II. Mexican Immigrants in the U.S. Health Care System

      Many Mexican immigrants are uninsured. Only a third of all short-stay Mexican immigrants (in the United States for fifteen years or less), and only two-thirds of long-stay Mexican immigrants (in the United States for more than fifteen years), have health insurance. This is compared to eighty-nine percent of U.S.-born whites and seventy-seven percent of U.S.-born Mexican Americans who have health insurance.

      One reason for high uninsured rates is that Mexican immigrants have limited access to the private health insurance system. In the United States, employer-sponsored health insurance is the most common form of health care coverage, but it is not offered by all employers, and its prevalence varies across employment sectors. Mexican immigrants primarily hold jobs in industries that do not offer employer-sponsored health insurance. Additionally, the jobs held in these industries are usually low-wage, which means other private health insurance options are unaffordable. However, these are not the only barriers Mexican immigrants face.

A. The Special Case of “Recent” Mexican Immigrants: Exclusion from Public Health Care

      Mexican immigrants also face restricted access to public health care. The federal government through the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) increased restrictions on Medicaid eligibility for documented immigrants. Before PRWORA, all documented immigrants who met poverty level requirements were eligible for Medicaid. After PRWORA, documented immigrants are not eligible for Medicaid for their first five years of residence in the United States, and states do not receive federal financial assistance for medical care given to this group. Though PRWORA permits partial federal Medicaid reimbursement for emergency care, these reimbursements do not cover the actual cost of ER care.

      States were forced to decide if they would permit immigrants excluded from federal Medicaid to qualify for state Medicaid programs. Among southwestern border-states, California, Texas, and New Mexico offer state programs, but Arizona does not. This means Arizona hospitals are responsible for the cost of care given to uninsured Mexican immigrants who do not qualify for Medicaid, even when such care is mandated by EMTALA.

B. Financial Strain on Hospitals

      Hospitals are accruing significant costs from providing medical care ineligible for reimbursement. The mandatory provision of emergency health care, the categorical exclusion of Mexican immigrants from public health care coverage, and the de facto exclusion of many Mexican immigrants from private health insurance threaten the financial integrity of the hospital ER. Mexican immigrants receive the majority of their medical care from the ER, yet they are often unable to pay for care out of pocket, and they often do not have health care coverage either. As a result, ERs have found it difficult to remain financially solvent.

      In response to ERs' plight, the federal government temporarily increased funding for hospitals, but these resources proved inadequate. In 2003, the Medicaid Prescription Drug Improvement and Modernization Act allocated $250 million for uncompensated ER services provided to undocumented immigrants or to Mexican citizens with border crossing cards. However, the total amount spent by hospitals on uncompensated care was much greater than $250 million, and the extra federal money only covered about fifteen percent of these uncompensated costs. Worse, the federal government does not seem inclined to increase funding again. The Border Health Care Relief Act of 2009, which would have extended the 2003 allocation, did not pass. In 2011 another such bill was introduced in Congress. Its future is uncertain.

      Southwestern jurisdictions are under more financial strain than other states with smaller Mexican immigrant populations. Medical institutions like St. Joseph's Hospital Medical Center in Phoenix, Arizona argue they are not able to afford long-term care for uninsured immigrant patients, and caring for them takes away from their ability to care for U.S. citizens. Though some would argue the easiest solution would be to end all ER care to all Mexican immigrants that cannot pay, not only is that a violation of federal law which carries its own fines, but it is also not a long-term solution for health care providers and individuals that are “adversely affected by high uninsured rates” in their communities. To protect the financial integrity of their hospitals, southwestern border-states should look for creative solutions to increase the number of insured Mexican immigrants, thereby increasing the number of Mexican immigrants eligible for cost-of-care reimbursements.