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Health requirements for new residents are under the microscope as Immigration New Zealand examines how much certain conditions cost to treat, and as the Government is asked to repeal laws which bar human rights complaints related to immigration.
More than 1500 people have had their temporary or permanent visa refused in the last five years because they were likely to impose significant costs or demands on health services.
Aisling Smyth is from Northern Ireland and works as an accounts administration manager in Queenstown.
"I've got mild relapse-remitting multiple sclerosis and I've had it for about nine years now," she said. "But otherwise, fit and healthy and it's well-managed. It doesn't define me really - but when it came to setting down roots and keeping ties here in New Zealand, then it became an issue."
Her visa was rejected because her condition was judged to be likely to cost more than $41,000 to treat. That cost threshold is among the rules that immigration and health officials are reconsidering.
Smyth was granted another work visa after she appealed to the immigration minister, and less stringent health requirements of the 2021 resident visa mean she also now qualifies for residence.
But she is continuing her fight through a collective, Migrants against an Acceptable Standard of Health. It includes individuals and families whose children do not meet the standard, and those who appeal for help and lobby government to be allowed into New Zealand, or to stay once they are here.
"It shouldn't have to come to that, you know, to plead with the media, have access to MPs or have thousands of dollars for lawyers, or create petitions on social media," she said.
"The Government keeps defending this policy, even though it directly discriminates against people with disabilities and health conditions."
The $41,000 threshold did not reflect what a high-cost condition looks like now, she said, and migrants were being assessed on what they cost instead of what they were bringing to New Zealand.
Immigration New Zealand (INZ) is also looking again at the list of medical conditions deemed to impose significant costs on New Zealand's health and special education services. It has already decided HIV will no longer be in the high-cost list.
Immigration lawyer Simon Laurent said migrants often had to resort to costly appeals to have their cases heard.
"The provisions for people who have serious intellectual or physical disabilities requiring full time care - they are essentially locked out of the residence application process. They can't request a medical waiver, which would weigh up their condition against the benefit of having them in New Zealand. And I think those rules need to be revisited because they are leading to some very unfair decisions and some very unfair outcomes."
Families were faced with a situation where one of them would not pass the health requirements for residence and that would sink their application and some had tried to circumvent the criteria.
"The disabled child or health-compromised adult would derail the whole application if they were included, so they were left off - the rest of the family gets residence and then they say, 'Well, we're all here - why can't we have this other family member here on compassionate grounds?'"
INZ tightened the policy in 2017, by saying all family members had to be assessed at the same time. But that has not stopped cases cropping up, with media reports of relatives begging for children to be allowed to join them in New Zealand.
Current rules do not allow immigration officials to take into account whether a migrant or their family can pay for health services, or residential care, or whether they have health insurance. Laurent thinks health insurance may be part of the solution.
"I know that's probably not a politically palatable thing to do because it creates a second class of residents, but it's something that I think is done within a couple of a couple of other jurisdictions and it should be considered here."
The immigration health policy also counts the cost of providing services to migrant children with special education needs.
The issue of immigration health requirements caught the attention of the UN Committee on the Rights of Persons with Disabilities, which in 2018 asked New Zealand to detail the measures taken to reduce the denial of residence on the grounds of impairment. It also asked what steps were being taken to reduce discrimination against persons with disabilities in immigration policy and procedures.
More recently, Tuvalu's Human Rights Commissioner lobbied New Zealand to drop what he described as discriminatory immigration laws for disabled people.
The Green Party wants human rights protection incorporated into immigration law. Its immigration spokesperson, Ricardo Menéndez March said immigration rules were reducing people to a cost.
"The problem with that is that it's deficit-based, it ignores our commitments to the rights of disabled people that we've signed up to internationally, and it's just dehumanising. The other issue as well is that it is not clear for people how Immigration New Zealand arrives to the $41,000 figure, and so the process of appealing a decision where you're deemed to be too much of a cost to the public health care system becomes nebulous and difficult to navigate for families."
He is drafting a member's bill so that people are able to make immigration complaints under the Human Rights Act. The Immigration Act does not allow for complaints under Human Rights legislation, stating "immigration matters inherently involve different treatment on the basis of personal characteristics".
Current immigration policy was tantamount to a blanket ban on disabled people, he said. Migrants can request a medical waiver for most conditions, but not for physical, intellectual, cognitive and sensory incapacities that require full-time care. The waiver process itself can be fraught.
Menéndez March also wants to make sure disabled people are consulted on the review of health requirements.
"I hope that there is that broader consultation and engagement as part of the review of the acceptable standard of health, because it is again not clear how much involvement disabled people are having in the review of this policy. And the last thing we want is just window-dressing and just to change the threshold, because that would end up leading to the same dehumanising process, just potentially less people being affected by it."
INZ said it would consult with the Health and Disability Commissioner and the Ministry for Disabled People once the review of high-cost medical conditions for residence visas has "progressed to the point where consultation can begin".
It said all non-New Zealanders coming to New Zealand must have an acceptable standard of health and everyone who applies for a visa to live in New Zealand for more than 12 months must provide a medical and chest x-ray certificate.
"There is however a list of medical conditions deemed to impose significant costs and/or on New Zealand's health and/or education services which have been determined as being likely to exceed a $41,000 cost threshold, which establishes whether a condition is likely to impose significant costs to the New Zealand taxpayer," said INZ general manager of enablement, Stephen Dunstan, in a statement.
"Immigration New Zealand (INZ) and the Ministry of Health are working together on the review of high-cost medical conditions and the $41,000 cost threshold. The review is reliant on significant data collection, health expertise and analysis, and will need to source information from District Health Boards regarding costs, patient data and health services, and source other information such as pharmaceutical data.
"The review is limited to looking at high-cost medical conditions and the $41,000 cost threshold. The work intends to update the high-cost threshold and the list of high-cost medical conditions in order to reflect developments in diagnoses, detection and treatment of high-cost medical conditions. The review will not look at the principles behind immigration health screening."