Health Care in the U.S.-Mexico Border Region


The four states (Arizona, California, New Mexico, and Texas) along the U.S.-Mexico border are home to over 78 million people of whom 8 million live in 44 counties that form the border area and border activity is at an all-time high.

This year, there have been over two million encounters at the U.S.-Mexico border, which is 24% higher than the number of encounters last year. Although migrants and asylum seekers generally have short stays in border communities, this increased activity is leading to growing demands on border processing capacity and border communities that already face health and socioeconomic challenges and to some state governors busing migrants to other states. Understanding who lives in the region and their experiences, including their health and access to health care, may help inform efforts to address their needs.

Overall, people living in the four border states generally are more likely to be Hispanic and noncitizen immigrants compared to those in other parts of the country. They also are generally more likely to be poor, and uninsured. This analysis further examines differences between and within border states in sociodemographic characteristics, health coverage, and access to care, as well as the health outcomes of people living there. It is based on KFF’s analysis of county-level data from the American Community Survey (ACS) five-year data tables, the Health Resources and Services Administration’s Area Health Resource Files (AHRF), the Centers for Disease Control and Prevention’s (CDC) WONDER database, and the Behavioral Risk Factors Surveillance System (BRFSS).

Aside from 2020 mortality data from CDC, the most recent reliable available county-level data from these sources are from 2019. All differences described between the border and non-border counties and between states in the text are statistically significant at the p<0.05 level. The data included in this brief are from the two years preceding the influx at the U.S.-Mexico border to provide context for the situation in the border region before the recent increase in immigration activity.

The findings show that, across many of the measures examined, Texas fared worse compared to the other border states. Moreover, within Texas, individuals in border counties faced increased challenges compared to those in non-border counties, with particularly low levels of educational attainment and income, higher shares of households with limited English proficiency (LEP) and no computer access, higher uninsured rates, and more limited access to providers. In the other border states, there are smaller differences in these measures between people living in border vs. non-border counties. In contrast to the other border states, Texas has not implemented the Affordable Care Act (ACA) Medicaid expansion to adults, contributing to lower rates of Medicaid coverage and higher uninsured rates compared with the other states, especially in border counties.

While immigration remains a contentious political issue, these findings highlight the potential benefits of providing resources and support to the border region to meet the needs of the growing number of migrants and asylum seekers in the area. Better preparedness, more job opportunities, and a greater allocation of resources to help migrants assimilate in the community may be helpful not only in improving socioeconomic and health outcomes and reducing disparities in border areas but in improving the economy overall, particularly in these border communities. Policies that increase opportunities for newly arriving migrants to work, such as reducing the wait time for applying for work authorization, could also reduce overcrowding at migrant shelters.

Although such policies could increase competition for jobs, research has found that immigrants and U.S.-born citizens in the low-skilled workforce usually fill different types of jobs as opposed to competing for the same types of jobs. A separate study found that immigrants in the U.S. create more jobs than they take, thereby improving the economic outcomes for U.S.-born workers.

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