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ENDNOTES

1 Texas Department of Health, Epidemiology in Texas, 1996 Annual Report (Austin, Texas, 1996).

2 Texas-Mexico Border Health Coordination Office, University of Texas System, The Rio Grande Valley Diabetes Registry Statistical Report (July 1997), p. 19.

3 Texas Department of Health, Bureau of State Health Data and Policy Analysis, Health Professions Resource Center, MUA-Medically Underserved Areas, MUP-Medically Underserved Populations in Texas, March 13, 1998, p. ii.

4 Texas Comptroller of Public Accounts, Special Financial Report, "Health Care Reform and the Three Faces of Texas" (May 1994).

5 Leprosy is now called Hansen's Disease.

6 Electronic mail message and telephone interview with Dr. Ronald J. Dutton, Office of Border Health, Texas Department of Health, Austin, Texas, April 23, 1998.

7 Telephone interview with Dr. Ronald J. Dutton; and Pan American Health Organization, "Re-emergence of Dengue in the Americas," Epidemiological Bulletin (July 1997), p. 2.

8 Donna Morris, "A System Approach to Prevention and Early Detection of Cervical Cancer," in Texas Medical Association, Change on the Border: Impact on Health, Third Annual Border Health Conference Proceedings, October 25-26, 1991, p. 99.

9 Texas Department of Health, "Selected Facts for Counties, 1995" (http://www.tdh.texas.gov/programs/shd&pa/C_SHDPA.HTM). (Internet document.)

10 Texas Department of Health, Bureau of State Health Data and Policy Analysis, Health Professions Resource Center, HPSA-Health Professional Shortage Areas in Texas (Whole County Geographic Areas), March 13, 1998, pp. ii-iii.

11 Institute for Border Community Health Education,"The Community Partnership Initiative and Community Development Component's `Promotora Model,' El Paso, Texas," by Leticia Paez. (Information sheet.)

12 Interview with Deliana Garcia, Migrant Clinicians Network, Monterrey, Nuevo Leon, Mexico, June 4, 1998.

13 Urban Institute, State Level Data Book on Health Care Access and Financing, by Pamela Loprest and Michael Gates (Washington, D.C.: Urban Institute, 1993), p. 47. The Urban Institute cites a cut-off of 100 employees, while the Comptroller analysis used 75 because it was a better fit with Texas employment statistics.

Small firms are less likely than larger firms to offer health coverage for several reasons. For instance, because they have a smaller pool of people to insure, they may get less favorable rates than larger groups. Furthermore, small employers typically have fewer administrative staff, and therefore are less able to handle plan administration, which can be very time-consuming. Finally, because the business has a smaller pool, one employee or dependent with a serious health problem may be enough to deter insurance companies from covering the business at all, because the employees will be seen as too risky a group.

14 Low-wage workers are less likely than those with higher wages to receive employer-sponsored insurance. This is partly because they are more likely to work for small employers. They also are more likely to work in service jobs, which typically do not provide benefits, and they are more likely to be either part-time or temporary workers, who also tend not to receive employer-sponsored coverage. Low-wage workers also are less likely to be able to afford insurance on their own. The cost of health care for the average Texas family in 1993 was $7,547, including health insurance premiums and payments for service. Texas Comptroller of Public Accounts, Health Care Atlas of Texas (Austin, Texas, January 1997), p. 18.

15 Interview with Clark Jobe, Texas Insurance Purchasing Alliance, Austin, Texas, May 4, 1998.

16 Memorandum from Clark Jobe to Bee Moorhead, Texas Comptroller of Public Accounts, May 4, 1998. "Estimate of Uninsured Small Employers in Texas." These figures include employers with two to 50 employees. Sole proprietorships are not eligible to participate in TIPA.

17 Texas Department of Human Services, HCFA Form MI379, Fiscal 1996.

18 Telephone conversations with Camille Miller, Texas Institute for Health Policy Research, April 14, 1998, and Dr. David Warner, Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, April 15, 1998.

19 Texas Institute for Health Policy Research, "County Indigent Health Care Program (CHIHCP) Information and Analysis" (April, 1998, Austin, Texas).

20 Telephone interview with Dr. David Smith, Texas Tech University Health Science Center, April 28, 1998.

21 Telephone interview with Richard Fenton, U.S. Department of Health and Human Services, Health Care Finance Administration, March 25, 1998.

22 Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, Binational Collaboration in Health Insurance Services between the United States and Mexico: Issues and Innovations for the Texas Health Insurance Industry, by Jeffrey John Stys, Special Project Report (Austin, Texas, 1996), p. 3.

23 Telephone interview with Dr. Guillermo Mendoza, Pan American Health Organization, Austin, Texas, April 24, 1998. In recent years, Mexico has begun to devolve its federal health care system to the states. The national government has also been considering privatization at the suggestion of the World Bank.

24 Antonio Hurtado-Belendez, "Achieving Accreditation for New Hospitals: Current Requirements" (1994), paper presented at a conference on "Health Care in Mexico: Infrastructure, Technologies, and Financing: Challenges and Opportunities, " La Jolla, California, July 18, 1995, as cited in Lyndon B. Johnson School of Public Affairs, Binational Collaboration in Health Insurance Services between the United States and Mexico, p. 6.

25 Cristina Laurell and Maria Ortega, "The Free Trade Agreement and Health Services," International Journal of Health Services (1992), as cited in Lyndon B. Johnson School of Public Affairs, Binational Collaboration in Health Insurance Services between the United States and Mexico, p. 13.

26 U.S.-Mexico Border XXI Program, "Border XXI Homepage" (http://www.epa.gov/usmexicoborder/ef.htm). (Internet document.)

27 Texas Department of Health, "Oyster Season Opens Nov. 1, But Many Bays Remain Closed Because of Red Tide," Austin, Texas, October 31, 1996. (Press release.)

28 Electronic mail communication from Elizabeth Arendale, special programs coordinator, National Center for Farmworker Health, to Andrea Abel, Austin, Texas, March 17, 1998; and interview with Elizabeth Arendale, special programs coordinator, National Center for Farmworker Health, Austin, Texas, April 24, 1998.

29 Texas Department of Health, Tuberculosis Elimination Division, "1997 Texas Tuberculosis Morbidity by Region and County," March 20, 1998. (Computer printout.) Cameron County rate is 45.5 per 100,000; Jeff Davis County rate is 47 per 100,000; Presidio County rate is 49.6 per 100,000, and Zapata County rate is 41.9 per 100,000.

30 Texas Department of Health, "Ten Against TB, 1997 Year in Review," Austin, Texas. (Annual report.)

31 Lyndon B. Johnson School of Public Affairs, "Health Care Across the Border: The Experience of U.S. Citizens in Mexico," by David C. Warner and Kevin Reed, U.S.-Mexican Policy Report No. 4 (1993), p. 11.

32 Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, "Health Along the Texas-Mexico Border: Insights on the Utilization of Health Services by Mexican Nationals," by Anita Kuhl Zinnecker, Professional Report (1990).

33 Interview with David C. Warner, Lyndon B. Johnson School of Public Affairs, June 25, 1998.

34 Frank Trejo, "People in U.S. Can Participate in Mexico's Health Care System." Dallas Morning News (July 25, 1997).