Finding Health Care in the Land of Opportunity

The “Essential Plan” is just one of the health plans offered through the New York State Department of Health.

Lying awake at night, I think about a quote that defines how I came to live here: “America did not invent human rights,” former U.S. President Jimmy Carter once said. “Human rights invented America.” And in my opinion, health is our most important right. Health is what determines whether you can work, have a family, fulfill your dreams, and ultimately, live your ideal life. Health is an essential part of your humanity – and with that, access to health care services should be a given – at least, that’s what I once believed.

For the roughly 3.2 million refugees and asylees currently living in the United States, health care is not an implied right. And the process of accessing health care can often feel like you’re walking along an endless road, with no coverage in sight. It’s confusing to know what to do, and even more confusing to know where to find help.

I know this on a personal level, because it is my own story. As an asylee living in America for the first time, with no family members or dependents, I have had to navigate the muddled and complex U.S. health care system largely on my own. This has meant hours of phone calls with insurance companies, countless internet searches, and frequently missing work so that I can meet with health insurance agents.

Nearly four years ago, I was living in my home country of Pakistan, working as a journalist. I often reported on controversial international affairs, and as a result of my reporting, I received threats against my life and was forced to flee. That’s how I found myself here – in the United States of America – seeking asylum. This nation is said to be “the land of opportunity,” so I came here with the idea that I would be safe; that I could become a great female journalist, and that I would be able to live as I wish. But I soon learned, quickly after arriving here, that daily life would be more challenging, especially when it came to securing my health.

In May 2015, after applying for asylum, I got sick with a stomach virus. I felt nauseous and weak. I spoke to a friend who works for an NGO, and she recommended that I visit a free clinic. I went and paid nothing for my treatment. At that time, though, I had no legal documentation. When I finally got my asylum in November of that year, I learned that I would need health insurance. At the time, I was eligible for Medicaid, which meant my treatment would be completely covered. But the following year, I was told by the New York State Department of Health (NYSDOH) that I would need to renew my insurance. They asked for my pay stubs, and I was informed that I was no longer eligible for Medicaid. I would have to buy the “Essential Plan,” which meant I would be paying $47 per month.

Given that I was working two jobs, seven days a week, and receiving the minimum wage, everything I made went toward my living expenses. I would not be able to afford coverage. I’ve spoken with many asylum seekers who are eligible for Medicaid coverage because they have families. However, as a single woman, living with zero dependents, I cannot reap the same benefits. And there are others like me.

A simple Google search will lead you to online forums, where many asylum seekers and asylees inquire about the U.S. health care system. I’ve also come across stories in my own life.

A few weeks ago, I spoke with Hassan, an asylee from Pakistan, who told me of his own struggles with the system. He does not have enough money to pay for health insurance, and only when his family comes to New York will he be able to receive Medicaid. Another friend of mine, Nasrin, is a student waiting to be granted asylum. She is trying to reduce her work hours so that she will not be placed in a higher-cost health plan. Despite what her income may show, like many asylees, she does not have the necessary funds to pay for rent, food, and transportation in one of the most expensive cities in America.

My experience is similar. Thanks to a minimum wage increase in New York, I am now making “too much money,” I was told, to be on the Essential Plan, notwithstanding the fact that I continually struggle to pay my current bills. I was shocked. I was told I would now need to be on the “marketplace plan,” paying nearly 50 percent of doctor fees, which can total up to hundreds of dollars. And in the event of an emergency, I could expect to pay in the thousands of dollars.

To make matters worse, I work as a cashier at a pharmacy and a store, with neither employer paying any portion of my health insurance. And in working at a pharmacy, continually dealing with customers in search of certain medications, I find myself on the front lines of this issue. So often when our customers come asking about prescriptions from their doctors, I watch as the pharmacist must break the unfortunate news: the medicine is not covered by their insurance. Sometimes they become nervous and leave the store. I will always remember one young woman, child in hand, who couldn’t even afford the price of an inhaler.

Earlier this month, when I went to meet with Community Health Advocates (CHA), a health care consumer assistance program, I opened up about all of these issues. They asked for my recent pay stubs, and uploaded them onto the NYSDOH website. I was stunned to learn that I would need to pay even more than the month before. The irony is that I went to CHA for help, and left with a higher bill.

I think back to my home country in these moments. There, if someone gets sick, they go to the hospital and receive treatment. We do not have monthly premiums and no one is forced to buy private health insurance. Not to mention the fact that health care is significantly cheaper. Granted, there are many issues with Pakistan, but I never once had to fear that I might not be able to afford health care.

Then again, Pakistan does not offer EBT cards or have a Medicaid equivalent, so lower-income individuals do not receive full health coverage. We do have government-owned hospitals that provide services, but the quality of the care is not like what you will find here.

I was thankful for the time that I was eligible for Medicaid. The American health care system starts to be challenging once individuals begin to earn a living wage. I was surprised by many things after moving to this country, but the biggest shock of all came with learning the costs and complexities of health care.

Part of the reason I applied for the CCEM Health Reporting Fellowship was that I wanted to learn how to ask the right questions. At the time, I thought I was the only person facing these issues, but after meeting with my class every week, I discovered just how many of my fellow classmates were experiencing the same challenges. It was eye-opening to explore the U.S. health care system and not only see what people are going through, but learn how the system is – or is not – taking their well-being truly into account.

I joke that I can only find affordable health care in one of two ways: first, by cutting my hours at work, which would lead to more financial strife, or second, by getting married and having children, so that I can be eligible for free health services. But in reality, I hope to find a job that will pay for my health insurance, and ensure that I can stay in the U.S. living a happy and healthy life.

Nadia Batool Bokhari, a journalist and TV anchor from Pakistan, hopes to build a journalism career here. Her article was written as part of the 2018 Health Reporting Fellowship of the Center for Community and Ethnic Media at the CUNY Graduate School of Journalism and funded by a grant from News Corp.

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