V. Selling Health Care to Arizona: How Arizona and Mexican Immigrants Could Accept Two New Health Care Plans

      The benefits of binational health insurance and a public health plan will need to be explained to U.S. citizens and Mexican immigrants who reside in Arizona. According to a joint study by University of California at Berkeley's California Program on Access to Care and the Health Initiative of the Americas, sixty-two percent of uninsured Mexican immigrants are willing to pay for low-cost binational health insurance. Like California, Arizona has a sizeable uninsured Mexican immigrant population that is ineligible for Medicaid and has additional economic and employment barriers to health insurance. Other southwestern states with similar demographics, such as Texas, have explicitly rejected binational health insurance. The support of the Arizona legislature and the general public is critical to health care reform and the implementation of these two new health policies. Why should Arizona residents support binational health insurance and a health plan for undocumented Mexicans when other similarly-situated states have not? Arizona residents should support these two health initiatives because they would support businesses, improve overall health, and reduce pressure on the hospital ER.

A. Private Support for Binational Health Insurance and a Public Health Plan

      Arizona employers concerned with health care costs can benefit from binational health insurance. U.S. employers are financially responsible for a large portion of health care spending. When health care costs increase, profits suffer. The Phoenix Chamber of Commerce supports affordable health care for business owners and would like the number of Arizona residents with health insurance to increase. In 2011, the Phoenix Chamber of Commerce held a “Health Care Issue Committee Meeting” to discuss “strengthen[ing] Arizona's health care system through reducing the number of uninsured persons and creating an environment of affordable and accessible health insurance.” Representatives from private insurance companies, local law firms, public community health centers, and small businesses voted unanimously in favor of increasing health insurance enrollment. Binational health insurance furthers the Phoenix Chamber of Commerce's goals by offering employers low-cost, employer-sponsored health plans and by increasing the number of insured workers living in Arizona. As a logical matter, employers and the Phoenix Chamber of Commerce should support binational health insurance.

      Small businesses would also particualry benefit from binational health insurance. Health Care Group (HCG) is a division of AHCCCS. It provides reduced-cost health insurance to small businesses that cannot afford employer-sponsored health insurance in the open market. HCG is under pressure to facilitate low-cost employer-sponsored health insurance for small businesses without using state money. To accomplish this, HCG needs a large pool of low-risk healthy workers to subsidize costs from high-risk individuals. Mexican immigrants, who are on average relatively healthy, can help subsidize high-risk individuals and keep premium costs low for small employers by choosing a cheaper binational health insurance plan.

      In addition to the business community, the medical community has also expressed support for medical care access for immigrants. The American Medical Association (AMA) supports health care for undocumented immigrants and is opposed to the criminalization of health care provided to this group. The AMA's position is important to the success of a health plan for undocumented immigrants for three reasons. First, opposition to the criminalization of care makes it more likely that private practice doctors would be willing to treat undocumented immigrants financially supported by the Mexican government. Ability to pay, not citizenship status, is more important to a private health care provider. Second, because possession of this health plan I.D. card can reveal the holder's immigration status, physicians must agree to not alert immigration authorities. If they alerted authorities, undocumented immigrants would be unlikely to participate in the plan. Third, the AMA is also willing to work with local and state medical societies to oppose any legislative proposals that would criminalize giving health care to undocumented immigrants. The AMA could provide support to local doctors who decide to participate in any future Mexican-sponsored health plan.

B. Public Support for Binational Health Insurance and a Public Health Plan

      Not only is support of the private sector important, governmental support and collaboration will also be necessary for successful implementation. The U.S. and Mexican governments both officially recognize the need for comprehensive health care policies along their shared border. The United States-México Border Health Commission (USMBHC) was established in 2000 to address this need. USMBHC is comprised of state health officers, community members, and federal officials from the four U.S. and six Mexican border-states who share information and collaborate on improving binational health issues. High uninsured rates in the border region are a major concern of the Commission. The USMBHC also sponsors an annual Binational Health Week. Binational Health Week could be used to bring together public officials and private companies from Arizona and Mexico to facilitate the cross-border cooperation to implement binational health insurance and a Mexico-sponsored plan.

      Arizona's Officer of Border Health (OBH) is another public organization concerned with border health that collaborates with USMBHC. Like the USMBHC, OBH also strives to improve access to health care in the border region. The OBH coordinates binational public health issues with Sonora, Mexico, the Mexican state that shares a border with Arizona. The OBH could be used as a forum to coordinate with health care providers in Sonora and private insurance companies in Arizona for development of binational plans.

      Arizona's judicial branch has also opined on health care for undocumented immigrants. In Scottsdale Healthcare, Inc. v. AHCCCS, the Arizona Supreme Court upheld Arizona law where undocumented immigrants “are eligible for publicly funded medical coverage . . . for an emergency medical condition.” The Court rejected AHCCCS's bright-line rule that would only reimburse hospitals up to the point of patient stabilization. Instead, the Court held hospitals will be reimbursed for care given if the medical condition suffered by the patient is still manifesting itself by acute symptoms and “that these acute symptoms [are] sufficiently severe that ‘the absence of immediate medical attention’ could reasonably be expected to put the patient's health in serious jeopardy . . . .” This “case-by-case” approach gives hospitals an opportunity to recover for more care than ACCCHS's bright-line rule would have allowed. Looking to the Court's precedent, if a Mexico-sponsored health plan is implemented, perhaps the Court would support the expansion of health care coverage to uninsured Mexican immigrants.

C. ¡Gritálo! Marketing New Health Care Options to Mexican Immigrants

      Informing eligible Mexican immigrants about private binational health insurance and a Mexico-sponsored health plan is also important to the success of the health care policy initiatives. Changes to the Arizona health care system should be accompanied by an outreach program targeted towards informing those who are eligible to apply. Research shows that some immigrants who qualify for state or federal programs are uninsured because they do not understand their health care benefits. Confusion about eligibility, concerns about adverse immigration consequences, and language barriers are all common reasons why eligible immigrants do not apply for health benefits. As non-native English speakers, Mexican immigrants face both linguistic and cultural barriers that can cause confusion about eligibility for health care plans. One way to inform Mexican immigrants would be to collaborate with the various Mexican consulates spread throughout Arizona, who are already charged with the responsibility of keeping this community abreast of changes in Arizona public policy.

      1. Ventanillas de Salud

      Ventanillas de Salud (Ventanillas), a health care program run by Mexican consulates in the United States, may be able to take on this informational role. Ventanillas provides basic health care services and information about the U.S. medical system to Mexican immigrants. Located inside the Mexican consulates, Ventanillas is in direct contact with the Mexican immigrant community. There are five Ventanillas in Arizona, located in Phoenix, Tucson, Douglas, Yuma, and Nogales.

      As a center for health care information dissemination, Ventanillas is an ideal place to disseminate information about binational health insurance and a Mexican-sponsored health plan. Private health insurance companies could supply Ventanillas with information in Spanish about their binational health insurance products, telling Mexican employees to ask their employers about low-cost binational plans. Additionally, undocumented Mexicans at Ventanillas could ask questions about a Mexican-sponsored health plan in their native language without the fear of deportation or other adverse immigration consequences they may have if forced to obtain information from an American agency.

      Collaboration with Ventanillas is also advantageous because it is an adaptable organization that changes as the needs of its community change. As evidenced by the health policy changes the organization has made throughout its existence, Ventanillas understands that the health needs of the Mexican immigrant community differ over time. Currently, the premier concern of Ventanillas is increasing Mexican immigrant access to affordable health care services. Ventanillas may be inclined to lend support and legitimacy to health policy changes that address its key concerns. Finally, given the negative attitude of many policy makers in Arizona towards Mexicans--and Latinos generally --in the state, without the legitimacy of Ventanillas support, it may prove difficult to convince Mexican immigrants in Arizona to sign up with either plan. Therefore, collaboration with Ventanillas is a prudent step towards success.