Health plans leave out border

As presidential candidates in both parties work to distinguish themselves from their competitors before upcoming primaries, a panoply of proposed health care plans will likely become subject to serious dissection.

In the Democratic race, Sens. Hillary Rodham Clinton and Barack Obama have both stressed that each of their plans is the most inclusive. Clinton has lambasted Obama for his lack of a mandate on the purchase of health insurance, and he has countered by claiming that his proposal will be more affordable.

But neither candidate has clarified how his or her proposal will be applied on the U.S.-Mexico border. Health care experts say that the region might not fit into a universal health care plan that allocates subsidies and tax credits based solely on income.

“Because people have more choices here, it’s harder to convince them that this is the right plan for them,” said Jose Pagan, professor of health economics at the University of Texas-Pan American. “Many might suspect that they can find cheaper care in Mexico.”

Both candidates aim to disperse costs by enrolling the now-46 million uninsured Americans into health insurance programs.

But for people like Lydia Sanchez of Weslaco, who asked that her real last name not be used, any proposed health care plan will have to compete against the medical service providers she has used in Mexico for the last decade.

“If I have to pay more than my doctor charges in Progeso, I won’t sign up,” she said. Sanchez, who works as a property manager, said she pays about $50 for a consultation, blood tests and prescription drugs to treat a respiratory infection. In the U.S., she said, the cost would be well over $300.

“When I sit down in the waiting room in Progreso, I’m surrounded by American citizens who are there for the same reason,” she said.

Clinton’s mandate would require people like Sanchez to buy health insurance or face a penalty, whereas Obama relies on a mandate for children only.

“He’s called his plan ‘universal,’” Clinton said in an Iowa speech last week. “Then he called it ‘virtually universal.’ But it is not either.”

But according to health care experts, the feasibility of a mandate — especially on the U.S.-Mexico border — remains uncertain.

“The mandate is pretty toothless,” said Mark Pauly, professor of health care systems at the University of Pennsylvania’s Wharton School. “To convince people with a mandate, you’d have to make the consequences very serious — like a jail sentence or a fine in the amount of the premium. Based on previous experience with mandates, this is not easy to do.”

Pauly points to the ineffective mandate on health insurance in Massachusetts and the large percentage of drivers that don’t have auto insurance, even when their state requires it. In some states, up to 34 percent of drivers do not have the insurance, despite the existence of mandates.

The best way to encourage residents of South Texas to sign up for American health insurance,” Pauly said, “would be to allocate larger subsidies along the border than in other regions. But this is not likely to be politically palatable.”

“Most likely, we’ll get a one size fits all subsidy, which will leave a large portion of South Texas uninsured,” he said.

According to a 2005 U.S. Census Bureau report, the uninsurance rate in border communities is 38 percent, compared to the national average of 15 percent.

A study funded by the National Institutes of Health (NIH) and organized by researchers at UTPA found that 32 percent of Rio Grande Valley residents have received medical attention in Mexico.

“It’s not only a question of cost,” said Elena Bastida, director of UTPA’s Center on Aging and Health. “Even if the plan is affordable, the big draw to Mexican health care providers is convenience. People can get inexpensive treatment without waiting in lines and filling out paperwork, as they often must in the U.S. It’s less fragmented than treatment in the Valley.”

The NIH-funded study also found that 73 percent of Valley residents who sought treatment across the border claimed that they received more attention from Mexican physicians. According to the study, 74 percent claimed that Mexican doctors offered better explanations than their American counterparts.

A mandated health care plan would not prevent U.S. citizens from seeking medical attention in Mexico, but it would obligate them to purchase American health insurance, even if they continue seeing family physicians in Mexico.

But there is evidence that subsidized medical care might keep Valley residents on the American side of the border — if the subsidies are generous enough.

Only 3 percent of adults over age 65 who receive government-sponsored Medicare sought treatment in Mexico, according the UTPA study. The study’s researchers cite the data as evidence of how people’s behavior might change if universal coverage becomes as affordable as the services currently offered to the country’s elderly.

But Bastida worries that if the next president’s health care plan is not affordable enough to encourage Valley residents to purchase insurance, there will be numerous negative implications.

“As long as there is a high rate of uninsurance here,” she said, “there is no incentive for more doctors to come to the region, and cost of treatment will remain high.”

According to researchers, these repercussions are likely consequences of a plan that is implemented without regard to circumstances along the border.

“In that case,” said Pagan, “we will see a decrease in uninsurance nationally, but less so here.”