30,000 Immigrants In Health Care Limbo

Nearly 30,000 legal immigrants from around the state face losing their health insurance at the end of August. Massachusetts state lawmakers erased the group from the state health plan because of budget shortfalls, but are now considering a plan to cover non-citizens at a reduced level.

Bazlul Wahab was born in Bangladesh. He studied engineering and developed skills attractive to American high-tech companies. He now lives in Woburn with his wife and children. Wahab's been in this country 17 years, and a few years ago he became a U.S. citizen.

One of the best parts of citizenship for Wahab was that he could finally get his mother a green card and reunite his family. "Obviously, I was very much interested to bring her here," Wahab says, sitting on the couch in his Woburn home.

Wahab's 62-year-old mother spends her days at home, where she helps watch Wahab's children. She suffers from diabetes and high blood pressure, but her health has has improved since she started seeing American doctors.

Wahab says care is better here, although way more expensive than in Bangladesh, where people pay out of pocket for relatively inexpensive doctor's visits.

Since Wahab's mother doesn't have a job with health insurance, she's used Commonwealth Care, the state's health care plan. It helps pay for her doctors appointments, lab work and medications. But that might stop. Lawmakers passed a budget this summer ending care for legal immigrants who've been in the country less than five years. And that could split up Wahab's family.

"If we find out that we are in a very difficult situation and she's not getting good health care here, it would be possible that she would go back," Wahab says. "Medical care is not affordable in this country."

Not affordable. That's what state lawmakers say about including the 28,000 legal immigrants in the state health care plan. Revenues are down some $3 billion. And new immigrants cost more to cover than citizens. The federal government doesn't subsidize Medicaid for people who've had green cards less than five years. But that wasn't always so.

"Historically, the U.S. government treated citizens and immigrants the same when it came to Medicare and Medicaid," says Leighton Ku, a professor of public health at George Washington University in Washington, D.C.

The law changed in 1996, and immigrants with green cards or other legal status for five years or less couldn't get Medicaid. "Nonetheless," Ku says, "a number of states have felt that wasn't right and have said, 'We're going to use our own state funds to cover legal immigrants.'

"This includes relatively big states, like New York and California, and, historically, Massachusetts. The United States as a whole feels a little ambiguous about immigrants. At times we welcome the huddled masses, and at other times we feel concerned and xenophobic and we don't want the immigrants."

State lawmakers may be wrestling with that tension now, as they consider whether to stick with the original plan not to cover immigrants, or cover them at a reduced level. The governor proposed spending $70 million — half the amount spent last year.

State Treasurer Tim Cahill spoke against the plan on a radio talk show broadcast on WRKO. "You know if we're going to bankrupt the middle class in order to cover people who just came to this state," he said. "And then send the message to everyone else: 'Come to Massachusetts and we'll cover you.'  That's not really protecting our own citizens who are trying to raise a family or keep their family here like I'm trying to do."

Cahill doesn't have a vote, but he may have a sense of popular sentiment. Several lawmakers have said off the record that they're receiving many calls from constituents urging them not to support the compromise — so much that they don't want to be connected to restoring health care coverage for legal immigrants.

That troubles Eugenio Hernandez. Like many of the immigrants who may lose state-sponsored insurance, he has a low-paying job that doesn't give him health insurance. "I pay my taxes," he said, in Spanish. "I pay my insurance. So how is that we contribute to this country, and then all of a sudden they say we're going to cut your insurance?"

Hernandez is in treatment for prostate cancer, and the Salvadoran janitor can barely afford to pay for medical appointments, never mind surgery or radiation. But he can't afford to miss them, either. And like the 28,000 other legal immigrants around the state in his situation, he's trying to imagine a life here without health insurance.

For Hernandez, that could mean skipping appointments that could save his life, or wracking up thousands and thousands in debt.