After his arrival in the U.S. as an Afghan evacuee, Mohammad Nisar was surprised to learn that even basic health services in the world's richest country — a country that also spent millions of dollars improving health care in his native country — are not free.
His surprise has now evolved into worries about the possible loss of Medicaid, the state-sponsored health insurance program for low-income Americans that is currently covering his family.
To remain eligible for the full medical coverage they have in the state of Virginia, Nisar's family of five must earn less than $49,000 a year before taxes.
"I try to work hard here, but I worry that we might lose Medicaid if we make just a little more than $49K a year," Nisar told VOA.
Uprooted from his home in Afghanistan, Nisar works 18 hours a day, as a part-time sales assistant and a full-time food delivery driver.
"I have to pay $28,000 in annual rent and utility bills for a two-bedroom apartment," he said during a lunch break from his work, "and there is food, clothes, home appliances and everything else to pay for.
"I can't afford a self-financed health insurance or through a partial contribution from my employer. … We can remain poor, but we can't have no health coverage."
Just last month, Medicaid paid more than $4,000 for his children's dental fees.
"America has the largest economy in the world," Nisar said, "and it doesn't make sense that it has such an expensive and complicated health care system."
Temporary protected status
The U.S. government offered temporary protected status (TPS) to tens of thousands of Afghans who had been evacuated to the U.S. under a program called Operation Allies Welcome. Under the program, the Afghans can live and work in the U.S. until November 2023.
Last month, U.S. lawmakers removed from a draft bill in support of Ukraine a provision to establish a legal pathway for the permanent settlement of Afghan evacuees.
It is unclear how and when the U.S. government will determine a permanent status for the Afghan evacuees, but the uncertainty worries some Afghans.
"I've seen people who have spent years waiting for their status to be determined, and I fear we will fall in the same category," said Mohammad Naweed, an Afghan man who entered the U.S. in September without a visa and was given humanitarian parole.
While parole allows Naweed and others to stay for now, without changes to U.S. policy, they cannot sponsor the immigration of their close family members still left in Afghanistan.
Over the past nine months, almost 15,000 Afghans have migrated to Canada under a special immigration program called Welcome Afghans.
"Our commitment is to provide protection to at least 40,000 vulnerable Afghans as quickly and safely as possible," a spokesperson for Canada's immigration and citizenship agency told VOA.
While most Afghans have migrated to Canada through a humanitarian program and a separate program for Afghans who worked for Canada in Afghanistan, scores of Afghans have also crossed the U.S.-Canada border to claim asylum.
Last year, 416 Afghans sought asylum at Canada's border entry points. Between January and March this year, 177 Afghans registered their asylum petitions at the U.S.-Canada border, according to Canadian government figures.
"Canada has shown that they're able to welcome Afghans quickly. They have a robust refugee welcoming system that has not suffered from the same political attacks that we've experienced here in the U.S.," Chris Purdy of Human Rights First, a U.S.-based nongovernmental organization, told VOA.
In the U.S., immigration has long been a divisive policy area. As of February, there was a backlog of 9.5 million immigration cases at U.S. Citizenship and Immigration Services, according to agency data.
There are also allegations of unequal treatment of immigrants and asylum-seekers.
Last month, in a letter to President Joe Biden, several U.S. senators expressed concerns about "inconsistency" in the treatment of Afghans and Ukrainians who sought to enter the U.S. under the humanitarian parole program.
"We applaud the administration's efforts to welcome to our shores all those displaced by war and its aftermath. But the disparate policies and requirements for those seeking refuge in the United States depending on their country of origin causes us concern," the letter said.
The U.S. and Canada share data and information about refugees and immigrants.
Under a 2004 agreement, refugees must seek protection in the first country they reach — either the U.S. or Canada. The agreement also "prevents asylum-seekers who are in the United States, or traveling through the United States, from making refugee claims at the Canadian border (and vice versa), subject to certain exceptions," according to a study by Harvard Law School.
"A second migration effort would be a very risky proposition for any Afghan who was brought to the U.S.," Purdy said.
Of the 177 Afghans who crossed the border and sought asylum in Canada, 96 were accepted and the rest are pending. None has been rejected.
For Nisar, the Afghan evacuee in Virginia, taking his family across the border to Canada appears to be an attractive option, at least in some aspects.
"What pains me is that I'd have to restart from the zero. … But if Canada offers a path for a normal life for us, we'll take that," he said.