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The ‘Collateral Damage’ of Obama’s Cuba Policy

How the closure of a little-known program linked to “wet foot, dry foot” could impact Miami’s medical landscape.
A medic ties up his surgical mask at Jackson Memorial Hospital in Miami, Florida.

A medic ties up his surgical mask at Jackson Memorial Hospital in Miami, Florida.

All along the streets of Hialeah and Little Havana,Cuban businesses pepper the streets. Septuagenarians crowd the windows of carretas, sipping cafecitos and gnawing on guava pastries; on street corners, Fidel Castro is discussed with the voracity he was nearly six decades ago. It’s tough to walk down any street in this part of Miami without feeling the impact of the city’s Cuban population, hundreds of thousands of whom either made their way across the Atlantic or were born to parents who did.

Here, it’s impossible to ignore public policy. Thanks largely to the late Clinton-era “wet foot, dry foot” law that expedited citizenship status for Cubans who successfully immigrated to the United States by touching American soil, the Cuban population in Miami exploded between 2000 and 2010, increasing from 1.2 to 1.8 million—a whopping 44 percent.

The Obama administration’s announcement last week that it would end “wet foot, dry foot” — to mixed reactions, as his immigration policy is wont to do — also signaled the end of the Cuban Medical Professional Parole Program (CMPP), a policy created in 2006 that allowed Cuban doctors working abroad to seek fast-track citizenship in the U.S.

The CMPP was created in response to Castro’sMais Médicos, a mammoth program that allows the Cuban government to sell medical contracts to foreign governments and loan Cuban-trained doctors to developing nations that need trained medical professionals, in exchange for foreign currency and other goods (its biggest benefactor is Venezuela, which gave Cuba upwards of 100,000 barrels of oil a day in exchange for a stable cohort of 10,000 doctors stationed in the country).

Sebastián Arcos, the associate director of Florida International University’s Cuban Research Institute, and Jaime Suchlicki, director of the University of Miami’s Institute for Cuban and Cuban-American Studies, both say Mais Médicos isn’t good for Cuban doctors; Suchlicki argues they’re used as “tools of the state.” (Doctors on the island make an average of $25 USD per month.) And, despite travel policy reforms implemented in 2013, Arcos says doctors in Cuba are legally required to obtain special permission from the government to travel, which is “rarely given.”

Arcos and Suchlicki note that closing the CMPP effectively forces Cuban medical professionals to continue working in Cuba, where they have less autonomy to travel or move outside of the island, except to work as proxies for the Cuban government in countries like Venezuela, Brazil, and Colombia.“It’s what makes the [Obama] administration’s decision [to close the pathway] particularly egregious,” Arcos says.

Suchlicki, calls Mais Médicos a “major” source of income for the Cuban government: “More than trade, more than tourism.” Arcos notes that the end of the program is a boon to the Cuban government, in part because it will “reduce the Cuban regime’s fears of more doctors defecting, because the door to the U.S. is closed.”

He also says the “vast majority” of Cuban medical doctors who sought asylum in the U.S. didn’t go on to open practices in Miami (re-taking medical exams in the U.S. is an expensive, arduous, and time-consuming endeavor), most joinedthe city’s medical community as nurses or medical assistants.

And they’re an important part of it.

Though he notes that Cuban-owned dental practices are more common than those specializing in other forms of medicine, Cuban businesses in Miami are ubiquitous: Census data shows that slightly less than half of the 244,148 Hispanic firms in Miami-Dade County were owned by Cubans (by comparison, Mexican-owned businesses in Miami accounted for about 3 percent of them); Solidaridad Sin Frontera, an immigration clinic geared toward medical professionals, estimates that 90 percent of the nearly 8,000 health workers registered with the organization are Cuban.

“For the most part, Cuba has a history of training good doctors. And in a system [like Miami] where nurses and medical staff are trained doctors, it increases the quality of care available,” Arcos says.

The logic seems to translate. Miami-Dade County’s hospitals, like the Jackson Memorial Medical Center and Mount Sinai, are consistently ranked among the best in the country. And Miami’s health-care industry continues to grow: Between November of 2015 and 2016, the county saw a roughly 3 percent increase in the number of people employed in education and health services.

While Arcos calls the potential decrease in highly trained medical assistantsa “collateral,” rather than “major,” issue, it’s uniquely poised to affect Miami: “No other city has the number of Cuban medical doctors residing in South Florida,” he says. The CMPP “benefited Miami more than other cities, [and so] Miami will suffer more than other cities in the U.S.” as that pathway between the U.S. and Cuba closes.