Care for immigrants severely limited

During the weeks before and after March 31, hundreds of thousands of workers and supporters across the country celebrated the birthday of United Farm Worker Union co-founder and hero, Cesar Chavez. Amid the celebrations, time was taken to reflect on the status of immigrant workers in 2002.

A key indicator of this is the quality of health care available to to immigrant workers and their families. What is the status of health care rights for immigrants in 2002? The short answer is that it depends on where you live. In Arizona, the birthplace of Cesar Chavez, for immigrants, documented and undocumented, the human right of access to necessary health care is severely limited.

Berto and Anastacia Aguilar, born in Mexico, have lived in Arizona for decades. In 1999, they became permanent legal residents. In their 70s, poor, retired and disabled, both easily qualified for Arizona Health Care Cost Containment System (AHCCCS), the underfunded Arizona Medicaid program touted by the Clinton administration as a model because of its managed care components.

Berto, a diabetic, started dialysis in April 2000. His three weekly treatments and necessary medications were provided by AHCCCS through its Emergency Services Program.

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 severely restricted the use of federal funds for even documented immigrants for anything other than emergency care. Arizona, along with several other states, chose to continue providing necessary medical care, including drugs, using the state rather than Federal portion of Medicaid funds.

After the 2000 elections, AHCCCS officials abruptly changed their definition of emergency services to match the strict federal guidelines. Berto and his wife do not fit into this new definition because he hasn’t been a legal resident for the newly requisite five years.

In November 2001, Berto, along with 200 other immigrant dialysis and chemotherapy patients, was abruptly terminated from AHCCCS. Berto was told he could continue his necessary thrice weekly treatments for $1,400 a week in cash.

A huge uproar forced the Arizona Legislature into an emergency session, where they came up with funds to continue treatment for these patients. The funds will be gone as of June 30 and the 2002 session has yet to deal with the problem.

Berto was told to go back to his country of origin. Several legal aid organizations have joined forces to sue the state for denial of his right to equal protection under both the state and U.S. constitutions.

Gustavo crossed the border with several other men and boys. His brother had written that he was guaranteed a job in the citrus groves south of Phoenix. He left his home in rural central Mexico, dreaming of a job with enough wages to send money home to support his family.

The dream ended in the nightmare of the southern Arizona desert, where daytime temperatures can exceed 120 degrees. Gustavo survived. Others in his group did not.

Gustavo was hospitalized with third degree burns on the soles of both feet and kidney failure from dehydration. While in an intensive care unit on a ventilator, emergency dialysis was begun. Two days after his transfer from ICU, he “voluntarily” agreed to be deported back to Mexico. Unable to walk because of the burns on his feet and still requiring dialysis to survive, he was returned to his rural home, hundreds of miles from appropriate medical services

Dolores is a 28-year-old mother of an eight-year-old boy. She has lived in Arizona since 1993, but does not have the right papers. She lives with her mother, who is a legal resident, and her son, who is a U.S. citizen. Dolores needed dialysis in January 2002. Her first treatment was effected through a temporary catheter placed in a vein in her groin. The doctor at the time refused to have a permanent dialysis access placed because if she had to go through the pain of a new catheter for a few times “maybe she would give up and go back to Mexico.”

Having no place to go in Mexico and not wanting to leave her mother and son behind, Dolores refused. She now has a permanent dialysis access, but because AHCCCS will only pay for emergency dialysis, she must wait until she is gravely ill and go to an emergency room for treatment. Every episode damages her body and the souls of her family and of everyone on the care team rushing to save her life.

As many as 14 other states continue to provide these services on a regular and routine basis by using state funds. The struggle in Arizona is to convince, through a combination of legal and community action, AHCCCS and the state that there is a moral, civic, and medical necessity to providing health care for all the human beings caught up in the fabric of life in Arizona.

The author can be reached at pww@pww.org

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CONTRIBUTOR

Phil E. Benjamin