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Are some refugees fleeing Utah in exodus for better health care options?

SALT LAKE CITY — The Bhutanese refugee community in Utah is tightly knit. They look after each other, according to some of its members.

But their numbers seem to be dwindling, said Tom Neupane, a 25-year-old University of Utah student who arrived in Utah with his family in 2009. He said several families, including some close friends of his, have fled to states where health care for low-income adults is more accessible.

"If nothing happens here by next summer, I'll be moving out of state, too," Neupane said. "We've been waiting for the good news for the last three years and nothing is happening."

The good news, he said, would be an expansion of Medicaid.

Neupane and his wife are insured through his job at the U., though he said he'd like to live in a state where Medicaid is available to a larger population of low-income adults so that he doesn't have to worry so much about his parents and his in-laws, and others in his family.

"Family is a big part of our culture. Taking care of them is our very first priority," he said. "It's been a very hard time."

Neupane doesn't think welfare programs should be free, but because he pays taxes, he wants to benefit from that in some way.

He said the Bhutanese culture is strong, encouraging education and progress in its youth. Many of his peers are seeking or have earned high-level degrees and "have unique talents."

"We could make the area richer, we have different business ideas," Neupane said. "Losing these communities is not a good thing. But it's really happening."

His father speaks limited English and works less than full-time as a janitor, therefore not qualifying for benefits. In 2014, he was paying about $30 a month for health care via, but he now has to come up with $132 a month, just for himself, as rates have increased sharply in the first years of the marketplace.

"My mom doesn't have health insurance," Neupane said. "She needs to see the doctor, but she's not seeing anybody."

A "low-cost" version of imaging his mother needed ended up costing the family close to $3,000. The family applied for financial aid, but Neupane said it is hard to come up with that much when several families are living on so little.

As the most educated person in his family, and the most active in the community, Neupane said he is relied upon heavily.

"They have faith in me," he said. "They believe in me."

He also said that if he leaves, his family and likely others will follow.

"Our community, it was very big. It's shrinking slowly," Neupane said, adding that he doesn't see a lot of new Bhutanese refugees coming to Utah.

The Utah Department of Workforce Services, which oversees refugee populations in the state, doesn't typically monitor the outflow of refugees and could not confirm any significant decline. Spokesman Nick Dunn said, however, that the department began tracking the numbers of closed public assistance cases (meaning people who stop requiring services from the state) just this year.

He said refugee populations are "generally growing" in Utah, with about 1,100 refugees resettled in the state each year. Refugees come to Utah from at least 20 countries, including the Southeastern Asian Kingdom of Bhutan. The Bhutanese, Neupane said, lived in refugee camps for years due to religious and political conflict.

Lina Smith, social services specialist at the Asian Association of Utah, said the issue of health insurance is important for refugees, but a lack of options in the state is also affecting other populations.

"Utah should make a move on it," she said, adding that another issue forcing some refugees to relocate outside of Utah is a longer wait for housing placement in the state. Smith generally tries to help her patrons get the available resources they need from the community, including enrollment in health plans.

But not everyone qualifies.

Only one member of Neupane's extended family has medical insurance. Others fall into what is called the coverage gap — making too much to qualify for Medicaid and too little to be eligible for subsidies on the federal marketplace — putting health insurance out of reach.

"If other states are finding alternatives and ideas to Medicaid expansion, something needs to be done here, too," Neupane said. "We had great hope in the last session of the Legislature, but nothing happened. Then there was to be a special session, and nothing happened. I keep an eye on all those things."

His family is saying enough is enough.

"A lot of families have the hope that their kids will get a better education, a better job, be able to buy a house and live in a house and not depend on programs or other people," Neupane said, adding that he comes from a hard-working culture. "I know that there's no such thing as a free lunch, if I go to a different state, someone has to pay for it there, too. But if I'm working so hard here, making a paycheck, and they are taking money in taxes for the people, those benefits should be helping me and my family."

Recently, the First Presidency of The Church of Jesus Christ of Latter-day Saints released a letter encouraging members to "observe the plight of the millions of people around the world who have fled their homes seeking relief from civil conflict and other hardships."

The letter reinforces methods that help refugee projects, as well as tells members to seek out local service opportunities "where practical."

While Neupane is not LDS, which is the dominant religion in Utah, he has felt welcome in the state. And he doesn't want to leave.

"It is the best place to live," he said. "It is kind of dry, but I like it. I would like to stay in Utah."

But family, Neupane said, "is above everything else."

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