Affluent Cross Border to U.S. for Childbirth

Gabriela Nicolas felt her first contractions while at a downtown San Diego movie theater. She could have easily rushed home to Tijuana. But that wasn’t the plan. She went to a hospital in a San Diego suburb, where she gave birth to Miguel Angel about 12 hours later.

By being born in the United States, Miguel has something that his parents don’t: American citizenship.

“I wanted him to have more choices,” said Nicolas, a psychologist who also had her first child in the U.S. Women have long been crossing the border from Mexico to give birth, pursuing the age-old yearning of parents everywhere to give their children better lives.

But contrary to stereotype, many of the expectant moms are not poor, uninsured and looking to take advantage of the American health-care system. Many are middle- and upper-class women like Nicolas, with an eye toward the future.

They are professionals -- physicians, business owners, lawyers -- who are such good, sure-paying customers that American hospital executives compete for their business. Many of the maternity patients pay their bills in prepay cash packages, allowing the hospitals to avoid the typical wait for insurance reimbursements.

Women from Mexico are not the only foreigners coming to the U.S. to give birth. Although there are no solid figures, expectant mothers routinely obtain tourist visas and travel to America from as far away as Hong Kong and South Korea.

To have their babies on American soil, Mexican women simply apply for visitors’ visas that permit border residents to travel inside a 25-mile zone in the United States for up to three days for shopping and family visits. The “laser” visas are given only to applicants who prove their financial stability and their border residency.

It’s legal for women to cross the border to give birth, as long as they have a current visa and can prove they can pay their medical bills, immigration officials said. As a result, women with financial means can cross legally and have their children in the U.S., but women without money and proper documentation may be turned around at the border.

“Those who have the ability to pay utilize the medical care in the United States because it’s high quality compared to what’s available to them in Mexico,” said Lauren Mack, spokeswoman for the Bureau of Citizenship and Immigration Services.

Women who are able to cross but fail to pay their hospital bills in America may have their laser visas revoked, Mack said. “The [visas] are not issued for the purposes of obtaining free medical services in the U.S.,” she said. “That’s something we have to watch out for.”

Critics say Mexican nationals are taking advantage of a loophole in immigration laws that makes it easy and legal for women with money to give birth in the U.S.

Barbara Coe, who heads the California Coalition for Immigration Reform based in Orange County, calls the American-born children of Mexican nationals “anchor babies.” When these children turn 21, they can help their parents -- rich or poor -- immigrate to the United States.

“Because they are born here, they end up funding the needs for the entire illegal alien family,” Coe said. “It’s a tremendous welcome mat for illegal aliens.”

Coe has tried to lobby politicians over the years to pass legislation that reinterprets the 14th Amendment of the U.S. Constitution, which reads, “All persons born or naturalized in the United States and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside.”

Many middle-class Mexican parents, however, say they do not want to immigrate; they are simply giving their children options for the future.

Edgar Lopez and Rosario Lujan, who live and work in Tijuana, expect to have their first child in America this spring and plan to pay in cash for the medical care. Lopez said they consider Mexico their home and don’t want to migrate to America. They just want their child to have a choice about where to live and attend school. “We live in a country where there isn’t much stability,” Lopez said. “We want our children to have the opportunity to live in a more stable country.”

Lopez, a computer manager, said he and his wife, who works at a university, probably will cross into San Diego shortly before the May due date and stay at a relative’s home. When the time comes to go to the hospital, they won’t have to worry about getting stuck in a long border line.

Though hospitals don’t advertise south of the border, Mexican couples say they learn about prepay packages by word of mouth.

At Scripps Memorial Hospital in Chula Vista, Calif., just six miles from the border, 501 of the 2,067 babies delivered in 2002 were born to foreign nationals. Nearly two-thirds of those women either prepaid or paid for medical services on the spot, Assistant Administrator Martin Mansukhani said.

“We want to be the hospital of choice for these patients,” Mansukhani said. “They are certainly profitable for us.”

Sharp Chula Vista Medical Center also offers a cash package, available to all prospective mothers: $2,400 for a standard delivery and $4,500 for a cesarean birth. Last year, 136 Mexican nationals prepaid for labor and delivery services at the medical center. Chief Financial Officer Rick King estimates that fewer than a dozen who gave birth at the medical center did not pay for their services.

In addition to the right to vote and run for office, American citizens have access to certain public jobs, as well as services such as welfare and food stamps. Citizenship also makes it easier to get accepted into, and pay for, American universities.

UC Berkeley public health professor Sylvia Guendelman has studied Mexican women coming across the border solely to give birth and said she found that low-income women were less likely to do so partly because they did not qualify for the border passes. They also were generally less resourceful and confident about seeking out American medical care than women with higher incomes and educational levels, she said.

Six hundred sixty-three women who gave birth in San Diego County in 2001 listed their country of residence as Mexico, said Phyllis Elkind of the county’s Health and Human Services Agency. According to a county report on the expected source of payment, 627 of the women were expected to pay for their own health care, 30 to bill insurance, five to use government programs and one to use a non-government program. The county does not have statistics on the actual payments.

Nevertheless, hospital administrators along the border say they are still burdened by some drop-ins who arrive with no money, no insurance and no prenatal care and go straight to the emergency room in active labor. Under federal law, hospital emergency rooms cannot turn patients away, regardless of their nationality or immigration status.

“They drop in to the emergency room, they deliver and they leave,” said Dr. Jorge Arce, an obstetrician in Chula Vista who delivers about 100 babies to Mexican nationals every year. “The hospital usually has to take charge of the bill.”

In San Diego and Imperial counties, hospitals spent $79 million providing emergency health care, of all kinds, to undocumented immigrants in 2000, according to a study funded by the federal government and issued by the U.S./Mexico Border Counties Coalition. The money was spent primarily treating patients who came to give birth or who were injured crossing the border or working in the U.S., according to the study.

As soon as Nicolas, 30, discovered she was pregnant with her second child, she went to see the Chula Vista doctor who had delivered her daughter nearly two years earlier. She scheduled appointments for the next several months and rounded up the cash to prepay for both prenatal care and delivery -- about $2,000 for the hospital and $1,500 for her doctor.

Two days before her baby was due, Nicolas and her husband, Victor, went to see “Gangs of New York” and “Star Trek: Nemesis” in San Diego. Miguel Angel was born the next morning, on Jan. 4, at Paradise Hospital in National City, Calif., and Nicolas picked up her son’s U.S. birth certificate a few days later.

Nicolas said that her children will not only have the freedom to live in America, but will also find it easier to compete for jobs. “If you can work in the U.S., you are going to earn a lot more money than here,” she said.

Cradling Miguel in her arms, Nicolas wiped his nose and adjusted a Winnie the Pooh hat on his head. As she wrapped a blanket around him, Nicolas said several of her friends and relatives have also crossed the border to have babies. “Many children who live here in Tijuana are American citizens,” she said.