HEALTH CARE/Joan Retsinas

Immigrants Test Compassionate Conservatism

They make great campaign backdrops. Candidate X walks down a street, buying water at the bodega, nibbling a roll from the Costa Rican bakery, chatting with the Somalian worker. Candidate X bleats on about the American dream, throwing in a quote from Emma Lazarus.

They have invigorated our cities. In depressed inner city neighborhoods, the small shops and restaurants have translated into genuine economic renewal as vacant storefronts start sprouting "open" signs.

They have enlivened our cuisine, introducing lemongrass, nasa goreng and fajitas into our food-lexicon. In the deepest South and the farthest West, fourth-generations Americans eat foods from places they have never visited.

They take the jobs that those fourth-generation Americans don't want &endash;- accepting minimum wage, or less, in under-the-table transactions. They rarely demand Social Security or health insurance. They work as maids, cooks, and gardeners. Candidate X probably employs a few in his McMansion of a home.

Most of all, we laud their grit. Often with nothing but the determination to work 18-hour days, whole families have wrested enough from a small business to propel their children into the middle class.

The "they" are the legal immigrants who have come here to start afresh, testing Emma Lazarus's promise.

This year they are also testing our leaders' promise of "compassionate conservatism." That was the campaign rhetoric that promised to square the political circle: to cut government spending, without hurting -&endash; indeed, while helping -- the people who depended on that spending.

In 1996 immigrants fell outside the flimsy safety net of the "welfare reform" legislation. That law barred states from using federal money to pay for health insurance for immigrant women and their children. Even though those women may be working beside citizens, at the same jobs, and the same income, the federal rules were explicit. States could not use their Medicaid dollars (or Supplemental Children's Health Insurance money) to pay for health insurance for these women until they had been in this country at least 5 years. A legalistic loophole, moreover, made it difficult for women to be eligible until they became citizens.

The consequence: lots of immigrant women and children have no health insurance. As many as 30% of uninsured children live in families of legal immigrants.

States can spend their own money to give health insurance to immigrants. Most don't. California and Texas are two of the states that do. Yet as states retrench on spending, that outlay becomes harder.

This year Congress has a chance to stitch up that hole in welfare reform's safety net. Tacked onto the Medicare Drug bill is a measure (section 605) that would allow states to use their Medicaid and Children's Health Insurance Programs to give health insurance to immigrant women and children. The section would not force states to add these clients to their insurance rolls, but the fact that states could use federal dollars toward this insurance suggests that most would. The measure has also been introduced independently: the Immigrant Children's Health Improvement Act. The Congressional Budget Office estimates that this measure would help 155,055 children and 60,000 pregnant women.

Rationally, this measure should pass. Its supporters include the American Medical Association, the American Academy of Pediatrics, the National Governors Association, the National Council of La Raza, and the Children's Defense Fund. Yet 33 Senators voted to strip section 605 from the Medicare drug bill. (Fortunately, 65 voted to keep it in).

Today's leaders bleat on about "fiscal austerity"and "tightening our collective belt." Except for a few iconoclasts, politicians sing the virtues of conservatism. We should remind them that they promised to couple "compassion" with the conservatism.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I.