Blurred Borders - International Community Foundation

Health coverage varies not only according to income, but also according to ethnicity and
citizenship/immigration status. More than one in four (28%) Latinos ages 0-64 are uninsured,
compared to only 9% of whites. 234 Latino children were five times more likely to have no
health insurance than white or African American children: over 90% of white, African-
American, and Asian American/Pacific Islander children were insured all year, compared to only
76% of Latino children. 235 Adult Latinos under age 65 had an even higher rate of uninsured:
28.5% had no insurance all year during 2001, and another 15% had it only part of the year. It is
the non-citizens, however, that lack health insurance most: a staggering 44% of adults, and 34%
of children, had no health insurance at all. 236 The ethnic disparities are even more pronounced
in San Diego County. In San Diego, only 73% of Hispanic children had health insurance,
compared to 94% of African-American and 93.4% of white children. 237
Health services delivery in the border region is characterized by a three-tiered system of care:
residents with private insurance and/or discretionary income, public insurance, and the
uninsured. In San Diego, consumers without insurance either obtain free (uncompensated) care
or pay out of their own pocket on a sliding fee scale at community clinics and other safety net
health providers. Medi-Cal and Medicare public insurance programs are available to strictly
defined segments of the population, and are often unavailable for many Mexican workers in San
Diego. As a result, many migrant workers and residents either do not qualify for health care
assistance, or frequently have no access to even basic medical services. The alternative they
often turn to is medical care in Mexico, which is much more affordable than in San Diego.
Some also turn to emergency rooms in San Diego medical facilities, although patients who
cannot pay for their medical care account for less than 5% of emergency room visits in San
Diego County. 238
The uninsured are not all poor: many middle class workers cannot afford insurance. Spiraling
health care premiums make it prohibitive for small and medium-sized companies to offer health
insurance as an employment benefit. Likewise, many poor would like to have health insurance,
but cannot afford it. The Academy for International Health Studies (AIHS) found that 73% of
Mexican nationals working in the US earned $25,000 or less per year, 239 which means,
according to the AIHS study, that the monthly premium would have to be $60 or less. 240 The
study found that an overwhelming majority of Mexican nationals working in the US had a strong
interest in an affordable, comprehensive cross-border health insurance – a policy that works on
both sides of the border. 241
234 Aguayo, et.al (2003), p. 1.
235 Brown et.al., p. 18.
236 Ibid., pp. 19-20.
237 San Diego County Child and Family Health and Well-Being Report Card 2002, p. 27.
238 Insure the Uninsured Project, Orange & San Diego Regional Workgroup 2002 Charts, available (as of 3/8/04)
from http://www.work-and-health.org/regionalWG/OrangeSDCounty/OrangeandSD.html
239 Grantmakers in Health Bulletin, July 24, 2000, p.3.
240 Managed Care Magazine 2000, available (last accessed on 3/8/04) at
http://www.managedcaremag.com/archives/0008/0008.news_intlplan.html
241 Grantmakers in Health Bulletin, July 24, 2000, p. 3.
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