It’s December, and Pedro, 78, still heads downtown to work during the day. He sings Mexican boleros and rancheras, accompanying himself with a guitar. He seems to camouflage himself under the foliage; countless Bostonians have listened to him in this shade for years, yet few know much about the man behind the music.
Pedro arrived in the United States in 1991. He left his wife and six children in Puebla, his hometown in Mexico, and put himself in the hands of a coyote to cross the border, running away from a debt and hoping to send money back to his family. After working in the construction industry, restaurants, shops, and mariachi ensembles, Pedro began doubting whether he could find what he was looking for. He was alone, working three shifts a day, living in a cramped apartment with 20 other people, and reaching his golden years. He fell into alcoholism and depression, and at one point even contracted tuberculosis and was hospitalized.
“I used to make a lot more when I worked for construction, but that job is just for young people,” says Pedro, who lives in a room in Jamaica Plain. After he recovered from tuberculosis, Pedro was able to move in with a friend who doesn’t charge him rent. Still, he says that he earns his entire living by playing music in public. “If I stop,” he says, “I will die. I cannot make it anymore.”
For the poorest seniors in the United States, about 70 percent of their income comes from Social Security, according to federal statistics. But undocumented seniors, who do not qualify for this benefit and are twice as likely as the general population to live in poverty, continue to depend on their day-to-day earnings.
Pablo Buitrón, a primary care physician from Ecuador who works at BMC, treats many Hispanic patients, some of them undocumented. “Their most common problems are chronic diseases, such as hypertension, heart problems, obesity, heart attacks, diabetes … and this is often a consequence of their lifestyle,” Buitrón says.
“To survive, many of these seniors keep working low-wage, often physically demanding jobs — cooking, cleaning houses, street vending, or working as home caregivers at 70 or 75 years old — or for the rest of their lives.”
Additionally, Buitrón explains, the majority of undocumented patients bring some psychological or psychiatric problem — either anxiety, depression, or traumas stemming from being away from family, a shocking experience they suffered as immigrants, or discrimination. Furthermore, that anxiety has only been exacerbated by uncertainty and fear of deportation in the Trump era.
In the Boston area, Buitrón continues, “There are not enough therapists who speak Spanish, and it is far from ideal to undergo mental therapy with the help of a translator instead of a doctor who speaks your language or understands your culture.”
Some lawmakers and others argue that undocumented immigrants are draining public services without paying their fair share. In fact, federal analysis reveals that unauthorized immigrants paid $13 billion into the program in 2010 alone while only taking $1 billion in benefits. Similarly, unauthorized workers annually contribute in excess of $12 billion more to Social Security than they take out. Other research has found similar trends for Medicare.
We have seen the proliferation of interesting and moving stories focused on the young beneficiaries of the Deferred Action for Childhood Arrivals (DACA) program or, most recently, Temporary Protected Status (TPS). But not much is known about the plight of undocumented older adults. They, unfortunately, have little to contribute to the productivity arguments commonly used to persuade lawmakers that undocumented can add to the economy if allowed to stay.
Overall, undocumented seniors are currently a very small group. According to the Center for Migration Studies of New York, only 76,753 (0.7 percent) of the 11 million undocumented people living in the United States are over 65 years old. Most of the immigrants who came illegally in the 1960s straightened out their status after the Immigration Reform and Control Act of 1986, during the presidency of Ronald Reagan. That law offered a path to citizenship to almost 3 million unauthorized immigrants who had entered the United States before Jan 1, 1982.
In the 1990s, according to the Migration Policy Institute, more than 6 million undocumented immigrants entered the US. Fast-forward to now, and almost 2.5 million people in this country without documents are between 45 and 64 years old, meaning the older population will grow sharply in the coming years without a new way to legalize their immigrant status.
Although undocumented immigrants can’t access health insurance throughout the US, Massachusetts has a generous resource called Health Safety Net, known as MassHealth Limited, which includes preventive visits and emergency assistance for people who do not qualify for health insurance.
“The biggest difference between standard health insurance and MassHealth Limited is that the person can only attend community health centers or public hospitals,” explained Hannah Frigand, associate director of the Help, the registration and education program of Health Care For All, a nonprofit that helps people navigate the health insurance system. Also, ambulance rides, long-term care, and nursing centers aren’t covered, while patients can only obtain medications in certain pharmacies.
“We have heard recent stories of people with cancer and what it means to them when they only qualify for the Health Safety Net,” Frigand says. “Someone who needs personal assistance does not have access to homecare, and that makes them more prone to being hospitalized for longer, an expense which is not included in the coverage either.”
Elders and the sick are the most affected by limitations in coverage. Following his illness, Pedro, the Mexican immigrant, was hospitalized in a rehabilitation center for 10 months, an expense that was not included in his coverage and which he was supposed to pay out of pocket. The hospital attempted to charge him, but he was unable to pay. This is common practice. A 2008 study by the Cambridge-based National Bureau of Economic Research found that those entering a hospital without health insurance double their chances of filing for bankruptcy over the next four years.
It’s common in the Commonwealth for private hospitals to reject patients with MassHealth (the state’s low-income Medicaid program) or Medicare. “Although in theory they should not discriminate, some health centers have ways of evading such patients, for example, by using an insurance system for practices for profit that do not admit MassHealth patients, or orienting their marketing strategy to target high-income families,” Buitrón says.
Most hospitals are nonprofits and are as a result exempt from local, state, and federal taxes so long as they provide a benefit to the community, such as charity care. But private nonprofit facilities often say they’re barely or not at all compensated for their care for the poor. Therefore, says Buitrón, the burden falls on public hospitals, which assume the financial weight of treating these patients.
“If the effort were distributed among all the hospitals, it would be better,” he says. “Incentives would be created.”
Before being admitted to the hospital, Pedro lived in a one-bedroom, one-bathroom apartment in East Boston with five other families. This situation is common.
“In immigrant neighborhoods like East Boston, this happens because accommodation costs simply cannot be afforded,” explains Andrés Del Castillo, a community organizer of the City Life/Vida Urbana, an organization dedicated to promoting fair and inclusive housing policies in Boston.
In fact, only New York City and San Francisco have higher rental prices than Boston, where a one-bedroom apartment costs, on average, $2,036, according to Reis Inc., which monitors rent costs. The waiting list for elders to find affordable housing averages about nine months, a tolerable period considering that waiting for a younger family can be from eight to 10 years. However, undocumented immigrants have zero access to subsidized senior housing.
“These programs are funded with money from the federal government, and there is a restriction that prevents the undocumented from participating,” Del Castillo says. “They just do not qualify … But now in Boston the problem of forced displacement is very serious. Such displacement is not only from your home, or from your neighborhood, but from the whole region, because the high prices will force them to move far away. That brings side effects such as isolation, and physical and mental deterioration.”
Del Castillo says a lack of access to information and education, as well as language barriers and discrimination, all factor into the overall threat faced by undocumented immigrants. Laws in Mass prohibit many forms of discrimination; still, in practice, those without the proper paperwork learn quickly that they can’t even apply for most jobs or apartments.
“We are now building the argument,” Del Castillo says. “All these mechanisms have a disproportionately negative impact on our community.”
This feature first appeared in Spanish in El Planeta, and was published in DigBoston.