Commonwealth Care: Immigration, Insurance and Independence

By Cristina Quinn

March 30, 2012

eugenio hernandez

Eugenio Hernandez didn't have health insurance, then he did, then it got cut back. This month he has full Commonwealth Care again — important for a cancer survivor.

BOSTON — Three years after Massachusetts’ health care reform was signed, the state pulled back some of its universal coverage. And among the ones who felt it the most were immigrants who were here legally, but were not U.S. citizens or green card holders for more than 5 years.

Up and down on the health insurance wave

Eugenio Hernandez was one of them. He’s lived in Boston since 1993 and experienced the ups and downs of health care in the state.

The first part: He had no health insurance.

The next part: He was covered as a result of Massachusetts health care reform by Commonwealth Care.

The next: The state reduced his coverage to save money.

“It made me feel more like a foreigner. More isolated. I thought I was forgotten. They forgot my rights. The rights I could have here because I was here for a long time, and I was working, paying my taxes,” Hernandez said through a translator.

A bridge … and a gap

Hernandez was among 26,000 immigrants who went from Commonwealth Care to what’s called the Commonwealth Care Bridge program in 2009. It meant higher co-pays and less coverage.

“What bothered me most was the reduction of services. When they changed the coverage to the Bridge, it didn’t cover certain things like eye exams," said Hernandez.

But eye care wasn’t his biggest issue. In 2007, MassHealth care was available but the individual mandate had not been put in effect. Hernandez had no insurance. While being treated at a local hospital for a high fever, he was diagnosed with prostate cancer. He turned to the advocacy group Health Care for All, which helped him secure medical coverage through Commonwealth Care.
But when that plan’s benefits were reduced by the state, Hernandez worried how he’d pay for care should his cancer return.

“It affected me very much," he said. "This is a very hard illness. I thought, ‘What am I going to do now?’ I could say that Massachusetts let me down. I came here to work, to pay taxes and I felt that Massachusetts was not responding to my efforts and sacrifices.”

Advocating for complete coverage

Health Care for All saw it as a huge problem. They were flooded with frantic calls to their helpline. Health Law Advocates filed suit on behalf of the immigrants against the Health Connector, the state agency that runs Commonwealth Care.

One of the lawyers working on the case was Wendy Parmet. “I believe that universality won’t survive if you pull at the thread of an unpopular group. And this case was an important step to showing that we’re all in this together and our universal health care survives because we offer it to every group, even the most vulnerable,” she said.

In this Health Care for All video, Hernandez talks about the importance of health insurance to him. The organization made the video in 2009 when it looked like immigrants might lose Commonwealth Care altogether.

This January, the Supreme Judicial Court ruled in favor of these legal immigrants, finding the Bridge program in violation of the Massachusetts Constitution. As a result, Hernandez and thousands of others were reinstated to Commonwealth Care coverage this month.

“Having the insurance, I feel happy. My life has changed. I was always worried before,” Hernandez said.

The financial impact on the state

What started as a way for the state to cut costs now returns to money. Massachusetts needs to find $150 million to implement the court’s ruling.

State Sen. Stephen Brewer is chairman of the Ways and Means Committee and is working on a budget proposal for the next fiscal year right now.

“Service and rate cuts are going to have to be found in other areas of the budget," he said. He pointed to certain possibilities in Gov. Deval Patrick's plan: "The governor had a budget that’s including $250 million in newer and enhanced revenues and $70 million of that was from the expansion of the tobacco taxes, and certain forms of smokeless tobacco were earmarked for Commonwealth Care program.”

Insurance and independence
Which gets us back to this week’s Supreme Court hearings and the debate over universal coverage. What is the government’s responsibility and a person’s rights when it comes to health care?

Parmet thought our cherished cultural obsession with independence belied the true relationship between the individual and health care.

“When it comes to health care and health insurance and how we pay for insurance, people often overlook or don’t recognize the degree to which they are not self-sufficient," she said. "People think, 'Oh, I’m paying for my own health care.' But in fact, their employers are paying for it and the taxpayers are helping to subsidize it because it’s a work benefit that’s not being counted as income."

And, said Parmet, when people get sick, no one can truly stand alone.

"None of us are independent when it comes to health care, and that’s just assuming we’re talking about people who are typically healthy. And anyone of course is one tragic accident or one unfortunate diagnosis away from being far more dependent than they realize,” she said.

While we don’t want to discover the various shades of independence that way, perhaps one thing that Massachusetts can teach us is that health care and independence don’t have to be mutually exclusive.

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Internist Danielle Ofri tells the stories of her immigrant patients and what they say about the state of health care. WATCH: WGBH Forum Network's health care reform series.

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