are being drawn at a national level. The states should seriously consider drafting legislation that allows for income-based health care for all. This can be a win-win situation altogether. But it will take courage to take the first steps.
Awaken 