IV. A Proposed Health Care Model for Arizona: Private Binational Health Insurance and a Public Health Plan

      Arizona is one such southwestern state facing problems from uncompensated ER costs that can benefit from increasing health care coverage for Mexican immigrants residing in state. The five largest hospitals in Arizona have spent hundreds of millions of dollars on uncompensated care, much of it attributable to uninsured Mexican immigrants. State Medicaid reimbursements and uncompensated hospital costs associated with Mexican immigrants are over $500 million. In addition to financial problems, Arizona ERs are also overcrowded, have the longest waiting times in the country, and can experience temporary shut downs when they get “too busy.”

      In response to the economic crisis that began in 2008 and to the overwhelming cost of uncompensated care, the Arizona legislature has proposed severe budget cuts to its Medicaid programs in order to reduce health care costs. However, Arizona has other options beyond cutting Medicaid spending to reduce health care costs. Better access to primary care through expanded health care coverage is another way Arizona can reduce health care costs. The Morrison Institute of Public Policy at Arizona State University concludes, “[n] ot having health insurance results in using fewer health services and greater likelihood of costly health outcomes later in life.” The uninsured are more likely to postpone health care because of perceived high costs and inadequate access to a regular primary care doctor. Health problems that could have been treated at a relatively lower cost if they were diagnosed early remain untreated until they balloon into emergencies that require more invasive and more expensive procedures. Offering affordable health care coverage to the 600,000 documented and 455,000 undocumented Mexicans immigrants who reside in Arizona opens the door to more affordable primary care. The question that remains is how Arizona can offer affordable health care to Mexican immigrants without expending more state resources. One such solution is a two-fold approach that would (1) offer private binational health insurance for documented Mexican immigrants and (2) offer a health care plan funded by the Mexican government for undocumented Mexican immigrants. Neither of these two approaches directly requires state or federal funding.

      Many Mexican immigrants travel to Mexico for health care services. In 2009, through binational health insurance coverage or paying out-of-pocket, about 500,000 Mexicans crossed the California-Mexico border for health care services in Mexico. Adopting private binational health insurance in Arizona will encourage more documented Mexican immigrants to utilize primary care doctors in Mexico, thereby reducing visits to the ER. However, because the goal is expanded health care coverage for all Mexican immigrants, binational health insurance is insufficient. It is unlikely undocumented Mexicans will risk leaving and reentering the United States to receive medical care through a binational plan. The health needs of undocumented Mexican immigrants should be addressed through an in-state public health plan funded by the Mexican government.