Massachusetts Reduces Some State Health Care To Five-Year Legal Residents. Fair?

Deval Patrick
Mass. governor Deval Patrick, Image via Wikipedia

Does this seem like a smart compromise? Now only legal immigrants who have lived in Massachusetts for more than five years with a green card can receive dental, hospice or skilled nursing care, reports today’s New York Times. Some of the rest will now face stiff new co-pays — up to $50 for non-generic prescription drugs, instead of $1 to $3 — and have to find new doctors.

Under the state’s three-year-old law requiring all residents to have universal health coverage, the state has the country’s lowest percentage of uninsured residents, 2.6 percent, versus a national average of 15 percent.

The state, says Governor Patrick Deval, has to save money somewhere and this is where they’ve drawn the line. Last in, first out. The move will affect 31,000 immigrants.

As someone who moved to N.H. and then to N.Y., and who had has a green card for 21 years, this wouldn’t affect me, but this decision bothers me. As anyone who comes to a new country can very quickly and painfully discover, a terrific job like the one(s) you might have had in your home country can prove extremely elusive. Your credentials and training, lengthy resume and excellent skills can — like your native currency — suddenly and surprisingly plummet in value when you make the enormous decision to move to the U.S. and stay. A recession, a job loss, a prolonged job search, a thin social safety net, all these affect new immigrants, at a wide range of skill and educational levels, not just dishwashers and other low-wage, low-skill work, the ones most often portrayed as the only immigrants.

In those first five years, many immigrants are trying to gain, or regain, their economic footing, make new friends, create some sense of security and community. It’s the worst possible time to lose whatever few government benefits are actually available to them. Under a 1996 federal law, immigrants do not qualify for Medicaid or other federal aid. It’s your wallet, the state’s wallet or your employer’s wallet.

If all three are empty, tough luck.

Another Health Care Cost: Two Ways Hospitals Are Losing Money

Intensive care bed after a trauma intervention...
Image via Wikipedia

A friend of mine works for a major New York City hospital, very close to someone in a very senior role. In this position, this person (whose gender I’m keeping deliberately vague) has a clear view of  some issues in the healthcare debate most of us don’t. I hadn’t seen this person in a while and asked how work was going — after all, every news report suggests that healthcare and education are booming, even in the recession, unable to find and hire all the help they need. If anyone’s job is safe and secure, this person’s must be.

Not true, they said. This year is OK, they told me, but next year might not be. As the recession drags on, this major, well-known and respected hospital is losing patients who are losing their jobs — and with them — their health insurance. The dominoes are falling in so many directions it’s hard to keep track.

As more Americans lose their jobs this hospital is losing patients, i.e. income. Without sufficient income, the hospital will likely have to cut services or staff. So this friend of mine might lose their job, too.

When patients don’t have insurance, they can go to an emergency room for care and get whatever the hospital decides it can afford to supply them. So, in two ways, the recession is draining income from hospitals: the formerly insured who can’t afford optimal care and the uninsured or indigent who take whatever they can get, a growing tab that hospitals legally must pick up. They’re getting hammered financially from two directions.

What strikes me about the healthcare “debate” is how little we still understand the minutiae, and how eager some stakeholders are that we do not. Those of us outside the system — and there are so many players, many with competing interests inside the system — can’t even ask all the tough, smart, informed questions because most of us, however intelligent or educated, don’t even know what to ask. There is a real sense of urgency to get to answers, now, as President Obama has said there will be a new healthcare plan by the end of this year, only 5.5 months away.

And how much do you even understand, or trust, the answers we’re being given?