I've learned a lot from the families in our community. One thing that I've learned is that people of low income in Dorchester can work very hard, often with two jobs, and still be unable to afford private health insurance or to pay for health care out of pocket.

The families must decide between paying for housing or health care, paying for utilities or health care, paying for food or health care, paying for clothing or health care, paying for day care for their children or health care. These are difficult decisions.

MassHealth is essential for hardworking low-income patients to get preventative health care (e.g., immunizations and cancer screening) or care for chronic diseases (e.g., asthma, diabetes, hypertension, heart disease and cancer).

Let me give you a couple of examples from our practice.

We have one young family who emigrated from Haiti a few years ago - a husband and wife with their two young children. Both parents work full-time and earn a bit above minimum wage. They work opposite schedules so they do not have to pay for daycare.

They lost their insurance and stopped coming to our clinic.

I saw them recently after one of the kids [came] to the Boston Medical Center's emergency room with worsening asthma (she had been out of meds for about a year). The ER scheduled her follow-up with me. When I saw her, I asked the child's mother why they had not been bringing in the kids for their immunizations and asthma care and she said: "Because we lost our insurance. We didn't have money and thought you wouldn't see us."

We see a lovely 59-year old woman from Jamaica who has diabetes, heart disease and arthritis. She is physically disabled. She lost her MassHealth insurance.

We've worked hard to try to maintain her health, finding ways to get her free services and medications, cutting corners, doing home visits after hours, but it's a struggle to manage a medically-complex patient without insurance.

We seem to spend most of our time trying to figure out ways to cut the cost of her care and finding her free services, and not enough time on how to improve the treatment of her illnesses, and it has shown, as she has had two recent prolonged hospitalizations at Boston Medical Center.

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Carving out sub-populations of the legal immigrant community and cutting off their insurance is cruel. It leads to poor medical care and increases the cost of health care through increased emergency usage, late diagnoses of disease and the occurrence of preventable diseases and hospitalizations.

It makes economic sense, it makes medical sense and it's the right thing to do.

Ying Hu, Greater Boston Chinese Golden Age Center
Her friend's story

I have a friend who immigrated to the US and became a permanent resident in 2002. 'Chen' is 72 years old, and joined MassHealth in 2002. A year later, he was informed that he was no longer covered under MassHealth Basic. He was put back on MassHealth Basic in the summer of 2004, but it was taken away again in December 2004.

Chen has a prostate problem. As well, one of his kidneys was removed due to cancer. He needs to visit the doctor regularly and take prescription medications, which are increasingly difficult to afford.

He is desperately looking for affordable health coverage. He failed to find an affordable, individual health insurance plan for his age group in the private sector. Last year, during the period he wasn't covered, he had to go to China to find medical treatment, waway from his family in the US. He knows that he was fortunate that he was able to get medical help in China through his old network. He also knows that there are many like him who don't have such a 'last resort' option, that most people wait until something happens and then end up in the ER - which ultimately is more expensive.

Lev Ioffe, Russian Community Association of Massachusetts
His friend's story

I have a friend 'Natalya' who emigrated with her husband from Russia. They are in their sixties. The husband is a Holocaust survivor. Several years ago, they moved to Massachusetts in order to be near to their family. They have three wonderful, little granddaughters who were born in America and are happy to live in the same country, not far from them.

While immigration isn't easy for anyone, especially for people their age, they have done their best to adapt to American life. They both go to school and attend conversation groups in order to study English. Natalya was able to eventually become a medical interpreter in order to earn a little money. She and her husband are able to live on this, but only if they have medical insurance.

Medical insurance is essential for them. Natalya is disabled and her husband has heart problems. They ran into a lot of troubles when the 'horrible new state law' was put into place. Last January her husband had cataract eye surgery and MassHealth refused to pay for it. They stopped getting most of their medications. They weren't able to get regular medical care because MassHealth Limited didn't cover it. It was a terrible experience for them that made them lose their health and their nerves.

Now they've restored MassHealth Essential for old and disabled immigrants, but only for a few months. They are scared to death of what will happen in the very near future if they are deprived of medical insurance again.

Natalya's husband will definitely need major heart surgery at a certain point in time. How will he get this if he only has MassHealth Limited?

Natalya says:

"[This] can't happen in the 21st century. I understand that the state [cut MassHealth to special status immigrants] to save money but maybe they could save money on something else? It should not [affect] a human's health!

"I've worked all my life in the medical field in Russia and know very well what serious (sometimes even fatal) complications happen if a patient with health problems can't get regular medical care and medications. Any disease is much easier and cheaper to treat at the beginning and on time…

"…[W]e live in a great country and great state and we are going to stay here and apply for American citizenship soon. We want to be equal members of American society…stay active and…participate in [American] life. And to do that we need MassHealth…There is nothing more valuable and more important than human life and health."