The Health Ministry is close to adopting a plan to provide health insurance for asylum seekers and other foreign nationals who can’t be deported from Israel.
Although Israel recognizes asylum seekers as “foreigners who can’t be deported,” it doesn’t currently provide them with any social benefits such as National Insurance Institute allowances, health insurance and welfare services. Consequently, some 28,000 adult asylum seekers, mostly from Eritrea and Sudan, receive no assistance, except in extreme cases.
A joint committee of the health and finance ministries considering solutions for asylum seekers is slated to submit its conclusions next week, in advance of the cabinet debate on the new state budget. It was established following a High Court of Justice ruling on a petition by Physicians for Human Rights in Israel that sought to require health insurance for minors who can’t be deported.
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The committee is considering two main options. One is to expand the health insurance program for minors who can’t be deported, which is run by the Leumit health maintenance organization, to cover adults as well. The other is to amend the National Health Insurance Law so that it also applies to adult asylum seekers.
But since Health Minister Nitzan Horowitz would prefer a plan he can implement without approval from the cabinet or Knesset, the first option is more likely. If it is chosen, the ministry would invite bids from all the health maintenance organizations to provide medical services to asylum seekers.
This option would require approval from Finance Minister Avigdor Lieberman, but he isn’t expected to object.
“We do expect some conflicts, but this is a decision that’s within the minister’s ministerial purview,” a Health Ministry official said. “These are people who aren’t going anywhere, and we want to do this.”
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Finance Ministry officials said the cost of the program would depend on what coverage it provides and how many people are actually insured. Nevertheless, they said, the estimated cost will be tens of millions of shekels, and the issue will be discussed as part of the discussions on the state budget.
“The time has come to arrange health insurance for asylum seekers who can’t be deported that will suit their life circumstances, their patterns of employment and our moral and international obligations to their welfare,” Dr. Zoe Gutzeit, who heads PHR’s Migrants and Open Clinic Department, said.
Providing them with health insurance, she added, will enable them to access preventive-medicine services so that relatively minor health problems don’t deteriorate into emergencies, thereby reducing the burden on hospital emergency rooms and preventing lengthy, expensive hospitalizations.
Because asylum seekers can’t access routine medical care, they frequently come to emergency rooms with serious problems. After they are released, they get no follow-up treatment, which often means their situation eventually deteriorates to the point where they have to go to the hospital again.
Moreover, since no insurer pays for these hospitalizations, the hospitals have to cover the costs out of their own budgets.
Kibrom (not his real name), a 31-year-old Eritrean, was rushed to Tel Aviv’s Ichilov Hospital in January with an intracerebral hemorrhage that apparently stemmed from untreated high blood pressure. He needed major surgery and was hospitalized.
Afterward, his doctors wanted to send him to a rehab hospital, where he could get the necessary neurological, motor and cognitive therapy. But since he wasn’t insured, this option wasn’t open to him.
However, he also wasn’t well enough to go home. As a result, he stayed in the internal medicine ward for 127 days. After his release, he received a bill for 271,402 shekels ($82,510), which he couldn’t pay.
Birhane, a 33-year-old Eritrean who has been here since 2011, fell from a two-meter (6.5-foot) height around a year ago while working in Ashkelon, where he lives. He spent eight days at Barzilai Medical Center, where he was diagnosed with cirrhosis of the liver – a disease he had apparently had for years but had never diagnosed because he had no access to regular medical treatment. About two months later, his condition worsened, and he spent another five days in the hospital.
But since he had no medical insurance, he wasn’t able to get the drugs, tests and follow-up treatment he needed. Instead, his only option was visiting PHR’s volunteer clinic in Jaffa, which can provide only very partial care. Meanwhile, he has a 40,000 shekel ($12,200) bill he can’t pay.
Tsega (not her real name), a 33-year-old married asylum seeker with four children, suffered for years from physical debilitation. As a result, she had to stop working and lost her private health insurance.
Last year, after an incident in which her vision deteriorated and she became paralyzed, she was hospitalized for 26 days and diagnosed with neuromyelitis optica. She ended up losing vision in her right eye and needed expensive drugs. She owes 30,000 shekels for hospitalizations in 2017 and 2018, and hasn’t yet been billed for her treatments over the last two years.
Based on data obtained by PHR through a freedom-of-information request and by Knesset members via parliamentary questions, asylum seekers’ unpaid bills have cost the hospitals hundreds of millions of shekels, and the amounts continue to grow.
In 2018-19 alone, the hospitals’ spent 157 million shekels treating asylum seekers. The figure for 2020 is expected to be significantly higher due to the coronavirus, not only because treating the virus is expensive, but because many asylum seekers lost their jobs and private health insurance due to the pandemic.
In a recent survey of adult asylum seekers, 46.4 percent of respondents said they had forgone medical treatment or medications over the last year because of the economic crisis caused by the virus.
Altogether, asylum seekers racked up 480 million shekels in debts to the hospitals from 2013 to 2020, data obtained by Haaretz shows. Ichilov Hospital was the hardest hit, with 212 million shekels in unpaid bills over the eight years. According to PHR’s data, Ichilov spent more than 30 million shekels on asylum seekers in 2019 alone.
In second and third place were Sheba Medical Center in Tel Hashomer and Wolfson Medical Center in Holon, respectively. Each spent tens of millions of shekels.
A state comptroller’s report issued in 2014 said there was “a real concern” that Israel’s failure to provide asylum seekers with access to medical treatment “doesn’t accord with the provisions of the Basic Law on Human Dignity and Liberty or the provisions of the International Covenant on Economic, Social and Cultural Rights.” In 2016, the Health Ministry told the Knesset State Control Committee that it had begun gathering data in order to formulate a comprehensive policy on this issue and was considering providing health insurance to foreigners who can’t be deported.
In January 2017, the ministry said it had finished mapping out the needs and would work with the justice and interior ministries to come up with an insurance plan. The following July, it told the state comptroller that the medical services provided to asylum seekers are insufficient and that it was working to find a way to insure them.
That was exactly four years ago. But as of today, asylum seekers still have no medical insurance.