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How will immigrants fare under Obamacare? It’s complicated

By By Lornet Turnbull

The Seattle Times (MCT)

Published: Tuesday, Sept. 10 2013 6:57 p.m. MDT

And then there are people like Afkas, whose status most Washingtonians — most Americans, for that matter — do not know.

Micronesia, Palau and the Marshall Islands are former United Nations trust territories, which the U.S. Navy administered between 1947 and 1951.

Today, they are sovereign nations, each with a Compact of Free Association with the United States under which their people can work and live in this country indefinitely, though they are neither U.S. citizens nor nationals.

In 1996, when Congress reformed welfare, it barred most legal immigrants from Medicaid and other federal health programs for the first five years of residency. It also indefinitely barred those from the compact states from receiving Medicaid.

Many use their immigration privilege to seek treatment — mostly state-funded — for the cancer and other health problems plaguing their countries, usually in Hawaii, but also increasingly in places like Washington state, said Xavier Maipi, who runs a nonprofit agency to advocate for compact state residents.

An estimated 2,000 — mostly Marshallese and Micronesians — live here.

Afkas lived on the island state of Chuuk in Micronesia before he came to the Seattle area a year ago, his health failing.

Already suffering heart problems and diabetes, he was diagnosed with kidney failure at Seattle’s Harborview Medical Center, whose reputation as a source for indigent care he and others say has become well known in the islands.

The medical bill for his monthlong stay totaled $100,000, which Medicare covered.

But in July, Afkas was notified he lacked sufficient job credits to continue receiving $700 in monthly Supplemental Security income and Medicare.

He’ll continue to receive weekly dialysis through a special program for those whose immigration status disqualifies them for Medicaid but will have to go uncovered for everything else.

Afkas’ wife earns a small amount to provide home health care for him from another part of the same state program that covers his dialysis. “Right now, I don’t know what I’m going to do,” he said.

Like many people, he doesn’t know much about the Affordable Care Act and hasn’t given it much thought. Paying for health insurance — any amount — isn’t in the household budget.

“Many of these folks are simply trying to survive,” Maipi said. “For health care they go to the emergency room — and usually that’s when they’re at death’s door.”

Immigrant advocates know they face a daunting task preparing clients and constituents for the coming change and making sure they enroll.

While information about the exchange will be available in eight different languages, the website the public will use to sign up for care will be available only in English and Spanish.

“Many of our clients are refugees and immigrants and 60 percent of them have limited English proficiency,” McKee said.

Health clinics like his and other federally funded health centers that now serve anyone who walks through their doors will continue to do so — regardless of their insurance status or ability to pay.

“This is the largest sea change in public policy since Social Security,” McKee said.

“Everyone wants to get it right. And at the end of the day, there will be a lot of questions and the hope is that we can, with this first run, enroll as many people who will benefit.”

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(Seattle Times reporter Carol M. Ostrom contributed to this report.)

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©2013 The Seattle Times

Visit The Seattle Times at www.seattletimes.com

Distributed by MCT Information Services

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PHOTO (from MCT Photo Service, 202-383-6099): HEALTHCARE-IMMIGRANTS

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