B. Undocumented Mexican Immigrants in Arizona: Mexican-Government Sponsored Health Care
Unlike documented Mexican immigrants, undocumented Mexican immigrants could not realistically benefit from private binational health insurance. Crossing the border is difficult, expensive, and dangerous, and it is unlikely that undocumented immigrants would risk leaving the United States for health care in Mexico. Purchasing health insurance with coverage in the United States is also too expensive for the majority of undocumented Mexican immigrants. Additionally, there is no state sponsored medical care for nonemergency services for undocumented immigrants. Undocumented Mexican immigrants need a publicly funded health care program in Arizona that is financed partially by the participants, but primarily by the Mexican government.
1. Mexico's Health Plan for Migrant Workers
The Mexican government should be encouraged to fund a preventative health care plan for undocumented Mexicans living in Arizona. Unlike the U.S. health care system, in Mexico, the majority of Mexican citizens access health care through publicly funded programs. Through federally funded public health care programs such as Seguro Popular (Popular Insurance), Mexicans can access affordable health care services regardless of their economic status. In fact, the Mexican Constitution bestows all citizens with the right to health care.
However, Mexican citizens who work in the United States do not enjoy this constitutional right and are largely left without access to affordable care. Some within the Mexican government would like this to change. Mexico's National Institute of Public Health (NIPH) has expressed support for a health insurance plan for Mexican migrant workers employed abroad. Proponents of the plan argue that Mexican citizens, regardless of their geographic location, have a constitutional right to affordable health care. Known as Salud Migrante (Migrant Health), the health plan would subsidize preventative health care services supplied by U.S. health care providers to Mexicans working in the United States. Migrant Health would be financed by enrolled migrant workers, their U.S. employers, and by Popular Insurance. Under Migrant Health, Mexican workers in the United States would utilize providers in nonprofit and community health centers.
Migrant Health as proposed by NIPH is a good starting point, but as it currently stands, it is not well suited to Arizona because (1) community health centers and non-profit organizations in Arizona are over-utilized and underfunded; (2) undocumented immigrants using Arizona-funded health care is a controversial policy; and (3) U.S. employers of undocumented Mexican immigrants would not likely contribute to the health plan because employing undocumented workers is illegal. An approach better suited to Arizona is a health plan program where: (1) participants utilize private health care providers for preventative health care services, (2) funding comes from participants and the Mexican government, and (3) the plan is administered either through U.S.-based Mexican consulates or through a third-party private insurance plan under contract with the Mexican government.
2. Mexico's Interest
Mexico would receive tangible benefits it if were to improve access to health care for undocumented Mexicans in Arizona. A subsidized health plan would further the Mexican government's interests and support the Mexican workers' families living in Mexico. Mexico receives enormous economic benefits from Mexicans who work in the United States. Remittances sent to families in Mexico are a vital part of the Mexican economy and are the country's second highest source of revenue. Health care coverage improves both physical and mental health and, generally speaking, healthy workers are more productive. This is especially true for Mexicans employed in jobs that require physical labor. Therefore, Mexico has an interest in their citizen's health while they work in the United States.
3. Health Plan Financing
Health plan financing should come from participants and from the Mexican government and should be structured similar to Popular Insurance. Enrollees in Mexico's Popular Insurance pay an annual fee that is calculated based on their income. Those with lower incomes pay lower fees, and vice versa. Participants in an Arizona-based migrant health program could pay into a similarly tiered system. Additionally, participants could be required to pay a one-time application fee for a health insurance I.D. card administered to plan enrollees. Finally, small co-pays, due at the time of appointment with a health care provider, could also be required. With these three sources of independent funding for the program, the Mexican government may be encouraged to cover the remaining costs as they do for Popular Insurance utilized in Mexico.
4. Health Plan Administration
Acting through its U.S. consulates, the Mexican government could create and distribute an official health insurance I.D. card for enrollees in this plan. The cards would be similar to I.D. cards issued by private health insurance companies and would include the individual's name and billing information. Mexican consulates regularly issue I.D. cards called the “matricula consular” to Mexican immigrants, regardless of their immigration status. As such, issuing a health plan I.D. card would likely be within their administrative ability. Health plan information could be added to current matricula consular cards, or a separate health I.D. card could be created.
The matricula consular in its current form is an acceptable I.D. for some private health insurance companies. For example, Health Net, a health insurance company with binational plans, accepts the matricula consular card as a valid form of I.D. to purchase health insurance. A specialized health care card issued by a consulate could perceivably gain the same credibility as the matricula consular with private companies and providers. Though Arizona's state agencies cannot recognize the matricula consular as a valid form of I.D., this does not affect the ability of private businesses to recognize the card. Private health care providers would likely be able to accept the matricula consular or a consulate health plan card, as they are private, not state, entities.
In the alternative, if the administration of the plan is too burdensome for the consulates, the Mexican government could contract with third-party private insurance companies to administer the health plan. Under this approach, experienced private U.S. insurance companies could do what they already know how to do, such as negotiating set prices with doctors and navigating the regulatory and legal scheme of state and federal insurance regulations. The Mexican government could pay an administrative fee to the private insurance companies in return for their day-to-day operation of the plan.
