Filipino Seniors in U.S. Looking to Return Home - with Medicare

While the U.S. Congress deliberates over proposed changes in the nation’s immigration laws, one group of immigrants who became naturalized citizens and who retired and have grown old in this country are seeking a congressional change that is the reverse of what most immigrants want.

Baby boomers, war veterans, widows and retirees originally from the Philippines are hoping welfare assistance and entitlement benefits they have earned would follow them should they decide to return to the land of their birth. Many are World War II veterans who fought under U.S. command and were promised federal compensation only partly provided since then. Advocates believe the United States could save money were it to permit the seniors to return home with their benefits, especially for Medicare.

Understandably, the accessibility of health insurance at this time in their lives is a major consideration as they dream of making their “giant leap” back home. Medicare recipients must be at least 65 or be disabled.

WWII-Era Seniors Assess Their Future

In Seattle’s Filipino-American community, aging WWII veterans and widows meet twice weekly at a senior center where they frequently share meals subsidized through the Older Americans Act.  At these gatherings they assess their hopes and future plans.

Veteran Tomas Villanueva, 90, and his wife Esther, 87, have lived in a subsidized senior housing facility in downtown Seattle for the past 21 years. 

During World War II, Villanueva served in Guam as a Philippine Scout recruit of the U.S. Army. Following the war, he returned to his home province in Southern Luzon where he served as a constabulary officer. He and Esther decided to emigrate to the U.S. in 1991. 

After securing their American citizenship in 1994, the couple filed petitions for some of their six adult children to receive visas enabling them to join their parents in Seattle. The Villanuevas were especially hoping that as they grow old, two of their daughters would provide them a family safety net. 

Eventually, the U.S. government approved four visas for the Villanueva children—but they have remained on the waiting list in the Philippines since 1994, because of tight annual numerical immigration quotas the U.S. sets for some countries. 

Two of the Villanueva children eventually lost interest in emigrating to the U.S.  And the two daughters, still determined to join their parents, learned that worldwide demand for U.S. family visas was so large in 2010 that the demand triggered a retrogression rule, effectively freezing visas and adding several years of wait time to the backlog of applicants.

According to the National Visa Center, the agency that releases visas for all approved applications processed by the U.S. Customs and Immigration Service (CIS), such a rule applies when the number of visa applications exceeds a given threshold. As of June 2013, CIS is processing applications filed as far back as 1992, two years before the Villanuevas petitioned for their daughters. Based on the past experience of petitioners, a delay of five or more years may be likely in this case.

As they waited, the aging couple needed medical attention. Medicare covered Esther’s pacemaker in 2008, and she has elevated blood pressure. Tomas, once active as an officer in Seattle’s Filipino war veterans’ association, has shown symptoms of dementia and oncoming diabetes.

Esther has been debating whether to keep waiting for her daughters to arrive, or to return to the Philippines for good. Keeping her Medicare coverage has been the single, most important factor, she said. 

Care Unaffordable in U.S.

“But whether or not Medicare will be accessible to us in the Philippines, there is no other choice but to go back home because we cannot afford caregiver services or retirement home expense in the States,” she explained. Experts say that despite Medicare coverage, uncovered out-of-pocket costs for seniors in the U.S. are now close to 20 percent of their income.

Esther continued, “The long delay of our daughters’ coming has made us decide to go home. We will be nearer to them if we need help.” 

An unofficial survey conducted by a coalition of Filipino organizations and community groups across the U.S. shows that about 100 Filipino American professionals retire every day. 

While they can take their Social Security retirement benefits and savings anywhere in the world, it is a different story for their Medicare coverage overseas. Until Medicare extends coverage to them outside the U.S., they will need private medical insurance. 

Elderly couples in Washington State whose combined income does not exceed $18,000 a year are entitled to a monthly average of $500 in Supplemental Security Income (SSI). Esther and Tomas qualified for SSI and receive a combined monthly supplemental income of $800. 

Esther also receives a monthly pension of $100 after retiring as an employee of Volunteers of America. Because Tomas receives a military pension only from his military service with the Philippine Constabulary, equivalent to $120 a month, he is entitled to SSI benefits as a senior residing in Seattle. 

If retirees return to the Philippines, they receive 75 percent of their Social Security pension. For Esther it will be a meager $75 per month.  If veterans choose to reside in the U.S., they receive burial benefits and each widow receives an average lump sum of $9,000, with the amount partly depending on a departed soldier’s rank. 

Medicare Portability

"Filipino-American war veterans and their widows are leading the way in the campaign for Medicare portability. In the 65-and-above age group are 200,000 Filipino elderly in the U.S.," explained Eric Lachica, organizer of U.S. Medicare Philippines, a nonprofit advocacy organization based in Washington, D.C. 

Lachica conducts monthly teleconferences among advocates of the movement based in key American cities, from Honolulu to Boston. 

A seasoned lobbyist in the U.S., Lachica spearheads the campaign for Medicare portability, an extension that will allow retired Filipino-American immigrant professionals access to their Medicare benefits at internationally accredited hospitals and health care providers in the Philippines.

The campaign by Filipino-American community advocates and elderly leaders for Medicare coverage for retirees wherever they decide to live has been bolstered by a study published in May by the journal Health Affairs.

According to the study, immigrants in recent years contributed about $14 billion more per year to Medicare than they received from the program. As a result, foreign-born U.S. residents produced a $115 billion surplus from 2002-2009, while the rest of the population created a $28 billion deficit over that same period.

The study points out that the aging U.S. population was sucking money from Medicare faster than it could replenish those funds, and immigrants helped cover the shortfall.

South of Seattle, Filipinos in Tacoma who are officers and members of the Filipino-American Physicians of Washington (FAPWA) take a differing view and are skeptical about the proposed Medicare portability. 

Change Unlikely, Say Some

Former FAPWA president Nic Panlasigui believes that Medicare “is simply too big an institution that it would take time for Congress and CMS [Centers for Medicare and Medicaid Services] to formulate any significant change.”

Panlasigui, a physician who is also a noncommissioned colonel in the U.S. Army and does work at nearby Fort Lewis, explains his view: “Because U.S. Medicare will demand higher standards of performance, any official extension to so-called Third World countries would entail extensive work. There are concerns about quality of facilities in overseas hospitals, physicians’ credentials, equipment, support functions and the ever-present concern over fraud.”

He continued, “20,000 Filipino doctors and 200,000 Filipino nurses practicing in countless medical centers across the U.S. know the score and we would be the first to wish that such benefits work their way to the native land to help retirees and old folks.” 

Following weeks of deliberation and earnest discussions among seniors at the nutrition site about the immigration reform bill pending in the U.S. Congress and Medicare, Esther decided to bring home Tomas. 

The old soldier had started to wander about the halls of the housing facility in the wee hours and this has alarmed Esther. After informing her daughters about her decision, she and Tomas flew home on May 21.

Her parting words to friends: “If the immigration reform bill will bring my daughters to the U.S., well and good. But the safety net we need as we age is not certain. Back in the old village, the caring family network I know can always take the place of Medicare.”