Epoch Times/New America Media, News Feature, Mei Zhou, Posted: Oct 28, 2011

Editor’s Note: The following article is adapted from a lengthy piece that appeared in Epoch Times about the challenges for older Chinese immigrants in using the U.S. healthcare system. Some of those interviewed did not wish to be fully identified and their names have been simplified to respect their wishes. The article’s author, Mei Zhou wrote this article under the MetLife Foundation Journalists in Aging Fellowship program, a project of New America Media and the Gerontology Society of America.

LOS ANGELES—Thanks to help from his daughter in Los Angeles, Papa Shue, now 80, came to the United States four years ago—arriving in a wheelchair—as an authorized immigrant with a green card. He now stands to receive health care benefits covering his multiple conditions.

Less fortunate has been Mrs. Wang, who arrived in Southern California to visit her son for just a few months, only to fall through the cracks of both the American and Chinese health care systems.
Papa Shue in America

Papa Shue, a retired librarian, survived a stroke 15 years ago. Although he was entitled to free public health care in China, it became increasingly important for him to be close to his daughter and her family, as he grew progressively frail from diabetes, cataracts, high blood pressure and other conditions.

Sponsored by his daughter, a resident of the Rowland Heights community of Los Angeles, Papa Shue obtained an immigrant visa four years ago and, although wheelchair-bound, set sail for America. Soon after his arrival, Ms. Shue applied to enroll her father in Medi-Cal (California’s version of the Medicaid program for low-income people).

Ms. Shue, a respiratory therapist, entered the United States with her husband, a community college teacher, years ago on student visas. After becoming settled and secure in the United States, Ms. Shue took it on herself to get green cards for her father, sister and brother.

Medi-Cal benefits provide free hospital care as well as the majority of Papa Shue’s prescription drugs. The program also covered his cataract surgery two years ago. Since he fell last year and fractured his pelvis, he was hospitalized for five days, followed by in-home physical therapy for another month, all paid by Medi-Cal.

In an ideal situation, it takes at least 10 years for new Chinese immigrants, most of them students, to move from an employment-based green card to citizenship, when they are about 35 or older. By the time they are citizens and able to obtain green cards to bring their parents from China, their fathers or mothers are usually 65 or older.

Some question whether naturalized United States citizens should be able to bring their aging parents to U.S. soil and immediately claim medical benefits here. Ms. Shue, though, argued that health care is a “citizen’s right.”

“As a taxpayer, we have made our contributions to the country. Therefore, we are entitled to be reunited with our family, including our elderly relatives. By extension, once the elderly relatives become permanent residents, they are also entitled to welfare provided for the elderly and the poor. This is what is great about this country.”

Mrs. Hsieh Paying Her Way

Others who arrive on America’s shores later in life do well enough to contribute directly to their eventual care in old age. A decade ago, Ms. Hsieh, a prominent financier in a southern Chinese city in her early 50s, moved to the United States due to growing political concerns and worries about her safety.

Now a doting grandmother, she lives in Las Vegas with her daughter, a single mother of a son, age 7.
Like other well-heeled Asian investors, Ms. Hsieh purchased real estate properties and lives off of rental income for the most part, although she has also worked as a nanny.

Intent on accessing the U.S. system within its rules, she began filing Social Security and Medicare taxes seven years ago, so that by the time she is old enough to claim benefits in three years, she will have paid into the system for the required 40 quarters.

Ms. Hsieh is generally healthy and returns to China twice a year for several weeks at a time. She commented, “I would go back to China to see doctors and stock up on pills good for six-to-12 months. Since I have been putting money in my health funds, why not use it when I most need to?”

Although Ms. Hsieh was proactive in seeking legitimate means to make the most of the U.S. system, others, such as her friend Mrs. Si, 68, avidly explore the system’s loopholes.

She is not eligible for Medicare and lives in Nevada, a state with a high threshold to qualify for Medicaid and limited benefits for those who do. So Mrs. Si, a Las Vegas resident, is using the address of relatives in Los Angeles. Now a “ghost” resident of California, she is insured by the California Medi-Cal and visits L.A. frequently.

Cracks in Two Systems

Many other seniors from China who come to the United States, such as Mrs. Wang, now in her mid-60s, arrive as family visitors. Increasingly ill from type-2 diabetes and other conditions, Mrs. Wang would fall through the cracks of both the Chinese and U.S. health care systems.

John, 38, holds the deeply ingrained notion in Chinese culture that one should care for one’s aged parents, a virtue highly valued by Confucian ethics. But recently he faced disturbing and confusing ethical choices presented by the U.S. health care system.

Having lived all her life in rural Hubei province and widowed at a young age, Mrs. Wang found herself increasingly frail. Two years ago she had a stroke that left her disabled and her mind less sharp. She also suffered vision loss from cataracts, which left her only able to see “two-to-three meters ahead of her,” John said.

John, who lives near Pomona, explained, “My mom felt that her days were numbered and she had to see me before it was too late. That was why she came here again.”

He and his mother look like peas in a pod with the same oval eyes, moon-shaped and tanned face, stocky build, and natural, spontaneous smiles when talking with people.

As a rural senior, she belongs to the group least protected by China’s already weak social safety net. China’s social security and medical systems are far more developed in cities, whereas a reliable pension system has never been established in rural areas.

There have been some recent changes, but researchers Song Gao and Xiangyi Meng at the China Academy of Public Finance and Public Policy, explained that limited rural funding for eldercare services means “many services are either not provided or only partially provided. Co-payment rates and deductibles are high, and the regime leans toward inpatient care.”

John set out to learn about what insurance she could access during her six-month sojourn to California. One health insurance agent told him people like Mrs. Wang should purchased travel insurance in China. Such insurance would cover emergencies more cheaply than U.S. policies.

But John also was told, “Given my mother’s medical history, unless she had forged documents, no insurance company would want the risk of taking her.”

One of John’s American colleagues recommended that he seek charity health providers. But a prominent Los Angeles hospital said they could not take uninsured patients.

John’s friend also told him to call 911 when needed and have mother delivered to the emergency room at Los Angeles County Hospital. By federal law, emergency rooms must accept all patients regardless of their ability to pay or of immigration status. To avoid charges, John was told that his mother, not he, should sign any admission papers.

But having substantial qualms about using ERs this way, John was left with his friend’s final option: shelling out loads of cash for mother’s medical care.

John had read that hospital care could run thousands of dollars a day. He told his wife, “She is my mother and I her son; I had to take care of her no matter what, even if it might mean to sell our house.”
Fortunately, a colleague referred John to a doctor at a clinic serving mostly Chinese patients. Although Mrs. Wang had multiple conditions, they were not as severe—or costly--as expected.

Cataract surgery, however, did cost $5,000. Now an outpatient procedure, the operation costs one-tenth that amount in China. But John’s mother remembered an uncle who suffered terrible pain after having the surgery back home. She wanted it done in the U.S.

Mrs. Wang recovered very well from the cataract surgery. In the care of her son and daughter-in-law, her blood pressure and glucose level stabilized, and her vision recovered. Each day she walked on her own to a community park. After six months, she returned to China.

But family conflicts at home precipitated Mrs. Wang’s decline. Although John offered to pay for a live-in nurse or to send his mother to be with another relative, his mother refused.

“In our village where everybody knows everybody else, if we had a nurse at home, people would take a dig at my brother,” John lamented. “That’s not something my mother would want to see happen. So she chooses to suffer herself. Honestly, I can do nothing about it.”

For elders, such as Papa Shue and Mrs. Wang, the complications of aging in today’s global economy can become ever more challenging when illness intersects with health care and immigration policy, family and culture.