How will immigrants fare under Obamacare? It’s complicated

By By Lornet Turnbull

The Seattle Times (MCT)

Published: Tuesday, Sept. 10 2013 12:00 a.m. MDT

An uninsured patient who asked not to be identified, waits for the doctor in this Wednesday, May 1, 2013 file photo at Wesley health Center in downtown Phoenix. Ultimately, how immigrants fare under the massive health care overhaul will depend on many factors: their income, immigration status, how long they’ve lived in this country.

Matt York, Associated Press

Enlarge photo»

SEATTLE — Likos Afkas is a native of the Federated States of Micronesia, part of a cluster of islands in the Pacific where nuclear testing by the U.S. government during the Cold War left behind high rates of cancer.

Together with neighboring Palau and the Marshall Islands, the Federated States of Micronesia has a special compact with the U.S. under which its people, heavily recruited by the U.S. military, can live and work here indefinitely — but as noncitizens are denied certain federal benefits.

Afkas, 48, first came to the U.S. a year ago, suffering from diabetes and heart problems, and was immediately diagnosed with kidney failure that requires three-times-a-week dialysis. Last month, he was notified that he lacked sufficient job credits to continue receiving the Medicare coverage he’s depended on to cover some of his medical bills.

Now, like untold numbers of his countrymen and other immigrants, Afkas is taking stock of his health care options as the clock counts down to the Oct. 1 opening day for enrolling in health coverage under the federal government’s Affordable Care Act (ACA). Coverage begins Jan. 1.

For him, it doesn’t look so good.

Ultimately, how he and other immigrants fare under this massive health care overhaul will depend on many factors: their income, immigration status, how long they’ve lived in this country and — in the case of people like Afkas — their country of origin.

While his household income would otherwise qualify him for Medicaid, the primary option under ACA for delivering health coverage to low-income people, Afkas’ immigration status makes him ineligible.

At the same time, under the new law, he’ll likely be required to buy health insurance or face a penalty — neither of which he says he can afford.

“I don’t know how I’d be able to do that; I don’t have a job, I don’t have any money,” he said through an interpreter.

Returning to Chuuk, his home state in Micronesia, is not an option because of the woefully inadequate health system there, he said.

“If I go back home, I’d only be going back to die.”

The health care overhaul law, commonly known as Obamacare, targets people who lack health insurance — an estimated 1.09 million Washingtonians.

It’s unclear what percentage of them are immigrants.

Studies have shown that in general, immigrants tend to be healthier than the rest of the population — they are younger and are subject to medical examination to obtain green cards — though many of the same studies also suggest they become less healthy over time.

“There are some people who have gotten used to being uninsured, so we need to provide a whole other level of information about why they’d even want to be insured now that it’s available to them,” said Michael McKee, health services director of the International Community Health Services, whose clinics serve large numbers of immigrants.

“Part of it is also helping them understand the penalties,” he said. “That’s going to be totally new to everybody.”

As complicated as the law will be for the average American, immigrant advocates worry it will be even more daunting for those whose primary language is not English and for whom regular visits to a doctor are not a cultural tradition.

“We look at access to care and coverage as opportunities to address health disparities,” McKee said. “It’s incumbent on us to educate people on the importance of preventive care and healthy options so they can avoid some of the costly outcomes.”