Needing a Lawyer on the Team

by Wendy Parmet

It’s easy to see the value of including scientists in public health law research teams; most public health lawyers lack the training to conduct rigorous empirical research.  It may be harder to see the need for adding lawyers to the research team, but their presence is no less critical. Sometimes scientists have as much trouble understanding the law as the lawyers have understanding the science.

The value of involving lawyers in public health law research became clear to me recently as I was working on a project relating to health policies affecting immigrants. One question I wanted to know was how the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) affected immigrants’ access to health insurance in the United States.  So I decided to review the scientific literature. The results were dismaying.

Several studies in well-respected peer reviewed journals offered numbers based on a clear misunderstanding of PRWORA and the complex way in which it categorizes aliens and restricts their access to public benefits.  For example, one paper written by a team lacking any JDs, claimed that “qualified aliens” are those who came to the United States before 1996, and “unqualified aliens” are immigrants who came to the United States after 1996 and are subject to PRWORA’s five-year waiting rule. In actuality, under PRWORA many immigrants who came before 1996 are “unqualified” and most “qualified aliens” who came after 1996 are subject to the five-year waiting rule. Because the paper used these terms to categorize the study’s subjects, the study’s findings cannot be trusted. Unfortunately, this wasn’t the only study or commentary in the medical and public health literature that misunderstood PRWORA.

Without question, PRWORA is an especially complicated statute — so complicated that the courts have had trouble interpreting it. Indeed, to really understand PRWORA, one has to understand how the courts have construed and applied its confusing terms.

PRWOA, however, isn’t the only such statute. Indeed our federal and state health laws are filled with equally confusing laws. In order to understand their impact, we need to have rigorously designed empirical studies. But we also need lawyers on the team to ensure that the researchers understand the law they’re studying.