NAM Coverage

“Who Will Care for Us?” Ask Indian American Seniors in Immigration Limbo

Photo: Seniors are shown receive free health care at the Guru Nanak Foundation of America’s health fair, held in Silver Spring, Md. (India West)

Part 1 of 2 articles.

UNION CITY, Calif.--Manjeet Kaur arrived in the U.S. in 1996, elated at the prospect of greeting her first grandchild at birth. The recently-widowed woman, who had never before travelled outside India,

Health Care Access Still Denied
For Undocumented Elders

President Obama’s executive-action plan on immigration, while welcome for many families, would not aid those, such as undocumented grandparents, with subsidized health care coverage under the Affordable Care Act. Even those authorized to be in the United States cannot qualify for Medicare, Medicaid or other nonemergency care programs for several years.

Using data from the 2010 Census, the Department of Homeland Security estimated that 11.5 million U.S. residents are undocumented. DHS estimates there are 240,000 Indian undocumented people, up 100 percent from the year 2000, when they numbered 120,000.

Undocumented Indians--two percent of U.S. residents without adequate immigration papers--represent the fastest-growing population by percentage, noted a 2010 DHS report.

About 575,000 people in the undocumented U.S. population of 11.5 million are ages 55 and older. Analysis of DHS statistics on Asians in the U.S., shows there are more than 33,000 undocumented Indian older adults living in this country.

The ineligibility facing these immigrants for health insurance coverage “is a huge step backwards for the undocumented population,” said Daniel Zingale, senior vice president of the Healthy California Team at The California Endowment. He noted that 25 percent of the country’s undocumented residents live in the state.

“We can’t avoid the undocumented,” said Zingale. “All Californians - regardless of status - need to have access to basic health care.”

“California needs to move ahead of the nation,” he stated, noting that the undocumented were left out of the ACA plan during its slow limp through Congress, in order to garner bipartisan support.

--Sunita Sohrabji

nevertheless took the long flight alone to San Francisco, and arrived on schedule, where she was greeted by her son and very-pregnant daughter-in-law, who was expected to deliver three days later.

The baby was not so punctual. “None of the babies in our family have come on time,” joked the tiny, spry woman, now 73, over tea in her Union City, Calif., home.

Two weeks later, baby Jasleen was born; Kaur said she was immediately entranced by the chubby, rosy-cheeked infant. “After so long, I was holding a baby again,” she said, smiling as she recalled the memory.

In the manner traditional to many Indian American families, Kaur immediately took charge, teaching her daughter-in-law the intricacies of caring for baby Jasleen. When her daughter-in-law went back to work as a dental assistant, Kaur was the sole caregiver during the day for the little infant.

Overstayed Visa to Help Daughter

Kaur entered the United States on a tourist visa, which allowed her to stay in this country for six months. In March of 1997, Kaur’s tourist visa was set to expire; but she was not ready to go home yet.

The family applied for an extension to the former Immigration and Naturalization Service – now U.S. Citizenship and Immigration Services – and Kaur was granted an additional six-months stay. She vowed to return to Chandigarh after Jasleen’s first birthday.

And then, the unexpected happened: Manjeet’s son abruptly left the household, and did not return. Attempts to find him through relatives and friends were unsuccessful.

Kaur again applied for an extension of her tourist visa, but this time was denied.

“My head said I must follow the rules and go home,” Kaur stated. “But my heart told me, ‘I must obey the rules of a higher order and stay to care for my grandchild.’”

The new grandmother had no immediate relatives in the U.S. to support a possible change of immigration status. So she simply stayed, joining the roster of an estimated 33,000 undocumented Indian seniors who live in the U.S.

Jasleen is now grown and will start university this fall. Kaur, however, has remained.

During her nearly two-decade long stint in the U.S., the Chandigarh native has been unable to get health insurance for a lack of funds; her daughter-in-law has been the sole breadwinner for the three-generation household with a meager salary from her dental assistant job.

Kaur’s undocumented status makes her ineligible for federal or state-subsidized health care. She has relied on free medical clinics, basic check-ups at free health fairs and word-of-mouth remedies — handed down through successive generations of Indians — to keep healthy. She has suffered no major illnesses thus far, but fears the day when she will have to go to the hospital.

Not Getting Basic Health Care

Indian American physician Anmol Mahal, who in 1997 launched the India Community Center’s (ICC) free medical clinic in Milpitas, Calif., stressed that this very vulnerable population has no access to health care when it most needs it. “They are not getting basic or ongoing preventive health care,” he stated.

“We have been seeing a number of visiting parents. They are here for an extended period of time – full-time babysitters to their grandkids – who invariably don’t have health insurance and are not eligible to sign up for Obamacare,” said Mahal, adding that the seniors who turn up at ICC’s clinic are often on multiple medications.

Visiting seniors may have traveler’s insurance, but most physicians are unlikely to accept it, he said; attempting to insure an elderly person in the U.S. will cost at least $800 per month in premiums, he added.

Sowmya Rao, of the University of Massachusetts Medical School, found first-hand when he attempted to get health coverage for his mother, age 71, during a visit from Bangalore.

In a paper published this September in the Annals of Family Medicine, Rao wrote that his fit and active mother started to feel momentary tightness in her chest during her daily walks around the neighborhood, but did not complain of pain or shortness of breath.

Rao decided to play it safe and took his mother to the hospital. A CAT scan revealed severe blockage in the arteries; an angiography was recommended at an estimated cost of $47,000, not including surgeons’ fees or hospital stays. The Indian American professor next found out that his mother’s traveler’s insurance declined to cover the procedure.

Rao took his mother back to Bangalore for the angiography; the procedure, including a 7-day hospital stay and all professional fees, was $4,300, one-tenth of the estimated costs in the U.S.

Undocumented seniors can “self-deport” and return to India for major medical procedures, but are then barred from returning to the U.S. for from five to 20 years. Seniors may be required to stay in a detention center during the “self-deportation” process.

Needs Beyond What ERs, Free Clinics Offer

The federal Emergency Medical Treatment and Active Labor Act requires any hospital that receives Medicare or Medicaid funds to see and stabilize anyone who shows up in their emergency room, regardless of the patient’s insurance or immigration status, or their ability to pay.

“Presently, if you’re undocumented, you seek a doctor who will accept cash payments or go to the ER for basic stabilization. But there’s no basic or ongoing preventive treatment,” explained Mahal, a former president of the California Medical Association.

Mahal used the example of a person suffering from pneumonia. “He comes into the ER, would be hospitalized, x-rayed, given breathing treatments, then sent home. And you’re back to square one,” he said, adding that recidivist patients scroll up the cost of health care delivery to the at-large population.

At the ICC free clinic, open twice a week on Wednesday evenings and Saturday mornings, volunteer physicians often see patients whose illnesses go well beyond treatment the clinic can offer, said Mahal.

Anand Gundu, who organized a free “mega health fair” held at the Livermore, Calif., Shiva-Vishnu temple last September that many of the 350 people who turned out for the event were seniors visiting their children and grandchildren, and on an extended stay in the U.S.

“Our programs are the only resource they use,” said Gundu, the former president of the Shiva-Vishnu temple and a retired member of the board.

The mega fair featured specialists in internal medicine, cardiologists, dentists, chiropractors, physical therapists, homeopaths and nephrologists. All were volunteer doctors, who could not prescribe medicine at the fair. “But if the doctor thinks the patient is really poor, they often offer to see them at their own clinics,” said Gundu.

A number of clinics around the country serve the uninsured, but Gundu said little information is distributed to those who need their services.

Sunita Sohrabji wrote this article for India-West with support from the Journalists in Aging Fellows program, a project of New America Media and the Gerontological Society of America.

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