Redressing the Limitations of the Affordable Care Act for Mexican Immigrants Through Bi-National Health Insurance: A Willingness to Pay Study in Los Angeles

The 12.4 million Mexican migrants in the United States (US) face considerable barriers to access health care, with 45 % of
them being uninsured. The Affordable Care Act (ACA) does not address lack of insurance for some immigrants, and the excluded
groups are a large proportion of the Mexican–American community. To redress this, innovative forms of health insurance coverage
have to be explored. This study analyses factors associated with willingness to pay for cross-border, bi-national health insurance
(BHI) among Mexican immigrants in the US. Surveys were administered to 1,335 Mexican migrants in the Mexican Consulate of
Los Angeles to assess their health status, healthcare utilization, and willingness to purchase BHI. Logistic regression was
used to identify predictors of willingness to pay for BHI. Having a job, not having health insurance in the US, and relatives
in Mexico attending public health services were significant predictors of willingness to pay for BHI. In addition, individuals
identified quality as the most important factor when considering BHI. In spite of the interest for BHI among 54 % of the sampled
population, our study concludes that this type of coverage is unlikely to solve access to care challenges due to ACA eligibility
among different Mexican immigrant populations.