A. Documented Mexican Immigrants in Arizona and Private Binational Health Insurance: State-Initiated Health Insurance Reform

      The Arizona legislature should reform state health insurance regulations to expressly authorize insurance companies licensed in Arizona to sell binational health insurance plans to documented Mexican immigrants. Arizona's Insurance Code provides regulatory guidelines for health insurance in Arizona. The Department of Insurance (DOI) is the state agency that regulates insurance companies licensed in Arizona, and insurance companies licensed in the Arizona jurisdiction are subject to the DOI's authority. The DOI can take remedial actions against companies that do not comply with its health standards through civil penalties or suspension or revocation of licenses to sell health insurance in Arizona. Currently, under the Insurance Code, companies licensed outside of Arizona can sell insurance plans that offer coverage exclusively in Mexico to Arizona residents. However, the DOI does not regulate these plans and does not offer consumer protections to those enrolled. The Insurance Code is also silent on whether health insurance companies can offer insurance coverage simultaneously in Mexico and in Arizona.

      Without express authorization of binational health insurance its legality remains unclear. Health insurance companies would be unlikely to invest in developing or marketing a binational health plan without a clear understanding of its legal boundaries. To protect Mexican immigrants enrolled in binational health insurance plans, clarify the scope of such plans, and encourage companies to offer this product, the Insurance Code should expressly define and authorize binational health insurance with Mexico. Additionally, the Insurance Code should give the DOI regulatory authority over these plans, similar to that allotted to the DMHC in California.

      Unlike California, Arizona should not authorize Mexican health insurance companies to sell binational plans in Arizona. The DOI's ability to ensure compliance with Arizona licensure law by a Mexican company may prove difficult. For example, the DOI has no authority to levy civil penalties against a foreign company, nor can it enter Mexico to inspect Mexican health care providers for compliance with Arizona health regulations. Instead, the DOI should require insurance companies to be licensed in Arizona and subject to Arizona jurisdiction before they can sell binational health insurance. This would allow the DOI to have the jurisdictional authority to fine noncompliant companies if the need arose.

      The DOI should also be granted the express powers to levy monetary penalties against Arizona insurance companies if their Mexican health care providers fail to meet Arizona health standards. This power may help allay fears that Mexican providers would give consumers sub-standard care. Binational health care consumers could alert the DOI if sub-standard care was received from a Mexican health care provider by filing a complaint with the DOI Consumer Affairs Division. Consumer complaints could be used to threaten Arizona insurance companies that contract with non-compliant Mexican providers with civil penalties, licensure suspension, or revocation if the complaints do not cease within a reasonable period of time. Stringent civil penalties would be an incentive for health insurance companies to ensure their Mexican providers are following DOI standards.

      Furthermore, unlike California, binational health insurance should be sold through both individual and employer-sponsored plans so that employer participation is not required before Mexican immigrants could purchase binational health insurance. Finally, as in California, the medical coverage areas should include providers in Arizona and in Mexico.

      1. Binational Health Insurance for an Arizona Market

      Binational health plans are well suited to documented Mexican immigrants in Arizona because of Mexico's proximity and its developed health care infrastructure. Many private Mexican hospitals are equipped with technology and staff comparable to U.S. hospitals. The Mexican city of Hermosillo, for example, is both close to the Arizona border and has hospitals with modern medical infrastructure. For example, the Centro Internaciónal de Medicina (CIMA) hospital network in Hermosillo is held to U.S. quality standards and is accredited by the Mexican Secretary of Health. Hermosillo hospitals also regularly treat Mexican patients transferred from Arizona hospitals and have an established relationship with the University of Arizona Medical Center.

      Tijuana is another Mexican city accessible from Arizona. Health care providers in Tijuana have successfully contracted with Californian health insurance companies and could do the same with Arizona companies. Additionally, some American hospital corporations are building their own facilities in Mexico hoping to capitalize on medical tourism from the United States. For example, the Texas-owned CHRISTUS hospital chain has a hospital in Monterrey that is accredited by the Joint Commission International, one of the most internationally respected hospital accreditation organizations. Private American companies such as Blue Shield and Health Net, already-licensed health insurance providers in Arizona, could tailor their Californian binational products to documented Mexican immigrants in Arizona.