From Our Team

ACA and its Unique Permutations on the U.S.-Mexico Border

While the pros and cons of the the Affordable Care Act (ACA) have been discussed ad nauseam, few have discussed the unique implications for residents of the U.S.-Mexico border region, particularly folks living in Texas.

In 2007, Theresa Byrd (Texas Tech) and I conducted a survey of El Paso County to determine what proportion of residents access health care services in Mexico. We also wanted to learn which services they use, and why they cross for care. We found that 32% of El Paso residents crossed into Mexico for some type of health care service. Of those that crossed, 27% were accessing medical services (beyond pharmacy purchases). Reasons for crossing included cost, lack of health insurance, language barriers with providers in the U.S., and convenience. Of course, much has changed in border dynamics in the last six years. Another survey would be needed to determine if this proportion of folks is still crossing the border for medical care, particularly recognizing U.S. residents’ perceptions of violence in Juarez.

In California, the state’s Knox-Keene Health Care Service Plan Act was amended in 1998 to legalize and regulate binational HMO’s. Put differently, California allows for health plans in which some or all the medical services are provided across the border. Sistemas Medicos Nacionales, S.A. de C.V. (SIMNSA, www.simsa.com) was one of the first healthcare plans under this amendment, allowing U.S. workers to have healthcare coverage for medical treatment provided in Mexico. The approach lowers premiums and allows patients to see Mexican providers, if they prefer. Even Blue Shield of California has a cross-border plan, allowing patients to access emergency/urgent services in California and use Mexican providers for primary care.

Back to the ACA – The Affordable Care Act (aka Obamacare) requires that all U.S. residents have health insurance. I recently emailed Frank Carrillo, the CEO of SIMNSA; he confirmed for me that SIMNSA is recognized as a qualified plan under the ACA’s individual mandate. Since Texas does not recognize healthcare plans like SIMNSA’s, Texas residents’ options only include healthcare plans with U.S.-based providers. Many of these individuals, like their peers in California, may prefer to have less expensive coverage and/or to see providers who they’ve historically seen in Mexico. In this regard, the combination of ACA and Texas regulations don’t maximize the choice for Texas residents living in the border region.

Forbes did an interesting article on this concept back in 2011. See the following link - http://www.forbes.com/sites/aroy/2011/09/26/rick-perrys-intriguing-idea-for-bi-national-health-insurance/).