Friday, March 4, 2011

Critical Issues when Considering Immigration to the USA

Reality Check: Critical Issues to consider when Immigrating to the USA Part 1

As I work with many international professionals and executives who are exploring immigrating to other countries or who have come to the US as expats, I have held many discussions about the differences of living in the USA compared to their mother countries

Recent studies have shown that with developing countries economies improving and many job opportunities overseas, there is reverse immigration going on, with American and immigrants choosing to go back to their countries and overseas. With tough immigration laws, anti-immigration sentiments, the lingering recession and high unemployment, these are challenging times to immigrate to the United States if you decide to come on your own.

Here are some critical factors to consider if you are thinking of immigrating to the United States. This is the first part of a multi-part series.


The United States has the most expensive healthcare system in the world. It is a privatized system with a range of options including employer-based, private and government healthcare for the poor. According to the 2009 Census, at least 51 million people do not have healthcare in the United States. In addition, at the current time, efforts are being made by states to reduce healthcare programs for the poor. In 2014, if the health care legislation passed in 2010 is fully implemented, all people will be mandated to have health coverage to spread the risks of this insurance so that healthy people, people with health conditions, young and old will be included in the system.

Be aware that the healthcare system in the USA is not like those in most developed countries. Be prepared to spend money on your healthcare costs. The actual costs depend on your health condition. If you have a regular job with employer-provided benefits, you will have a choice of healthcare plans from which to choose. Have your Human Resources department review with you the differences between these plans as they can be very confusing. Be sure to understand what is covered and what is not covered and the limitations placed on the different types of services and hospital services

Most people will incur costs for their care even under their employer plans. You will pay when you see a doctor and for a range of services Health plans can have limits on certain types of care, like certain tests, hospital visits, physical therapy or psychological care. There may be limits on the amount of money that the health insurance will pay every year for individuals and families. Anything over that amount is your own responsibility. The cost for drugs can also be expensive as the government does not negotiate prices with pharmaceutical companies, as governments do in other countries. Insurance companies can raise the cost of their plans and drug costs without letting you know about these changes. You get an individual card that has the name of the company and the type of plans and the costs of doctors and drugs.

If you lose your job, there is a federal law called COBRA that guarantees that you will have health insurance for 18 months longer. However, you pay for the full cost of this coverage as your employer no longer subsidizes these costs. It can cost more than $1000 for a family to have health coverage under COBRA. Thus, some people decide not to have health coverage at all. If they need healthcare, they go to hospitals where they will get billed for this care. Some hospitals will absorb these costs, but some won’t and people can risk going bankrupt due to expensive hospitalizations and procedures without health coverage. If you finish COBRA or are self-employed, you can buy private health insurance which can be very expensive for individuals and families. It can be even more expensive if you have pre-existing health conditions. There are separate health plans for your overall health, your eyes (vision plans) and dental plans for your teeth. So make sure you understand the different plans, costs and limitations of these plans. By 2014, under the health care legislation passed in 2010, you will be able to buy private healthcare through state health insurance exchanges. Every state will have different insurance plans. Subsidies will be given to those unable to pay for healthcare.
For more information about the healthcare system in the United States, please read the following article
While healthcare will be a major budget item and consideration when you live in the United States, education will be another critical area as well.


Public elementary and secondary education is free and open to all. The funding for public education occurs at the federal, state and local levels through property taxes. Every child starting at the age of 4 or 5, depending on the state and the school system, must be enrolled in school or have home schooling that is approved by the state. Please note that, in general, public pre-school or childcare before the age of 4 does not exist. There is also no system of publically-funded and trained day care workers, day care centers or creches. Thus, working parents with babies and young children make their own private arrangements, using babysitters, nannies or private pre-schools. Private pre-schools can be expensive - as expensive as private colleges- as well as very competitive in New York City. In New York City, children often need to take exams to get into private pre-schools where places are limited.

As education in the United States is not national but is controlled locally, every school system is different. Thus, you need to research the schools and school system in the community where you are thinking of living to make sure that it will meet the needs of your children.
After high school, the cost of higher education is also private and paid by families. In the United States, many families start saving money for the cost of college for their children when the children are young, if they can, and a part of their paycheck will go towards saving for education. If they have not saved enough, then students will need to take out private loans, get scholarships if they qualify or even work. There are some scholarships and grants available from federal, state and private foundations such as the Hope Scholarships, which give students several thousand dollars towards college. Some colleges provide need-based or merit-based scholarships. Students and parents need to research these options.

There are a range of options for higher education, including community colleges, private and public universities. The cost of college varies greatly, with public universities costing much less than private universities.

For more information about education in the United States, please read the article in Wkipedia

I will write about other critical factors to consider when thinking about immigrating to the United States. I hope that this information is helpful. It is important to be an educated consumer and to be well-informed when considering immigration. I welcome your comments and feedback.