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A broken heart

Zohra Khatum, a 75-year-old legal immigrant from Dhaka, Bangladesh, still can't believe the cost of prescription drugs in the United States. When she found out that the four medications she must take for her chronic heart condition cost $240 per month, she was stunned. Actually, Khatum didn't fully comprehend the meaning of the that sum. Until, that is, her son explained it translates into 15,000 takas, the Bangladeshi currency. And 15,000 takas equal two months' salary at a decent-paying job. It equals rent, utilities, and food - for a family of four.

"I'm totally puzzled by the price," Khatum says in her native tongue, as her son, Munir, translates. "I'm taking the same medicine as I did in Bangladesh. So why is it so expensive here?"

The question has haunted Khatum ever since she lost her full-coverage Medicaid, known as MassHealth standard, in August. Khatum first enrolled in Medicaid in September 2002, right after she had emigrated to West Boylston to live with her son, a naturalized US citizen. An elderly immigrant who has a green card but no income, Khatum qualified for state-funded health benefits. It was a fair arrangement: every month, she would pay $18 in co-payments to renew her prescriptions and see her doctor. She paid what she could afford - or rather, her son paid the co-payments - and tended to her medical needs.

But then, she got a July 2003 letter from the state informing her that she would be terminated from full-coverage Medicaid. Instead, she would get emergency Medicaid, which covers ER visits and other urgent health-care needs. The problem, however, is that Khatum's four prescriptions don't fall into this emergency category - even though they help to keep her alive. Diagnosed with congestive heart failure, she takes medicine to lower her blood pressure and enable her heart to pump. One medication works to drain the water collecting in her lungs, a symptom of the disease. Because the drugs are critical to treating her illness, Khatum assumed they'd meet the definition of crisis health care. But when her son picked up her prescriptions in August, he discovered that Medicaid felt differently.

"This is a serious condition," says Munir, motioning to his mother, a petite, frail woman whose shockingly white hair peaks out from underneath a traditional Bangladeshi headscarf. "Without medicine, my mother is going to die."

The loss of her full-coverage Medicaid has left Khatum deeply distressed. While her son has stepped in to purchase her prescriptions so far, Khatum has decided to abandon her monthly check-ups for fear her son can't afford them. Even though her heart palpitations are getting worse. Even though her breathing seems heavier. "I'm worried about putting a burden on my son," she says. Though Munir says he makes "a good salary" as an engineer, he also supports a wife, a son, and a baby girl, who was born with a rare medical condition.

And so, Khatum has begun to think soberly about her options. Her daughter, a naturalized US citizen who lives in Minneapolis, is looking into whether Minnesota offers full-coverage Medicaid benefits to "special status" immigrants - if so, Khatum could move there. Or she could return to Bangladesh, which offers universal health care. Indeed, in her native land, she would never have to worry about the cost of her prescription drugs again. But her two children have built lives for themselves in the US, and her husband died decades ago. "I have no ties there," she says. "I would have to die alone."

Not surprisingly, Khatum feels duped by the great American dream. Immigrants come to this country believing it's the best place on earth to live. Yet those who arrive here sick, aged, or disabled are met with a rude awakening when they try to navigate the American health-care system - especially if they have no insurance. People, Khatum observes, "should tell immigrants to bring a lot of money for health insurance." Otherwise, they'll end up like her - "stuck."

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