Challenge to California’s Race-Based Health Program

Weeks ahead of her due date, first-time mother Erica Jimenez sought assistance during her pregnancy. However, she faced rejection from California’s Black Infant Health Program due to her race. Although she met the eligibility criteria—being pregnant, living within the program’s service area, and being over 18—her race excluded her.

Jimenez is now challenging the race-based eligibility of the Black Infant Health Program. Her challenge argues that the program violates the equal protection clause of the 14th Amendment to the Constitution. This clause prohibits the government from differentiating between individuals based on race without a compelling interest. Since 1989, California has run this program to enhance the health of African American women, infants, and children by focusing on pregnant and postpartum Black women. Despite these goals, data show that Black infant mortality rates remain higher than those for white infants even after three decades of the program’s implementation. Yet, California persists with the same race-based approach.

A recent op-ed in The Hill criticized Jimenez’s lawsuit, suggesting that adhering to the Constitution in public maternal health programs and preventing racial discrimination is wrong. The argument claims that considering race in healthcare saves lives. However, Black Infant Health has not shown this outcome. California continues to deny Jimenez and others equal treatment under the guise of benefits that have not materialized.

While it is important to save mothers and infants, this does not justify disparate racial treatment by the government. The Constitution prohibits racial discrimination, recognizing the nation’s history of unequal medical care. Throughout history, the government has used public health and life-saving rhetoric to justify racial classifications. Simply stating that something “saves lives” does not justify discrimination. Otherwise, the government could sustain any discriminatory program by claiming life-saving objectives. The Supreme Court has consistently rejected broad goals like promoting diversity or remedying societal discrimination as insufficient justifications for racial discrimination.

California’s aim to reduce health disparities is no different. The Constitution does not allow a program that disadvantages or stereotypes individuals like Jimenez based on race. The fundamental eligibility requirement for the Black Infant Health Program is racially based. The narrative decries efforts to eliminate discrimination as “cruel” for supposedly undermining maternal and infant health.

Justice Clarence Thomas emphasized that placing citizens into racial categories demeans everyone involved. Jimenez’s lawsuit does not seek exclusion based on race. Instead, she advocates for all mothers meeting the criteria to access the program, irrespective of race. It is California and its supporters that wish to maintain exclusionary practices that history has rejected.

The potential for the Black Infant Health Program to save lives through racially segregated care remains doubtful due to its ineffectiveness over three decades. A study in Florida posited that Black infants had lower mortality rates with Black providers. However, a follow-up review using the same data challenged this finding. The initial study was flawed due to omitted-variable bias, as white physicians treated the highest-risk newborns.

Better care for California’s mothers should align with constitutional principles, emphasizing individual treatment. As the Supreme Court stated in Students for Fair Admissions v. Harvard, the government must treat citizens as individuals, not racial components. This principle also applies to healthcare. William Osler, a prominent physician, noted that a great physician treats the patient, not just the disease. Medicine should adapt and abandon failed treatments, but California’s strategy persists with an ineffective and unlawful remedy.

Andrew Quinio, an attorney with the Pacific Legal Foundation, represents Erica Jimenez in her lawsuit against California.