Immigrant fighting cancer and the fear of losing care

Almost two years ago, the immigrant from El Salvador was diagnosed with cancer, and his doctors in Boston fought it with surgery, radiation, and multiple checkups. It still lurks inside his stocky frame, but he is alive, and he has insurance.

Now he is among 30,000 legal immigrants who are poised to lose their state-subsidized health insurance at the end of the month, as Massachusetts leaders wrestle over the state budget.

As a low-wage worker with an expensive disease, he is suddenly confronting an unexpected dilemma: He cannot afford insurance, but missing his checkups could put him at risk.

“For me, the illness doesn’t end,’’ he said yesterday, sitting in the tiny parlor of the apartment he shares above a red-brick bodega in East Boston. “I have to keep going. I can’t just lie down and die.’’

State lawmakers deleted money for immigrants’ health insurance as one of many cuts made to balance the budget for the fiscal year that began July 1.

Governor Deval Patrick has proposed a $70 million compromise plan that would grant immigrants access to medical care in August, when their coverage ends, through a patchwork of other state programs that health advocates say is spotty and confusing, especially for those who, like Hernandez, do not speak English.

The proposal would require lawmakers and state regulators to create an alternative insurance system for these immigrants come September. Lawmakers expect to vote on the proposal before the end of this month.

If lawmakers reject the proposal, legal immigrants would use a state program, Health Safety Net, that would allow a limited amount of medical care indefinitely, but they would pay a larger share of their care than they do now.

The uncertainty is creating an anxiety that is palpable, said Carlos Solis, a counselor at the consumer group Health Care for All, who is helping Hernandez and dozens of other immigrants navigate the state system. The group has received calls from more than 200 families.

“The question we keep receiving is, ‘What am I going to do?’ ’’ Solis said.

Lawmakers proposed eliminating healthcare for legal immigrants because, as noncitizens, they do not qualify for matching federal subsidies and thus are more expensive for the state to insure.

But health policy specialists say terminating the immigrants’ coverage is probably going to shift costs to other portions of the state budget, as well as to hospitals that care for them.

“At least a portion of the costs . . . are still going to occur, because people will still get care if they need it. The question is, who is going to be paying for it?’’ said Anya Rader Wallack, executive director of the Massachusetts Medicaid Policy Institute and cochairwoman of a state-created committee that will soon recommend proposals to contain soaring healthcare costs.

The 30,000 immigrants caught in the middle have “special status’’ in the immigration system. Many have been in the country less than five years and are seeking asylum from war-ravaged regions.

Hernandez, a 51-year-old janitor, said he arrived in the United States on a visa in 1993, a year after a 12-year civil war ended in his homeland. He applied for asylum and was denied, but was able to obtain temporary legal status in 2001 after a series of earthquakes shattered his country.

Before his illness, his priority was work: He had two jobs, cleaning office buildings during the day and at night. Health insurance seemed beyond his reach.

Besides, his older brothers and a sister in El Salvador needed the money he sent home.

Then one day in 2007, he felt pain while going to the bathroom.

A local doctor referred him to Tufts Medical Center, where a specialist diagnosed him with prostate cancer. The rest is a blur: He recalls the worry on the doctors’ faces and being told that he had a 50 percent chance of survival. The doctors rushed him into surgery in October 2007.

“I didn’t know anything,’’ he said, shaking his head. “I fell into a depression. I didn’t ask anything.’’

After the surgery he spent two nights in the Boston hospital, and then embarked on a series of critical checkups. At three months and at six months, he was fine.

At nine months, the cancer was back. Eight weeks of radiation followed.

“The doctors have done everything for me,’’ Hernandez said. “Without them, I would have died.’’

But his illness has devastated his finances: Shortly after the operation, he received a bill for $24,000 because he did not have insurance at the time. The debt, which he is fighting through a lawyer, is more than he earns in a year.

“See how it is when you don’t have insurance?’’ he said, gesturing to the bill.

The cancer also cost him his day job. When he told the boss he needed two months to recover from the surgery, he was fired.

Now he works part time at night, sweeping and vacuuming an office building after the employees have gone home. He usually grosses $350 a week.

His latest pay stub shows that he has made a total so far this year of about $13,400, including overtime, and has paid roughly $2,000 of that in federal and state income taxes.

To keep costs low, he does not own a car, never eats out, and rents a room for $250 a month in a third-floor flat in East Boston, up a staircase covered with a tattered gray carpet.

Losing the insurance while still being treated for cancer is unthinkable, he said. He has no savings and has two doctor’s appointments coming up.

At the last visit, he underwent scans, because his doctor worried that his cancer may have spread.

“I don’t know what’s waiting for me,’’ he added. “Now, I’m OK. But what if I need more surgery, more radiation? And what if I don’t have insurance?’’

Maria Sacchetti can be reached at MSacchetti@globe.com. Kay Lazar can be reached at klazar@globe.com