852 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION VOL. 101, NO.

9, SEPTEMBER 2009
O R I G I N A L C O M M U N I C A T I O N
BACKGROUND
T
he laws of the United States and corresponding
legislative action, such as affirmative action,
have always played an integral role in expanding
equal opportunity and access in education, health care,
housing, and in opening doors within the democratic
institutions of American society.
1
However, in the last
2 decades, the need for the continuation of affirmative
action programs, particularly in education, has been
under intense scrutiny in the courts and the topic of state
voter initiatives or legislative action in Florida, Texas,
California, Michigan, and Washington.
2
In conjunction
with the November 2008 elections, efforts to outlaw the
use of race, ethnicity, sex, and national origin in pub-
lic education programs have been the subject of intense
debate and antiaffirmative action campaigns targeted
at Arizona, Oklahoma, Missouri, Nebraska, and Colo-
rado.
3
Referred to as the Super Tuesday of equality by
state voter-sponsored initiative proponents lobbying to
remove affirmative action in public education program-
ming, including student pipeline programs, these ballot
initiatives managed to only make their way onto the bal-
lots in Colorado and Nebraska.
4,5
On November 4, 2008, Colorado became the rst
state to defeat the state-sponsored antiafrmative
action voter initiative known as Amendment 46. How-
ever, with passage of Initiative 424 in Nebraska, the
ability to ensure diversity in the public workforce and
educational sectors faces new challenges.
6,7
In particular,
the University of Nebraska Medical Center, other cam-
puses in the University of Nebraska System, heavily
Author Affiliations: Health Services Research & Administration (Dr Smith,
associate vice chancellor for academic affairs, chief student affairs officer,
associate professor), Internal Medicine-Pediatrics (Dr Nsiah-Kumi, assistant
Background: Despite recent challenges to educational
pipeline programs, these academic enrichment programs
are still an integral component in diversifying the health pro-
fessions and reducing health disparities. This is part 2 of a 2-
part series on the role of pipeline programs in increasing the
number of racial and ethnic minorities in the health profes-
sions and addressing related health disparities. Part 1 of this
series looked at the role of pipeline programs in achieving a
diverse health professional workforce and provided strate-
gies to expand pipeline programs.
Methods: This paper presents an historical overview of affir-
mative action case law, antiaffirmative action legislation,
and race-conscious and race-neutral admission programs in
education. Additionally, part 2 reviews current legal theory
and related law that impact the diversity and cultural com-
petence pipeline programming at higher-education institu-
tions. Finally, based on recommendations from a review of
legal and other literature, the authors offer recommenda-
tions for reviewing and preserving diverse pipeline programs
for health professional schools.
Conclusion: Affirmative action is an essential legal means
to ensure the diversity-related educational programs in the
health profession educational programs. Antiaffirmative
action legislation and state-sponsored antiaffirmative voter
initiatives have the potential to limit the number of under-
represented minorities in the health professions and create
even greater opportunity gaps and educational disparities.
Therefore, we must shift the paradigm and reframe the dia-
logue involving affirmative action and move from debate to
a collaborative discussion in order to address the historical
and contemporary disparities that make affirmative action
necessary today.
Keywords: health disparities n children/adolescents n
minorities n education
J Natl Med Assoc. 2009;101:852-863
Pipeline Programs in the Health Professions,
Part 2: The Impact of Recent Legal Challenges
to Affirmative Action
Sonya G. Smith, EdD, JD; Phyllis A. Nsiah-Kumi, MD, MPH; Pamela R. Jones, PhD, MPH, RN;
Rubens J. Pamies, MD, FACP
professor), Community-Based HealthCollege of Nursing, Health Promo-
tion, Social and Behavioral HealthCollege of Public Health (Dr Jones,
assistant professor), University of Nebraska Medical Center (Dr Pamies, vice
chancellor for academic affairs, dean of graduate studies, professor of
medicine), Omaha, Nebraska.
Corresponding Author: Sonya G. Smith, EdD, JD, Associate Vice Chancel-
lor for Academic Affairs, Chief Student Affairs Officer, Associate Profes-
sor, Health Services Research & Administration, University of Nebraska
Medical Center, 984250 Nebraska Medical Center, Omaha, NE 68198-4250
(sonyagsmith@unmc.edu).
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION VOL. 101, NO. 9, SEPTEMBER 2009 853
PIPELINE PROGRAMS AND RECENT LEGAL CHALLENGES
populated underrepresented minority (URM) communi-
ties, and concerned citizens, eager to address the dispro-
portionate number of students of color entering medical
schools and the health care professions, are looking to
other states where similar antiafrmative action legis-
lation has passed in order to discern the possible impact
and develop lawful diversity initiatives.
8
In light of such current political action and ongoing
assaults on equal-access P-16 pipeline programs, it is
imperative to review the history of afrmative action
law in America and discuss the impact of recent chal-
lenges aimed at diversity programs to increase URMs in
the health professions. As asserted in part 1, pipeline
programs are an effective strategy for increasing the rep-
resentation of racial and ethnic minorities in the health
professions and reducing health disparities. A discus-
sion of pipeline programs, particularly those dedicated
to improving the number of URMs in medicine, is pro-
vided in greater detail in the rst part of this series.
To fully appreciate the impact of this type of legisla-
tion on P-16 pipeline programs and other projects
designed to increase diversity in the health professions,
we begin with a review of afrmative action legislation
and subsequent antiafrmative action laws in America.
These laws are discussed in the context of equal oppor-
tunity legislation, US Supreme Court education, and
afrmative action case law, state postsecondary percent-
age plans, and state-sponsored voter initiatives affecting
public education. Additionally, because data are readily
available in California, a review of the impact of the
antiafrmative action ballot initiative on Californias
college and universities higher-education admissions is
provided. Finally, despite the dissension surrounding
antiafrmative programming, recommendations related
to furthering diversity pipeline programs in the health
professions are also included. However, these recom-
mendations should not be construed as legal advice on
behalf of any of the authors. Additionally, as stated in
part 1, afrmative action, for purposes of this article, is
dened as programs, policies, laws, and strategic plans
designed to increase the number of historically under-
represented and disadvantaged groups who have con-
fronted unlawful societal discrimination in education,
employment, government, and other areas.
AN OVERVIEW OF
AFFIRMATIVE ACTION AND
EQUAL-OPPORTUNITY LAW
Many of the issues of educational access and increas-
ing the health professional pipeline have evolved from
antidiscrimination and afrmative action case law
and legislation in the employment context, federal con-
tracting, and educational arena. Antidiscrimination laws
stressed the importance of nondiscrimination employ-
ment and federal government contracting, particularly in
relation to race, color, and national origin.
9
Closely tied
to antidiscrimination laws is afrmative action legisla-
tion, which requires employers and businesses to take
afrmative steps with the regard to race, sex, national
origin, and color in federal contracting and the fair hir-
ing and creation of equal employment opportunity.
9

However, the rst use of the term afrmative action
was in the 1960s by President John F. Kennedy in sev-
eral executive orders focusing on antidiscrimination
laws and calling for equality
10
in reference to an equal
opportunity policy designed to improve integration in
federally nanced work projects.
11
Although in 1941
President Franklin D. Roosevelt issued the rst execu-
tive order8802
12
outlawing antidiscrimination mea-
sures in employment by private employers contracting
with the federal government above a specic monetary
amount, almost every US president has reissued or
revised these orders.
In 1965, President Lyndon B. Johnson issued Execu-
tive Order 11246,
13
forbidding discrimination on the
basis of race, color, national origin, and religion. It was
later amended in 1967 to outlaw sex discrimination.
14

Additionally, President Richard Nixon issued Executive
Order 11478, prohibiting discrimination in federal
employment on the basis of race, color, religion, sex, or
national origin.
15
Other amending executive orders were
issued by Presidents Jimmy Carter and Bill Clinton.
President Carter added handicap and age as protected
classes in terms of employment discrimination and, in
1998, President Clinton, under Executive Order 13087,
made sexual orientation discrimination unlawful in fed-
eral employment.
16,17
During the 1970s, antidiscrimina-
tion laws and afrmative action policy were expanded to
include postsecondary admission programs.
11
Equally,
afrmative action plans were put in place as race- and/or
sex-specic plans designed to provide a remedy for pres-
ent and persistent effects of historical discrimination
against African Americans and women, along with any
effects of discrimination motivated by unconscious
biases and stereotypes
18
(Figure 1).
Title VII of the Civil Rights Act of 1964, which for-
bids public and private employers, labor organizations,
and employment agencies from discriminating in the
workplace on the basis of race, color, sex, religion, and
national origin, is among the most signicant civil rights
and antidiscrimination legislation. However, it does not
use the phrase afrmative action.
10,18,19
The most impor-
tant amendments to Title VII came in 1972, extending
coverage to not only federal and state governments, but
also to local governments.
18
The Fourteenth Amendment
20

of the US Constitution also provides protection under the
due process and equal protection clauses, which makes it
unlawful for states and municipalities to discriminate.
18
In the same way, Title VI of the Civil Rights Act of
1964 makes it unlawful to discriminate on the basis of
race, color, or national origin in any program or activity
which receives federal nancial assistance.
21
This
854 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION VOL. 101, NO. 9, SEPTEMBER 2009
PIPELINE PROGRAMS AND RECENT LEGAL CHALLENGES
includes K-12 and postsecondary institutions receiving
federal grants, participating in federal student loan pro-
grams, and obtaining federal contracts.
18
Additionally,
states receiving federal Medicaid and Medicare dollars
are covered by antidiscrimination legislation such as
Title VI.
22
Likewise, Title IX of the Educational Amend-
ments of 1972 prohibits sex discrimination in any edu-
cational program or activity receiving federal nancial
assistance.
18,23
Therefore, if any student or faculty mem-
ber receives federal grants or loans, public and private
postsecondary institutions must comply with Titles VI,
VII, and IX civil rights legislation (Figure 1).
Both antidiscrimination laws and afrmative action
legislation have major implications for the implementa-
tion, design, and maintenance of academic readiness,
outreach, and medical school pipeline programs. Most
afrmative action litigation and policy development has
been specically directed at the legality of race-specic
college admissions criteria.
24-26
Nevertheless, an out-
growth of antidiscrimination and afrmative action laws
has been the use of afrmative action in the context of
college admissions and higher-education diversity. As
time progressed, more colleges and universities started
to apply afrmative action in new ways in order to not
only diversify faculty and staff but the student body.
Nevertheless, afrmative action continued to be contro-
versial and criticized as watering down the application
pool, and opponents of afrmative action charged that
less-qualied minorities and women were admitted in
place of more-qualied white students.
27-29
In response to this criticism, higher-education insti-
tutions devised new pipeline and preprofessional pro-
grams as a further outgrowth of afrmative action prin-
ciples to increase the success of racial and ethnic
minorities and women in the admissions process, and
improve academic readiness for graduate and medical
schools. Traditionally, due to lack of social capital, seg-
regation and discrimination, and inequality in nancial
resources, these groups were denied access to educa-
tional opportunities and equal protection under the
law.
1,30
These new pipeline and preprofessional programs
provide minorities and women with improved academic
preparation and skill sets required for success.
THE US SUPREME COURT
EQUAL OPPORTUNITY EDUCATION
CASE LAW
The quest for educational equality began with the
landmark ruling, Brown v Board of Education in 1954,
declaring that separate but equal was no longer the
law of the land in terms of segregated black and white
public schools.
30
Following this landmark case was
Regents of the University of California v Bakke (Bakke),
striking down the University of California medical
schools 2-tiered admissions policies, including setting
aside admission spots for African Americans and
enabling the white applicant who brought the case to be
admitted.
31
Because the medical school had 16 set-asides
for minority students in the entering class, Bakke, a
white candidate for admission, claimed that the univer-
sitys medical school had unlawfully denied him admis-
sion under the Equal Protection Clause and Title VI of
the Civil Rights Act of 1964.
31

Most notably, Bakke stands for the proposition that
achieving a diverse student body in academia is a suf-
ciently compelling state interest; thus, the consider-
ation of race and ethnicity, among many other factors, is
a constitutionally legitimate means of achieving this
goal.
31
Other possible diverse admission factors asserted
by the Court were talents, economic background, inter-
est, and geographical region.
31

Bakke further outlawed specic set-asides, quotas,
and separate admission tracks for racial and ethnic groups
in admissions but permitted universities under the Four-
teenth Amendment to voluntarily establish admissions
programs based on racial preferences to remedy past dis-
crimination.
31,32
Under the Courts ruling, all race-con-
scious admissions programs were subject to the most rig-
orous legal test, strict scrutiny.
31
The strict scrutiny test
requires that the state show (1) it has a compelling inter-
est in its race/ethnicity-based program or policy deci-
sion in order to achieve a mission such as the educational
benets of diversity; (2) the race/ethnicity-conscious
program and/or policy decision is necessary to address
issues of equal opportunity consistent with the university
mission and education focus, after having evaluated race
neutral alternatives; (3) the race-conscious program or
policy is reasonably limited in time and scope; and (4) a
narrowly tailored means is used to achieve the states
compelling interest.
2,31,33,34
The compelling state interest portion of the strict
scrutiny legal standard has 2 prongs. The government
must be able to show that its reason for considering race
as a factor is not based on prejudice or racial animosity
but is intended to serve a legitimate and highly substan-
tial government interest. Finally, the race-based policy
and/or decision must also be necessary to either achieve
or protect the compelling interest such as the educa-
tional benets of diversity
32,34
(Figure 2).
In looking at whether a race/ethnic-based admissions
program is narrowly tailored, the Court will look at a
public universitys diversity program, which is the means
it is using to achieve a compelling state interest, such as
the educational benets of a diverse student body, to see
(1) if there is a precise t in which race and ethnicity are
considered in a limited manner; (2) the necessity of using
race/ethnicity to achieve an end goal, such as the educa-
tional benet of a diverse student body; (3) the exibility
of the race-based program; (4) the burden placed on the
racial/ethnic nonbeneciaries of the program; and (5) if
there is an end point to the race/ethnic-based program.
2,33-
35
Although Bakke remains one of the major cases by
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION VOL. 101, NO. 9, SEPTEMBER 2009 855
PIPELINE PROGRAMS AND RECENT LEGAL CHALLENGES
Figure 1. Key Affirmative Action Events and Antidiscrimination Laws
856 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION VOL. 101, NO. 9, SEPTEMBER 2009
PIPELINE PROGRAMS AND RECENT LEGAL CHALLENGES
which the constitutionality of race-conscious admissions
programs is judged, even after 1978, the lower federal and
state courts continued to be divided regarding the consti-
tutional viability and the meaning of the legal standard for
the use of race set forth in Bakke.
31,36-39
In 2003, the US Supreme Court joined 2 cases and
handed down a set of historical rulings that would also
forever shape the landscape of diversity in higher educa-
tion. Factually, in the 2 cases, Grutter v Bollinger et al
(Grutter) and Gratz et al v Bollinger et al (Gratz), 2 white
students alleged that they, respectively, had been denied
admission to the University of MichiganAnn Arbor law
school and undergraduate program in violation of the
equal protection clause of the Fourteenth Amendment of
the US Constitution, Title VI of the Civil Rights Act of
1964, and 42 USC 1981.
40,41
The Court upheld the law-
fulness of the University of Michigan law schools admis-
sions policy, but because the undergraduate policy was
not sufciently narrowly tailored, 6 of the justices
found the undergraduate admissions policy unlawful.
40,41
Writing for the majority in Grutter, Justice OConnor,
relying on the strict scrutiny test triggered by race/eth-
nicity-based programs, reafrmed that public educational
institutions seeking diversity must do so in a narrowly
tailored form but also agreed with Bakke that the rele-
vant context mattered and not every decision inuenced
Figure 2. Strict Scrutiny Legal Standard and Race-Conscious Policies and Programs
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION VOL. 101, NO. 9, SEPTEMBER 2009 857
PIPELINE PROGRAMS AND RECENT LEGAL CHALLENGES
by race was equally objectionable.
37,41
Importantly, the
US Supreme Court deferred to the University of Michi-
gans assessment that diversity was essential to its mission
and that, as Justice Powell had written in the Bakke opin-
ion, student body diversity is a compelling state interest
that could justify the use of race in university admis-
sions.
37,41
The Court also held that the law school did not
violate the law by seeking to enroll a critical mass of
minority students and that some attention to numbers
could be paid without constituting a quota system.
37,41
Specically, the Court in Grutter not only agreed that
higher-education diversity could serve as a compelling
state interest but agreed that the University of Michigan
law schools admissions policy, which included race as a
plus in its holistic and individualized review of appli-
cants based on many factors, was narrowly tailored under
strict scrutiny, as Justice Powell had laid out in Bakke.
40,41

In contrast, the Court, in Gratz, struck down the Univer-
sity of Michigans undergraduate admissions point-based
afrmative action policy selection index due to its
inability to provide an individualized evaluation of the
applicants les, which violated narrowly tailoring and
operated very similar to the quota system in Bakke.
40,41
The major implication for the Gratz and Grutter cases
is that whether a race/ethnicity-based public education
policy or program will be held lawful depends upon how
it is applied (Figure 1). Therefore, some confusion still
exists about the application of race/ethnicity-based poli-
cies and programs in public education and how to suc-
cessfully implement them in a lawful context.
37
Two new cases focusing on race-based admissions
programs came before the US Supreme Court in 2007.
These cases were Parents Involved in Community Schools
v Seattle School District No. 1 (Seattle) and Meredith v
Jefferson County Board of Education (Louisville)
42,43

(Figure 1). The Seattle and Louisville cases were decided
in June 2007 and were not cases involving remedies of
dejure or past desegregation. The Louisville case involved
a white plaintiff in Louisville, Kentucky, whose son had
been denied a transfer to attend kindergarten in the Jef-
ferson County Public Schools, which had adopted a race-
conscious school assignment plan. Under this plan,
schools were to seek black student enrollments between
15% and 50%, a target based on the demographics of the
public schools in the county.
42-44
In the Seattle case, the Seattle school district embraced
an open choice plan for 10 high schools, and 5 of the 10
high schools were usually overly requested. Students
wishing to attend overly requested high schools were
assigned to these schools based on 4 tiebreakers: (1) a
preference for keeping siblings in the same school, (2) an
integration tiebreaker, (3) distance from home to school,
and (4) a lottery system.
42-44
If 1 of the 5 oversubscribed
high schools had a racial imbalance, dened as white and
nonwhite enrollments, not within 10 percentage points of
the school districts demographics, the integration tie-
breaker was utilized.
42-44
Specically, African American
students were classied as blacks and all other non-
white students were placed together in a category called
other. Comparing racial variances within the schools
student body composition and percentages of all students
in the district as part of their decision making process, the
Seattle school district focused on racial imbalances in
order to attempt to bring high schools closer to a 60%
nonwhite and a 40% white balance.
42-44
Because both the school districts in the Louisville
and the Seattle cases employed race-conscious policies,
this triggered evaluation under the strict scrutiny stan-
dard, thereby requiring each district to demonstrate that
the policies were narrowly tailored to promote a compel-
ling governmental interest.
44
Specically, race-conscious
policies: 1) explicitly use racial classications as a fac-
tor in evaluating a candidates admission to an educa-
tional program, and 2) may be policies that appear to be
racially neutral on their face, but the motive for utilizing
the policy is indeed discriminatory.
45

Importantly, it must be noted that the two school dis-
tricts in the Louisville and Seattle cases were not pursuing
these race-based or race-conscious plans to further the edu-
cational benets of diversity, nor did the plans involve a
holistic review of factors for admission such as students
talents or socio-economic background. In other words,
diversity was dened solely by race and ethnicity.
42-44
Because the districts did not prove that the use of
race was necessary to achieve their prescribed goals and
that each had not considered race-neutral alternatives,
the Court ruled that neither of the districts had satised
the strict scrutiny legal standard. However, based on
these cases, race and ethnicity can still be used as 1 of
multiple factors in admissions.
42
Nevertheless, the Louisville and Seattle cases demon-
strate that despite Grutter, in public educational institu-
tions and related pipeline programming, caution must be
exercised in attempts to establish a critical mass of
minority students.
46
It is important to note that most legal
scholars agree the achievement of a critical mass is
still somewhat illusive terminology and needs further
clarication from the Court.
32,33
For example, a critical
mass of URM can include a clearly stated objective but
not operate as a rigid quota system. The Grutter Courts
reference to critical mass theory incorporated students
of color in terms of (1) meaningful numbers, (2)
meaningful representation, (3) a number that encour-
ages underrepresented minority students to participate in
the classroom and not feel isolated, (4) students from
groups which have been historically discriminated
against, (5) individuals who are likely to have experi-
ences and perspectives of special importance to the [edu-
cational institutions] mission, and (6) minority students
who do not feel like they must be spokespersons for their
race or ethnic group nor feel uncomfortable discussing
experiences that may differ from the majority.
2,33,34,41
858 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION VOL. 101, NO. 9, SEPTEMBER 2009
PIPELINE PROGRAMS AND RECENT LEGAL CHALLENGES
Furthermore, critical mass must be linked directly
to the educational benets of diversity that the educa-
tional institution or medical school has as its mission.
2,41

Additionally, race-neutral alternatives must be consid-
ered, and educational institutions must solidly dene
their missions and educational objectives in relationship
to the role that diversity and/or cultural competence
plays in achieving their goals and missions.
44
Race can-
not be a deciding factor in admission to public educa-
tional programs. A holistic review of all applications
that incorporates other factors must occur.
41,46
It should be noted that there is not a specic body of
equal opportunity or afrmative action case law that
addresses the admission/selection of racial and ethnic
minorities to precollege, outreach, pipeline, or preprofes-
sional admissions programs. The US Department of Edu-
cation refers to these Bakke-like programs as develop-
mental approaches or approaches designed to diversify
student enrollments by enriching the pipeline of appli-
cants equipped to meet entry requirements and achieve
academic success.
47
However, higher-education ofcials
and attorneys have long assumed that Gratz and Grutter
apply to many different kinds of race-based admission
policies and programs, such as pipeline and precollege,
that consider Bakke-like race and ethnicity factors.
48,49
For example, as Calleros notes
Race-neutral developmental approaches could
encompass any race-neutral measures designed
to increase the number and quality of diverse
applicants who make their way into the applica-
tion pipeline. These might include governmental
measures to improve K-12 education, especially
in schools or districts that have fallen behind in
academic success, as well as private or govern-
mental outreach measures to encourage a broad
spectrum of students to aspire to higher educa-
tion and to apply for admission.
49
Calleros further states that
Even if schools more consciously target minority
groups with their outreach efforts, race-conscious
efforts to enhance diversity in the applicant pool
likely will be subject to less searching review than
race-conscious decisions that result in actual
admission. Moreover, developmental programs
are an important supplement to race-conscious
admissions programs as well as a means of fur-
thering race-neutral admissions.
49
STATE-SPONSORED ANTIAFFIRMATIVE
ACTION VOTER INITIATIVES
Since 1996, state-sponsored voter initiatives have
sought to ban afrmative action in public education, pub-
lic contracting, and public employment in California,
Washington, Michigan, Nebraska, Oklahoma, Missouri,
Colorado, and Arizona.
3
Freedom from unlawful racial
and sexual discrimination requires measurable progress
goals and monitoring to alleviate historical unfair and
discriminatory treatment and opportunity gaps experi-
enced by women and minorities.
50
Therefore, state-spon-
sored voter initiatives seeking to displace afrmative
action programs and pipeline programs for URM stu-
dents have been placed in jeopardy by such measures.
Prior to 2008, antiafrmative action and/or anti
equal opportunity state voter initiatives had passed in 3
states: California (Proposition 209), Washington (Initia-
tive 200), and Michigan (Proposal 2).
51
The language of
these state-sponsored ballot initiatives is basically uni-
form in nature and very similar in that they seek to
remove what their proponents view as racial, ethnic,
national origin, and gender preferences from any pro-
grams associated with public education, public employ-
ment, or public contracting.
51
Sample language from
these state-sponsored ballot initiatives typically propose
a constitutional amendment or enactment of a statute
virtually banning most forms of afrmative action. An
example of the language is:
The state shall not discriminate against, or grant
preferential treatment to, any individual or group
on the basis of race, sex, color, ethnicity, or
national origin in the operation of public employ-
ment, public education, or public contracting.
51
Leading the charge for these state-sponsored ballot
initiatives is Ward Connerly, a businessman and former
regent of the University of California system and head of
the American Civil Rights Institute (ACRI).
52
The ACRI
sponsored November 2008 antiafrmative action ballot
initiatives in Arizona, Oklahoma, Missouri, Colorado,
and Nebraska.
3,7,51
Ballot initiatives only successfully
appeared on the Colorado and Nebraska 2008 ballots.
The ballot initiative failed in Colorado, thus ending its
political course, but passed in Nebraska.
7

The state with the longest history and most available
published data related to the poststate ballot initiative
impact is California. Due to the recent passage of the
antiafrmative action ballot initiatives in Michigan and
Nebraska, more time is needed in order to discern the
possible ramications in these 2 states. Additionally,
there are limited published and longitudinal data on the
impact of the antiafrmative action ballot on the health
professional schools for the state of Washington.
53

In California, substantial decreases in the number of
URM students in higher education have been devastat-
ing and have required innovative approaches to diversi-
fying the student body and maintaining educational
pipeline and enrichment programs. For example, after
the passage of Prop 209, the University of California
Berkeley saw a decline of 65% in minority student
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION VOL. 101, NO. 9, SEPTEMBER 2009 859
PIPELINE PROGRAMS AND RECENT LEGAL CHALLENGES
enrollment, and the University of CaliforniaLos Ange-
les experienced a 45% decline in the matriculation of
students of color.
7
Additionally, data from the Association of American
Medical Colleges on minority admissions and matricu-
lation at California medical schools before and after
Prop 209 show decreases in the number of URMs who
are California in-state residents enrolling in MD pro-
grams.
54
California residents approved Prop 209 in 1996,
banning the use of race/ethnicity as factors in admis-
sions. Pre-Prop 209 medical school acceptance reveals
an acceptance of 233 minority residents to California
medical schools in 1993, compared to 157 in 1997, and
only 156 in 2001.
54
Likewise, the percentage of minority medical school
California residents studying in the state dropped from
23.1% in 1993 to 14.3% in 1997.
54
Consequently, the
percentage of Californias in-state minority residents
studying at state medical schools has averaged between
16.4%, a decrease of 6.7% as of the last decade.
54
Most
notably, since 1995, more than half of Californias
minority residents accepted to medical schools outside
the state have chosen to matriculate at non-California
medical schools.
54
One year after the passage of Washingtons I-200 in
1998, the University of Washington reported a one-third
drop in minority enrollment with African Americans con-
stituting 1.84%; American Indians, 0.91%; and Hispan-
ics/Latinos, only 2.9% of the entering class.
55
However, in
2004, minority enrollment at the University of Washing-
ton rose again to preI-200 levels, with African Ameri-
cans making up 3.04% of the freshmen class; American
Indians, 1.27%; and Hispanics/Latinos, 4.64%.
55
During
the passage of Proposal 2 in 2006, the University of Mich-
igan was in the middle of its admissions cycle; therefore,
the longitudinal impact of Prop 2 in Michigan is still
unclear. However, after its rst full admissions cycle since
approval of the ban, the University of Michigan has only
seen a 2% drop in minority enrollment.
7
STATE-SPONSORED PERCENTAGE PLANS
Although voter ballot initiative antiafrmative plans
have not been enacted in these states, both Florida and
Texas have implemented controversial percentage plans
as part of their efforts to move toward admissions race-
neutral. In November 1999, Jeb Bush, Floridas gover-
nor, issued Executive Order Number 99-281, eliminat-
ing the use of race, national origin, or sex in university
admissions, employment, and contracting, thereby abol-
ishing afrmative action in higher education and other
state agencies.
51,56
Former Governor Bushs executive
order was in response to Ward Connerlys attempt in
Florida at a state voter referendum that would end afr-
mative action policies, similar to Proposition 209 in Cal-
ifornia.
56
The Florida executive order was an extenuation
of the One Florida plan or the Talented 20, which guar-
anteed admission of the top 20% of all Florida high
school graduating students to 1 of Floridas 11 public
universities
57
(Figure 1).
As part of the Talented 20 plan, need-based nancial
aid was increased by 43%, or $20 million, in hopes of
increasing access for underrepresented students and
expanding diversity in the State University System
(SUS).
56
However, Florida high school graduates who
qualied received no guarantee of admission to the SUS
institution of choice.
Taking into consideration the entire Talented 20
applicant pool in 2001, fewer than half enrolled at a SUS
institution. Specically, 3 years after the implementation
of the Talented 20 plan, only 43.1% of eligible Hispanics
and 49.4% of eligible African American students
enrolled in the system in 2001.
56
Nevertheless, at the
University of Florida in 2000, the number of rst-time
college African Americans did increase from 9.8% in
1998 to 12.9%.
56
However, the number of rst-time Afri-
can Americans dropped signicantly to 9.4% at the Uni-
versity of Florida in 2001, while the proportion of His-
panics rose from 10.9% in 1998 to 12.1 in 2000 and held
steady in 2003.
56
Data from 2000 demonstrated that of the eligible Tal-
ented 20 students applying to SUS institutions, 95.5%
were accepted, but in 2001 only 81.9% were admitted. In
looking at African American Talented 20 applicants in
2000, 92.5% were accepted to SUS campuses but
accounted for only 72.1% in 2001.
After the 1996 Fifth Circuit Court of Appeals ruling
in Hopwood v Texas,
39
ending the use of race-conscious
admissions, Texas adopted a Top 10 plan. The Top 10
plan automatically admitted the top 10% of graduating
seniors in Texas, regardless of standardized test scores, to
any public college or university in the state. This plan
was signed into law by then Governor George W. Bush.
58
The Hopwood case involved 4 white students who
alleged that they were not admitted to the University of
Texas law school in violation of the Fourteenth Amend-
ments Equal Protection Clause. At the time, the Univer-
sity of Texas law school used an admissions process that
placed students into relative categories such as presump-
tive admit, discretionary, or presumptive denial. These
categories were based on a weighted index score consist-
ing of the candidates undergraduate grade point average
and Law School Admission Test (LSAT) score.
39
Under this procedure, Mexican American and Afri-
can American applicants could have lower index scores
and be presumptively admitted. The US Fifth Circuit
Court of Appeals ruled the law schools policy violated
the Equal Protection Clause of the Fourteenth Amend-
ment and could not withstand strict scrutiny.
39
Signi-
cantly, this lower court, the Fifth Circuit Court of
Appeals, went even further and outlawed all race-con-
scious admissions policies, thus, rejecting the US
Supreme Courts ruling in Bakke.
39,58
860 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION VOL. 101, NO. 9, SEPTEMBER 2009
PIPELINE PROGRAMS AND RECENT LEGAL CHALLENGES
In an attempt to offset Hopwood, the Texas Top 10
plan was implemented. Prior to Hopwood, whites made
up 64% of the total enrollment at the University of
TexasAustin (UT-Austin). Minorities represented 36%
of the universitys enrolment; African Americans, 5%;
and Hispanics, a little less than 15%.
59
However, in 1997,
minority enrollment at UT-Austin reached its lowest
decline since 1994, with African Americans accounting
for only 3% and Hispanics 13%.
59
Although the undergraduate minority enrollment con-
tinues to increase at UT-Austin, the percent of African
American admits and matriculants still needs much
improvement. In 2001, the number of African Americans
applying to UT-Austin increased by 24%, but the percent
admitted decreased by 19%.
59
In 2003 Grutter would over-
rule Hopwood and, as a result, allow the voluntary use of
race as a factor in a holistic admissions procedure.
41

It should be noted that in 1960 California adopted a
percentage plan for its colleges and universities.
60
The
plan, A Master Plan for Higher Education in California,
recommended that California State Colleges (currently
California State University) select rst-time freshmen
from the top one-third (33.3%) and the University of
California from the top one-eighth (12.5%) of all gradu-
ating California public high school students.
60

Additionally, as part of the University of California
policy on undergraduate admissions, California would
reafrm the importance of enrolling a culturally, racially,
geographically, and socioeconomically diverse student
body in May 1988.
60
Furthermore, during the 1980s,
University of California admission guidelines estab-
lished a 2-tier process in admissions, allowing campuses
to admit the top 40% to 60% of their rst-year freshmen
class solely on academic criteria and the remainder of
the class based upon a combination of academic and
supplemental criteria (nonacademic) such as commu-
nity service or special talents.
60
However, in 1995, and 1 year prior to the passage of
Prop 209 in California, the University of California
Board of Regents passed Special Regental Action Num-
ber 1 (SP-1) prohibiting the use of race, ethnicity, and
gender in admissions
61
(Figure 1). Additionally, SP-1
included a percentage plan allegedly aimed at ensuring
equal treatment by requiring that not less than 50% and
not more than 75% of any entering class on any campus
be admitted solely on the basis of academic achieve-
ment. In this case, academic achievement referred to
grades and standardized tests only.
61

After the passage of SP-1 in 1995, the number of
minority applicants applying to University of California
declined.
60
Specically, 22.1% of freshmen applicants
were minority students in 1995; however, these numbers
fell to 18.8% in 1998. SP-1 would be overturned by the
passage of Prop 209 in 1996, with the proposition taking
legal effect in 1998.
60
In February of 2009 the University of California
adopted another major change to its undergraduate
admissions policy.
62
The policy is likely to decrease the
percentage of California high school graduates who are
guaranteed places on at least 1 of the University of Cali-
fornia campuses, from approximately the top 12.5% to
the top 10%.
62
The policy also eliminates the 2 SAT sub-
ject tests. The goal of the University of California is to
move toward a more comprehensive admissions review
and enlarge its applicant pool.
62
University projection,
based on 2007 data, indicates that the new policy may
potentially decrease the number of admitted Asian Amer-
ican students while increasing the number of whites.
Nevertheless, university ofcials state that the new pol-
icy will improve the educational access of minority and
students from low socioeconomic backgrounds.
62
MAINTAINING THE PIPELINE:
STRATEGIES FOR OVERCOMING
CHALLENGES TO AFFIRMATIVE ACTION
As public colleges and universities struggle with liti-
gation and legislative initiatives challenging afrmative
action, it is essential that institutions do not abandon
their missions and goals related to diversifying the stu-
dent body and their commitment to developing pipeline
programs that will provide opportunities for URMs in
postsecondary education. As indicated in part 1 of this
series, medical professionals of color will be instrumen-
tal in resolving many of the economic and healthcare
disparities which challenge America.
Below are recommendations that K-16 educational
institutions, graduate and professional schools, health
care organizations, and policy makers should consider
in developing diversity pipeline programs to increase
URM students in the health professions as they undergo
afrmative action scrutiny.
Clearly affirm or reaffirm the institutional mission
and objectives to insure that diversity and cultural
competence are incorporated as core institutional
values.
2,35
Ensure there is a strong connection between the
benefits of educational diversity as a part of the
institutional core mission and universitywide
strategic plan objectives.
2
Incorporate strategic enrollment management,
which includes recruitment, retention, outreach,
marketing, alumni/advancement, as an integral part
of any diversity plan and align all strategies and
goals across departments and colleges.
If race-conscious or race-based admissions
procedures are utilized, make sure they are part of a
holistic plan which considers other factors such as
talents, interests, socioeconomic background, and
overcoming adversity.
Whether a diversity pipeline program is considered
race neutral has to do with the actual intent or

JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION VOL. 101, NO. 9, SEPTEMBER 2009 861
PIPELINE PROGRAMS AND RECENT LEGAL CHALLENGES
motive behind the program and/or admissions
policy. Therefore, consider inclusive outreach
marketing and race-neutral recruitment programs
which focus on:
academic qualificationsgrade point average,
test scores, evaluations, and rigor of course
work and academic major for candidates to
postsecondary institutions.
45
talents, interests, abilitiesgeographical
background, socioeconomic status, parental
education, first-generation college students
and/or professional students, cultural
competence/awareness, commitment to
working in underserved communities or
reducing health disparities, high school/
community demographics (both rural and
urban), participation in study abroad programs,
athletics, artistic ability or other talents, and
volunteer and employment experiences in
underserved communities and/or countries.
45
Align definitions of underrepresented minorities
with federal government language such as the US
Department of Health and Human Services in
describing shortages in medicine, biomedical field,
nursing, etc.
In designing P-16 pipeline programs to increase
URM students in the health professions, link
program and policy goals/mission to federal
objective programs such as those in the federal
Office of Minority Health objective.
Review race-based programs regularly and in doing
so, consider viable nonrace-based or race-neutral
alternatives.
2,34
Make sure that documentation
of ongoing reviews is kept on file and consult
with academic affairs, enrollment management,
legal counsel, and student services as part of a
collaborative process.
Ensure that the definition of diversity as it relates to
pipeline programs is inclusive and represents more
than race and ethnicity.
2
In stating objectives and institutional mission, tie
the goal of the educational benefits of diversity to
measurable strategies that promote access and equal
opportunity.
2
Consider adopting precise goals of racial literacy,
multicultural literacy, and cultural competence that
can be measured and monitored in connection with
the educational benefits of diversity.
63
In conducting regular reviews of diversity-related
programs and policies, incorporate specific
institutional evidence and outside sources that
support the connection between the university
mission and the educational benefits of a diverse
student body.
35

GUIDELINES FOR ANTIAFFIRMATIVE

ACTION BALLOT INITIATIVE STATES
In an effort to further diversity, the University of
Nebraska Board of Regents Ofce of the General Coun-
sel issued guidelines for its campuses to assist them in
complying with the I-424 ballot initiative in January
2009.
64
These guidelines serve as a resource in promot-
ing the compelling interest of diversity in higher edu-
cation within the legal parameters allowable by state and
federal law. The University of Nebraska guidelines draw
upon the experience and guidelines published by the
University of California in their efforts to ensure diver-
sity and comply with the Prop-209 ballot intiative.
65

Both the University of Nebraska and University of
California guidelines state that outreach programs tar-
geted exclusively for 1 gender, race, or ethnicity are not
allowed. However, as part of their comprehensive out-
reach programs, universities may sponsor programs that,
because of their content, are of particular interest to
members of a particular racial groups or 1 gender, if
they are open to all persons.
64,65
The University of
Nebraska guidelines use a conference on womens
issues in higher education that may attract more women,
as an example.
64
Furthermore, the University of California Regents
guidelines state:
Outreach. Proposition 209 prohibits outreach
programs that are targeted exclusively to or avail-
able exclusively for one gender or one or more
particular racial group, when such efforts pro-
vide informational or other advantages to can-
didates who have access to them. Nevertheless,
the University may, as part of a comprehensive
program of outreach, target or increase specific
efforts within that program to reach particular
groups where the programs benefits are available
broadly to other groups, and the special efforts
are necessary to reach the targeted groups mem-
bers effectively and therefore to level the infor-
mational playing field. Such activities might
include, for example, workshops or materials ori-
ented toward specific communities or groups. The
benefits of the program must be available on a
non-selective basis such that interested individu-
als from all racial groups and both genders have
access to the same benefits.
65
In terms of admissions criteria, the University of
Nebraska guidelines specically state:
Use of Neutral Selection Criteria. The Universi-
ty may choose to advance its educational goals,
including diversity, by considering gender/race/
ethnicity neutral selection criteria in both admis-
sions and employment decisions. Economic dis-
862 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION VOL. 101, NO. 9, SEPTEMBER 2009
PIPELINE PROGRAMS AND RECENT LEGAL CHALLENGES
advantages, first generation college attenders,
neighborhood or community circumstances, low-
performing secondary schools, and the impact of
an applicants experiences are permissible crite-
ria, which may promote greater diversity. (Note:
the Universitys long tradition of admitting any
Nebraska undergraduate student who meets cam-
pus academic requirements generally eliminates
questions of preferential admission.)
64
The guidelines also allow campuses to continue tak-
ing steps to comply with their federal afrmative action
programs and plans. States with similar antiafrmative
action laws may wish to further consult the University of
California and University of Nebraska guidelines in
terms of assessing neutral selection criteria and review-
ing race- and gender-specic admissions, outreach, and
hiring programs.
64,65
CONCLUSION
While pipeline programs are designed to prepare dis-
advantaged students for health professions education,
starting as early as kindergarten, the dismantling of afr-
mative action has the potential to end these programs
and signicantly reduce the number of URM students
who enter the pipeline early and are prepared for careers
in the health professions. It is essential that the diverse
pipeline programs are preserved through creative
approaches designed to close opportunity gaps and
improve academic readiness.
To preserve these diversity pipeline programs in light
of continuous afrmative action challenges, there must
be a paradigm shift and a reframing of the issues sur-
rounding afrmative action. As Frank Wu, law professor
and former dean of the Wayne State University School
of Law, observed at a Michigan Journal of Race and
Law symposium in 2008, we must move from debate
to dialogue among individuals and communities and
ask a different question.
63
According to Wu, the question
should be, What will we do to make good on the ideals
we claim to sharewhat will we do as a diverse democ-
racy so that all of us are able to write the scripts of our
own lives?
63
As Wu points out, such questions force us to move
from a debate of the pros and cons of afrmative action
to the historical reasons and the contemporary dispari-
ties that make afrmative action still necessary.
63
They
implore us as a collective to tackle the difcult and lin-
gering inequalities in socioeconomic status, educational
nance reform, postsecondary access, and true admis-
sions indicators as predictors of actual degree comple-
tion. In doing so, we collaborate in our dialogue and
explore new and novel ways to improve enrichment pro-
grams that act as a bridge for URM students in the health
profession.
ACKNOWLEDGMENTS
Special thanks to Mary Jo Price Esq, Carmen Maurer
Esq, and Lois Colburn for their feedback and comments
related to this manuscript. Thanks also to Teresa Hart-
man, K. Diane Ullrich, Carly R. Crim, Margaret T. Rob-
inson, Dr Mary McNamee, Stacie Ortmeier, Anne Con-
stantino, and Jo Giles Galbreath for their assistance with
the preparation of this manuscript.
REFERENCES
1. Katznelson I. When affirmative action was white: an untold history of
racial inequality in twentieth-century America. 1st ed. New York: W.W. Nor-
ton; 2005.
2. Coleman AL, Palmer Scott R. From theory to action: policy development
stategies for meeting access and diversity goals in lawful ways. The Col-
lege Boards collaborative on access & diversity in higher education. Den-
ver, CO: The College Board; May 2008.
3. Schmidt P. 5 more states may curtail affirmative action. Chron High Educ.
October 19, 2007.
4. Wiedeman R. Voters in 13 states will cast ballots in referenda related to
higher education. Chron High Educ. October 10, 2008. http://chronicle.
com/weekly/v55/i07/07a02201.htm. Accessed October 31, 2008.
5. Fulbright L. Connerly gearing up for wider crusade: affirmative action foe
considers launching campaigns in 9 states. The San Francisco Chronicle.
December 14, 2006. http://www.sfgate.com/cgi-bin/article.cgi?file=c/
a/2006/12/14/MNGR2MV3I51.DTL. Accessed October 31, 2008.
6. Wiedeman R. Analysis: how Colorado became the first state to reject a
ban on affirmative action. Chron High Educ. November 10, 2008. http://
chronicle.com/daily/2008/11/7031n.htm. Accessed November 11, 2008.
7. Wiedeman R. Ban on preferences Succeeds in Nebraska; Colorado
measure remains undecided. Chron of High Educ. November 5, 2008.
http://chronicle.com/free/2008/11/6652n.htm. Accessed November 5,
2008.
8. Hansen M. City, NU to look for legal ways to aid minorities. The Omaha
World-Herald. November 6, 2008. http://www.omaha.com/index.php?u_
page=2835&u_sid=10479833. Accessed November 6, 2008.
9. The US Equal Employment Opportunity Commission. Federal laws pro-
hibiting job discrimination questions and answers. 2002. http://www.eeoc.
gov/facts/qanda.html. Accessed March 13, 2009.
10. Welch S, Gruhl J. Affirmative action and minority enrollments in medical
and law schools. Ann Arbor, MI: University of Michigan Press; 2001.
11. US Commission on Civil Rights, The commission, affirmative action, and
current challenges facing equal opportunity in education. 2003. http://
www.usccr.gov/aaction/ccraa.htm. Accessed October 31, 2008.
12. Executive Order 8802, 3 C.F.R. 234 (1941).
13. Executive Order 11246, 3 C.F.R. 339 (1965).
14. Executive Order 11375, 3 C.F.R. 684 (1967).
15. Executive Order 11478, 34 Fed. Reg. 12985 (1969).
16. Executive Order 12106, 44 Fed. Reg. 1053 (1978).
17. Executive Order 13087, 42 USC 2000e (2000).
18. Belton R., Labor Law Group (US). Employment discrimination law : cases
and materials on equality in the workplace. 7th ed. Eagen, MN: Thomson/
West; 2004.
19. Title VII of the Civil Rights Act of 1964. 42 USC 2000e et seq.
20. USCA. Const. Amend. 14.
21. Title VI of the Civil Rights Act of 1964, 42 USC 2000d et seq.
22. Fact Sheet: Your rights under Title VI of the Civil Rights Act of 1964. June
9, 2008. http://www.hhs.gov/ocr/civilrights/resources/factsheets/yourright-
sundertitleviofthecivilrightsact.pdf. Accessed October 30, 2008.
23. Title IX of the Education Amendments of 1972, 20 USC 1681 et. seq
24. Nickens HW, Smedley BD, Institute of Medicine (US). The right thing to
do, the smart thing to do: enhancing diversity in the health professions:
summary of the Symposium on Diversity in Health Professions in honor of
Herbert W. Nickens, M.D. Washington, DC: National Academy Press: Insti-
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION VOL. 101, NO. 9, SEPTEMBER 2009 863
PIPELINE PROGRAMS AND RECENT LEGAL CHALLENGES
tute of Medicine; 2001.
25. Smedley BD, Butler AS, Bristow LR, et al. In the nations compelling
interest: ensuring diversity in the health-care workforce. Washington, DC:
National Academies Press; 2004.
26. Coleman AL, Palmer SR. Diversity in higher education: a strategic plan-
ning and policy manual regarding federal law in admissions, financial aid,
and outreach. 2nd ed. New York: College Board; 2004.
27. Alexander L, Schwarzschild M. Grutter or otherwise: racial preferences
and higher education. Const Comment. 2004;21.
28. Herrnstein R, Murray C. The bell curve: intelligence and class structure in
American life. New York: Simon and Schuster; 1994.
29. Jencks C, Meredith P, eds. The black-white test gap. Washington DC:
Brookings Institute; 1998.
30. Brown v. Board of EducationTopeka, Kansas, 347 US 482 (1954).
31. Regents of the University of California v. Bakke, 483 US 265 (1978).
32. Perry BA. The Michigan affirmative action cases. Lawrence, KS: Univer-
sity Press of Kansas; 2007.
33. Coleman AL, Palmer SR. Admissions and diversity after Michigan: the
next generation of legal and policy issues. Washington, DC: The College
Board; 2006.
34. Malcom SM, Chubin DE, Jesse JK. Standing our ground: a guidebook
for STEM educators in the post-Michigan era. Washington, DC: American
Association for the Advancement of Science; October 2004.
35. Coleman AL, Palmer SR., Winnick, SY. Roadmap to diversity: key legal
and educational policy foundations for medical schools. Washington, DC:
Association of American Medical Colleges; 2008.
36. US Commission on Civil Rights. Toward an understanding of percent-
age plans in higher education: are they effective substitutes for affirmative
action. 2000. http://www.usccr.gov/pubs/percent/main.htm. Accessed
October 31, 2008.
37. American Council on Education. Affirmative action in higher education
after Grutter v. Bollinger and Gratz v. Bollinger. 2003. http://www.acenet.
edu/AM/Template.cfm?Section=Search&section=Legal_Issues_and_
Policy_Briefs1&template=/CM/ContentDisplay.cfm&ContentFileID=716.
Accessed 11/10/08.
38. Smith v. University of Washington Law School, 233 F.3d 1188 (9th Cir.
2000).
39. Hopwood v. Texas, 78 F. 3d 932 (5th Cir. 1996).
40. Gratz et al v. Bollinger et al, 539 US 244 (2003).
41. Grutter v. Bollinger et al, 539 US 306 (2003).
42. Parents Involved in Community Schools v. Seattle School District No. 1 et
al., 127 S.Ct. 2738 (2007).
43. Meredith v. Jefferson County Board of Education, 127 S.Ct. 2738 (2007).
44. Coleman AL, Palmer SR., Winnick, SY. Echoes of Bakke: A fractured
Supreme Court invalidates two-race conscious k-12 student assignment
plans but affirms the compelling interest in the educational benefits of
diversity. Washington, DC: The College Board; July 2007.
45. Coleman AL, Palmer SR., Winnick, SY. Race-neutral policies in higher
education: from theory to action. Washington, DC: The College Board;
June 2008.
46. Przypyszny J, Tromble, K. Impact of Parents Involved in Community
Schools v. Seattle School District No. 1 and Meredith v. Jefferson County
Board of Education on Affirmative Action in Higher Education. 2007. http://
www.acenet.edu/AM/Template.cfm?Section=Legal_Issues_and_Policy_B
riefs2&CONTENTID=23636&TEMPLATE=/CM/ContentDisplay.cfm. Accessed
November 11, 2008.
47. Office of Civil Rights. Achieving diversity: race-neutral alternatives in
American education. Washington DC: Department of Education; March
2004. http://www.ed.gov/about/offices/list/ocr/edlite-raceneutralreport2.
html. Accessed March 16, 2009.
48. Farmer J. The No Child Left Behind Act: will it produce a new breed of
school financing litigation. Colum J Law Soc Probl. 2005;38:443.
49. Calleros CR. Law, policy, and strategies for affirmative action admis-
sions in higher education. In Selected Essays from the Western Law Profes-
sors of Color conference 2006. Calif West Law Rev. 2006;23.
50. Curtis JL. Affirmative action in medicine: improving health care for
everyone. Ann Arbor, MI: University of Michigan Press; 2003.
51. Coleman AL, Palmer SR., Sanghavi, E, Winnick, SY. From federal law to
state voter intiatives: preserving higher educations authority to achieve
educational, economic, civic, and security benefits associated with a
diverse student body. Washington, DC; 2007. http://www.collegeboard.
com/prod_downloads/diversitycollaborative/preserving-higher-educa-
tion-authority.pdf. Accessed November 4, 2008.
52. Schmidt P. 3 States poised to vote on affirmative action. Chron High
Educ. July 18, 2008. http://chronicle.com/weekly/v54/i45/45a01702.htm.
Accessed October 31, 2008.
53. Cohen J. The consequences of premature abandonment of affirmative
action in medical school admissions. JAMA. 2003.
54. Steinecke A, Terrell, C. After affirmative action: diversity at California
medical schools. Analysis: In Brief. September 2008;8(6). http://www.aamc.
org/data/aib/aibissues/aibvol8_no6.pdf. Accessed November 1, 2008.
55. Baker M. Outreach offsets I-200 decline. The U.W. Daily. December
9, 2004. http://dailyuw.com/2004/12/9/outreach-offsets-i-200-decline/.
Accessed October 31, 2008.
56. Marin P, Lee, EK. Appearance and reality in the sunshine state: the Tal-
ented 20 Program in Florida. Cambridge, MA: The Civil Rights Project at
Harvard University; 2003: http://www.civilrightsproject.ucla.edu/research/
affirmativeaction/florida.pdf. Accessed November 12, 2008.
57. Yardley W. One Florida rules hit campuses. St. Petersburg Times. Febru-
ary 23, 2000. http://www.sptimes.com/News/022300/State/One_Florida_
rules_hit.shtml. Accessed November 1, 2008.
58. Horn CL, Flores, SM. Percent plans in college admissions: a compara-
tive analysis of three states experiences. Cambridge, MA; 2003: http://
www.civilrightsproject.ucla.edu/research/affirmativeaction/tristate.pdf.
Accessed November 12, 2008.
59. US Commission on Civil Rights. Beyond percentage plans: the chal-
lenge of equal opportunity in higher education. Washington, DC: US Com-
mission on Civil Rights - Office of Civil Rights Evaluation; November 2002:
http://permanent.access.gpo.gov/www.usccr.gov/pubs/percent2/main.
htm. Accessed November 11, 2008.
60. Geiser S, Ferri C, Kowarsky J. Admissions briefing paper - underrepre-
sented minority admissions at UC after SP-1 and Proposition 209: trends,
issues, and options. 2000. http://www.ucop.edu/sas/researchandplan-
ning/admbriefpaper.pdf. Accessed November 14, 2008.
61. Chacon J. Race as a diagnostic tool: Latinas/os and higher education
in California post-209. Paper presented at: Symposium: Taking Initiative on
Initiatives: Examining Proposition 209 and Beyond, 2008; Berkeley, CA. In
Calif Law Rev. 2008;96:1215.
62. Keller J, Hoover E. University of California adopts sweeping changes in
admissions policy. Chron High Educ. February 13, 2009. http://chronicle.
com/weekly/v55/i23/23a.03301.htm. Accessed March 19, 2009.
63. From Proposition 209 To Proposal 2: Examining the effects of anti-affir-
mative action voter initiatives. Paper presented at: Michigan Journal of
Race and Law Symposium, February 9, 2008; University of Michigan Law
School, Ann Arbor, MI. In Mich J Race Law. 2008;13:461.
64. Milliken, JB. Board of Regents Resolution and General Counsels Guid-
ance on Enhancing Diversity Following Amendment of the State Constitu-
tion, January 29, 2009: Lincoln, NE. http://www.nebraska.edu/docs/legal/
GCGuidanceArt1Sec30.pdf. Accessed March 3, 2009.
65. Regents of the University of California Office of the General Counsel.
Enhancing Diversity at the University of California. http://www.ucop.edu/
ogc/enhance_diversity.html. Accessed March 13, 2009. n