Bitter Medicine

Even though the community boasts per capita 33 times as many physicians than the national average, almost a quarter of all Indian Americans lack health insurance.

It’s just a little card that fits into your wallet: if you own it, you have a whole battalion of physicians, specialists, nurses, technicians and hospitals at your command. And if you don’t – you’d better watch every step you take and hope and pray that you don’t get sick. You could end up losing your house, your livelihood and your way of life.

We are talking, of course, of health insurance – or the lack of it.

One who knows all about this is Rajesh Kumar. This is not his real name – one wonders whether he even remembers his real name, living in the shadows as he does. He has no papers and no health insurance, and his low-paying bottom-rung job at an ethnic store offers him no benefits.

Unlike low-income legal immigrants who often use the emergency room as their primary care place, Kumar, who lives in New York, is too afraid to go to any public place where he may be asked for identification. Having little money, when he has an emergency, he is compelled to go to a private physician and is faced with big bills. He says, “This is my life. I have to think of something or the other to manage.”

It seems almost obscene that in this, the richest country in the world, almost one in six Americans – 45 million people – has no health insurance. Even though Indian Americans are among the most affluent ethnic group in the country, 10 percent, or 200,000, live below the poverty line. Nationally, more than a third of the foreign born population lacks health insurance, according to census data. As many as a quarter of all Indian Americans, some 500,000, lack any form of health insurance.

This is surely a disconcerting fact for many in the affluent Indian community who cling to the model minority myth. It is especially ironic in community that boasts 33 times as many physicians per capita than the national average

Nearly 15 percent of the all foreign medical graduates in America are from India, comprising the single largest foreign medical group in the country. While the Indian population is just 0.15 percent of the total population, Indian doctors make up a hefty 5 percent of the American medical community – 33 times the national average. Nevertheless, the proportion of uninsured rate Indians is almost twice the national average.

Many within the community feel that the failure of Indian medical professionals to expand health opportunities within the community is nothing short of scandalous. The American Association of Physicians of Indian Origin (AAPI), the powerful body representing 35,000 Indian physicians, has failed to develop any serious programs for the poor and uninsured in the Indian community.

Vijay N. Koli, president-elect of AAPI, is not unaware of the problems of the uninsured and has encountered many cases of struggling, uninsured Indians in his practice in Texas. He recalls the case of a young girl with an overactive thyroid who was unable to concentrate on her studies in school and was getting poor grades. Her family could not afford the medical care or the lab tests and other services: “With the help of an Indian radiologist, endocrinologist and surgeon we took care of her problem. We also requested the local hospital to reduce her hospital bill considerably,” says Koli.

He points out that Indian physicians in particular provide indigent care in the U.S. through health clinics sponsored by AAPI in places like Michigan, Illinois, North Carolina and Texas. He adds, “We also provide some counseling and care though health fairs organized by local Indian doctors from time to time.”

Many Indian families are visited by relatives, especially by elderly parents, for a short stay in this country. Invariably they do not carry health coverage, and Koli says they seek help from local Indian physicians: “In general many of my Indian colleagues give generous discounts to Indian families for their services.”

He says that AAPI is in the forefront in providing health care to underserved communities in rural America, among whom there are many uninsured.

But shouldn’t AAPI with all its clout be trying to do something about health access, especially when it lobbies in Washington?

“While health access is an important issue, I do not think it is specific to physicians,” says Koli. “AAPI is sympathetic to this, however this is not our top priority as it is a much broader issue. We are supporting the bills to put a cap on non-economic damages in medical liability cases as that directly affects access to health care. We have addressed it in a different way.”

So, left to their own devices, many of the uninsured are coping as best they can. Tragically many poorer immigrants are unaware of medical services that are available to them, Although the 1996 federal welfare hreform legislation made most non-citizens ineligible for Medicaid and other social benefits, several states, such as New York, continue to provide coverage for pregnant women and children, including undocumented families.

But few immigrants, especially illegal ones, know of their rights, cut off as they are by language and cultural barriers. Marjorie Cadogan, executive director, Office of Health Insurance Access, says, “For undocumented children, the city is particularly interested in reaching their parents and letting their communities know that the Child Health Plus B Program is available for those families who qualify, regardless of the children’s immigration status.”

The Health and Hospital Corporation (HHC) has kicked off an aggressive citywide outreach program amongst immigrant communities that includes no cost and low cost health screenings, information and education about disease prevention and affordable health insurance.

However, this health insurance plan is restricted to low income families; left standing out in the cold are the self-employed and those earning moderate incomes, but with no access to health care, all in danger of falling through the cracks.

Many states have grassroots community organizations initiated by the South Asian community to help those in need. The South Asian Network (SAN), for example, is a decade old community organization in Artesia, Calif., and the majority of its clients live at or below the federal poverty level and over 40 percent lack health care insurance.

SAN’s outreach workers target the underserved and its Health Care Access projects enroll eligible individuals in health programs such as Medi-Cal, Healthy Families and California Kids. Those who are ineligible are hreferred to low cost and free clinics or to South Asian healthcare providers who see them for a nominal fee

Adam Gurvitch, director of health advocacy at The New York Immigration Coalition, says the government has an ideology of forcing the individual to go it alone, to cut healthcare safety nets. “This isn’t a problem people can solve on their own. Healthcare is not like buying a loaf of bread; it’s beyond the economic means of most Americans to afford health care out of their pocket.”

Partha Banerjee, director of New Jersey Immigration Policy Network, points out that New Jersey has the fifth largest immigration population in the country and a large percentage of these immigrants don’t have health insurance: “Basically their health issues are being completely overlooked by their employers and their status is being taken advantage of. The economy really runs on the back of immigrants, and if we really want to include immigrant workers in our society then their health concerns must be addressed.”

Most immigrants are unaware that even without health insurance, regardless of where they live in the United States, they have the right to access services at public and private hospitals at affordable rates.

Says Gurvitch, “There are far more private hospitals in this area and throughout the country that don’t do enough to open their doors to those who are uninsured – and the fact is that these hospitals receive billions of dollars every year from the government to help them to cover their expenses for the uninsured. So hospitals are pocketing the money and many uninsured are told that they have to pay outrageous rates for services.”

For the uninsured, public hospitals offer fees on a sliding scale that take into account a person’s income and household size. These programs are available for incomes up to 400% of the Federal Poverty Level, regardless of immigration status.

The income thresholds for these plans are: single person household $37,240; Two person household, $49,960; Three person household, $62,680; Four person household, $75,400; Five person household $88,120; Six person household $100,840.

Individuals who qualify based on family income are charged at reduced rates – ranging from $15 to $60 – for each emergency room or clinic visit. This charge includes the costs of medical exams, lab tests, routine radiological procedures and consultations with specialists. HHC Options also offers greatly discounted rates for outpatient surgery, MRI testing, prescription drugs, and inpatient stays. Payment plans can also be arranged.

“Every hospital across the U.S. can do this, but there’s no law or rule about how much it should be, since there’s no one standardized public health system,” says Gurvitch. It can vary by locality, depending on whether the hospital is run by the municipality, county or the city. “Yet the savings are available for anyone taking the time and trouble to ask.”

One of those unaware of these reduced fees is Manu Daswani, who lives in Jersey City in New Jersey. A self-employed single male on medium income, he’s managed to survive without health insurance for 20 years.

Soon after he came into the country, a cabbie ran over his foot at a pedestrian crossing. His thick winter boots seemed to have safeguarded him, but once he got home and took them off, he found his foot had swollen up like a giant pumpkin.

He finally, but very reluctantly went to the emergency room for tests and X-rays. The bill? A whopping $700. Being a new immigrant, he simply paid up.

Now years later and still uninsured, Daswani thinks he’s found a viable alternative: he takes a trip to India every two years and while there he has a complete check-up in his hometown of Hyderabad. “It costs me just $30!” he says. “I also have my dental and vision check- ups while I’m there.”

But doesn’t it seem a crazy way to live – to actually hop into a plane – go to the other side of the world to check your blood pressure? “Believe me, it still works out cheaper than buying health insurance!” he says.

So unless things change dramatically over here, we may all be compelled to shuttle between New York and New Delhi to keep one step ahead of the healthcare hassles.

One morning we may wake up in a fantasy world and find that all our health needs are taken care of by a comprehensive national healthcare system like that of the U.K. or Canada, but that’s not going to happen any time soon.

In the meantime, it’s every man, woman and child on their own. When Rajesh Kumar – unknown, undocumented and uninsured – sneezes, the rest of the world does not get a cold or care.