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By Rajkamal Rao
Go back to Dilemma
The decision to return to India or not is extremely personal. Most of us are responsible for three generations of individuals - our elders, ourselves, and our children. The dilemma drives from our desire to balance the needs of these three generations. Families who have decided not to return to India have simply rationalized this balance - but the question generally continues to dog them.
In the US and the UK, Indians have been successful in creating mini-India communities. In the US, as Indian immigration has surged, these India enclaves have flourished. Chicago, New York, Dallas, Philadelphia, Houston, Northern New Jersey, San Francisco and Atlanta all have extremely large diaspora Indian populations. So deep is this penetration that a person of Indian origin can probably spend an entire life in these enclaves without ever having to voluntarily interact with an American.
To address the three-generation balance issue, some Indian families have embraced family immigration opportunities to sponsor their parents and siblings. But for parents and elders who immigrate to the US on such visas, the experience is often a mixed bag. These people have to give up a life (and identity) of their own in India - work, home, friends and their own siblings - to be with their children in the west. They have to resign themselves to be known as the “parents of their children” rather than be known for their own achievements.
When the grandchildren are young, these grandparents can relate to their development and participate in the joy of their growth. But as the grandchildren step in to school, their interests begin to deviate from those of the grandparents. Language and culture become barriers too. Children raised in America generally refuse to speak the language of their grandparents - and over time, communication becomes difficult.
Mobility for the elders is an issue too. Used to traveling anywhere in India in their own vehicle, getting on a bus or hailing an auto rickshaw, the elders in the West are stuck at home dependent upon the schedules of their children to ferry them around. In colder regions, elders, used to taking morning walks back home, are limited to doing so only during a few months in a year.
And then, there’s the big elephant in the room - health insurance. Parents and elders cannot be added to health insurance plans of those who sponsored them. Obtaining individual health insurance plans for the elders becomes almost impossible. There is no marketplace for health insurance for those above 65 years because no company can compete with the universal benefits offered by government-run Medicare. An elder who has emigrated from India has to wait 5 years on a Green Card (or until he becomes a US Citizen) to qualify for Medicare. This means that elders who are over 65 may not have health coverage for five years - a risky proposition for the sponsoring family. Visitors health insurance does not apply because elders, by definition, are immigrants and not visitors. Further, these policies expire at the end of a year. Even if the elder is to re-enter the US each year to get a new policy, restrictions on the policy around pre-existing conditions limit its appeal.
The Obama Healthcare Law addresses some of these issues through the so-called state exchanges where people can buy insurance from private companies. But many states have yet to approve these exchanges, and even in states which have supported Obamacare, these exchanges are not yet in force. Finally, no one knows how expensive these private policies will be. After all, private companies know that the elders will sign up with Medicare as soon as they are eligible, so what business incentives do they have to offer them competitively priced insurance plans?
And so, many families reluctantly enroll their elders into Medicaid - a program for the poor. Medicaid’s qualification rules vary by state. In states like New York, California and New Jersey, the rules are rather lenient - but in more conservative states like Texas and Oklahoma, enrollment rules are strict. Successful families, making hundreds of thousands of dollars a year in income, squirm at the thought of having to falsify paperwork to have their elders enrolled in Medicaid. But they do so nevertheless.
Go back to Dilemma
The decision to return to India or not is extremely personal. Most of us are responsible for three generations of individuals - our elders, ourselves, and our children. The dilemma drives from our desire to balance the needs of these three generations. Families who have decided not to return to India have simply rationalized this balance - but the question generally continues to dog them.
In the US and the UK, Indians have been successful in creating mini-India communities. In the US, as Indian immigration has surged, these India enclaves have flourished. Chicago, New York, Dallas, Philadelphia, Houston, Northern New Jersey, San Francisco and Atlanta all have extremely large diaspora Indian populations. So deep is this penetration that a person of Indian origin can probably spend an entire life in these enclaves without ever having to voluntarily interact with an American.
To address the three-generation balance issue, some Indian families have embraced family immigration opportunities to sponsor their parents and siblings. But for parents and elders who immigrate to the US on such visas, the experience is often a mixed bag. These people have to give up a life (and identity) of their own in India - work, home, friends and their own siblings - to be with their children in the west. They have to resign themselves to be known as the “parents of their children” rather than be known for their own achievements.
When the grandchildren are young, these grandparents can relate to their development and participate in the joy of their growth. But as the grandchildren step in to school, their interests begin to deviate from those of the grandparents. Language and culture become barriers too. Children raised in America generally refuse to speak the language of their grandparents - and over time, communication becomes difficult.
Mobility for the elders is an issue too. Used to traveling anywhere in India in their own vehicle, getting on a bus or hailing an auto rickshaw, the elders in the West are stuck at home dependent upon the schedules of their children to ferry them around. In colder regions, elders, used to taking morning walks back home, are limited to doing so only during a few months in a year.
And then, there’s the big elephant in the room - health insurance. Parents and elders cannot be added to health insurance plans of those who sponsored them. Obtaining individual health insurance plans for the elders becomes almost impossible. There is no marketplace for health insurance for those above 65 years because no company can compete with the universal benefits offered by government-run Medicare. An elder who has emigrated from India has to wait 5 years on a Green Card (or until he becomes a US Citizen) to qualify for Medicare. This means that elders who are over 65 may not have health coverage for five years - a risky proposition for the sponsoring family. Visitors health insurance does not apply because elders, by definition, are immigrants and not visitors. Further, these policies expire at the end of a year. Even if the elder is to re-enter the US each year to get a new policy, restrictions on the policy around pre-existing conditions limit its appeal.
The Obama Healthcare Law addresses some of these issues through the so-called state exchanges where people can buy insurance from private companies. But many states have yet to approve these exchanges, and even in states which have supported Obamacare, these exchanges are not yet in force. Finally, no one knows how expensive these private policies will be. After all, private companies know that the elders will sign up with Medicare as soon as they are eligible, so what business incentives do they have to offer them competitively priced insurance plans?
And so, many families reluctantly enroll their elders into Medicaid - a program for the poor. Medicaid’s qualification rules vary by state. In states like New York, California and New Jersey, the rules are rather lenient - but in more conservative states like Texas and Oklahoma, enrollment rules are strict. Successful families, making hundreds of thousands of dollars a year in income, squirm at the thought of having to falsify paperwork to have their elders enrolled in Medicaid. But they do so nevertheless.
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