U.S. Congressman Michael C. Burgess, M.D. (TX-26)
Dr. Homer, President of the Texas Medical Association

The U.S.-Mexico border is home to many of the crises that are featured across the front pages and evening newscasts—illegal immigration, human smuggling, drug trafficking, and gang violence. One of the gathering storms along the U.S. border that goes unreported by the press is the impending health care crisis. Dense populations, poverty and high traffic, across the border, creates a serious public health risk. One of the top issues for border residents is getting adequate health care. Over reliance on government payers, such as Medicaid and Medicare is leading to a shortage of medical professionals to serve a population disproportionately affected by diabetes, heart disease, tuberculosis, and cancer. The poverty rate along the Texas-Mexico border is nearly 30 percent as opposed to 14.5 percent statewide. Eighteen percent are on Medicaid versus 10 percent statewide. Unfortunately the solutions to these problems are often costly and require a change improved reimbursement for physicians along with cross-border coordination on shared public health issues.

In order for Texas to maintain a strong, vibrant economy the infrastructure must be strong and reliable. The health care network is an important component of that infrastructure. If it fails in one area it causes system imbalance elsewhere. Often times, that imbalance begins at the Texas-Mexico border where physicians can be in short supply. Because of a heavy reliance on government payers (Medicare and Medicaid) with low reimbursement rates, it can be difficult for communities to recruit and retain experienced physicians.

Here is one area where Congress can be proactive. For too long, physicians have faced diminishing Medicare reimbursement rates. While reimbursement rates are dropping, the cost to run a physician’s practice has increased 15 percent. . This trend is exacerbated along the border areas, leading to more hemorrhaging of the physician workforce and ultimately affecting the patient’s ability to receive care. I, along with others in Congress, am working to address this important patient access problem by trying to pare back an overly bureaucratic and top-heavy approach to Medicare payment. Congress is working toward a system that reflects actual medical costs to reimburse physicians fairly. Stabilizing Medicare payments for physicians will go a long way toward improving the availability of physicians in our communities, especially along the U.S. border where instability of this nature is felt on an order of magnitude greater than other areas of the country.

This step alone is not a panacea to the health problems along the border. There are layers of health care concerns along the border. Patients in the United States are purchasing prescription medications in Mexico and bringing them back across the border without a doctor’s prescription. Patients self-medicating combined with the significant question of the quality of the prescription drugs they are purchasing creates a substantial health risk to Americans. High rates of chronic disease are characteristic of the communities along the border, often necessitating robust disease management strategies. Cross border cooperation is also key to addressing a variety of public health threats not native to other parts of the country.

The U.S. Border is the “canary in the coal mine” when it comes to these health trends. Already other parts of Texas and interior parts of the U.S. are beginning to see similar trends that have long been endemic to the U.S.-Mexico border. Border hospitals and doctors have long incurred a high percentage of charity care, but now even hospitals in North Texas are experiencing a dramatic rise in indigent cases. For instance, 4 out of 5 births at JPS Hospital in Fort Worth are to non-citizen mothers. As a result, the local taxpayer picks up the tab with increased insurance rates increase.

For many years now the U.S.-Mexico Border Health Commission has attempted to address many of these issues, and has made positive headway in establishing cross-border partnerships. But the U.S. Congress must take the lead in resolving these systemic problems. Addressing the affordability of health care is critical. Ensuring that there are adequate payments for physicians and health care providers is another essential reform, especially as it relates to public payers like Medicare and Medicaid. Working collaboratively with state and local officials to resolve these very difficult questions is essential. Addressing U.S. border problems is good preventative medicine before these same problems become entrenched farther into the interior.