Home Care In Algodones, NM

For years, Jake and Marqui Balle of Clinton, Utah, had budgeted carefully and avoided splurges so they could afford lifesaving insulin for their diabetic son, Reid, at a cost of $550 a month — their second-highest expense after their mortgage.

Reid, who is 7, was diagnosed when he was 18 months old with Type 1 diabetes, a condition in which his pancreas makes little to no insulin. There is no cure for this kind of diabetes, and Reid needs insulin every hour around the clock, delivered through a small pump attached to his abdomen. So the Balles have braced themselves for the expense.

“It’s a major cost, but it comes first for us because without it, our son would die,” said Jake Balle, 33, who works as a real estate agent. “It’s heart-wrenching to know there are families out there who can’t even afford the insurance deductible.”

Now some of the financial burden for the Balles and several other Utah families will be eased because of a couple who decided to use their extra airline miles to make trips to Mexico to buy low-cost insulin for strangers, saving them thousands of dollars.

In December 2018, Balle had mentioned the high cost of Reid’s insulin pens to Eric Threlkeld, 31, a technical engineer who had hired Balle as his real estate agent when he bought a new home. Threlkeld travels frequently for his job and was helping to build a factory for a bagged salad company in Mexico at the time.

Threlkeld was shocked to learn what the Balles paid each month for the pens — small vials of insulin that can be injected directly without a syringe. (Reid’s dosages are transferred to his insulin pump.)

Knowing that prescription drugs were much cheaper in Mexico, Threlkeld offered to pick up several insulin pens at a pharmacy for Reid during his next trip and bring them back in an insulated lunchbox, provided he could find the same brand Reid used, NovoLog.

Threlkeld found the NovoLog brand with the same packaging and paid about a tenth of the cost.

“He came home with six or seven and paid only $13 each for them,” Balle said. “Here, they would have cost about $110 each, and our son uses five a month. Besides being extremely grateful, we were stunned at how much cheaper it was.”

In January, Threlkeld offered to make another trip to buy insulin for Reid. This time, he took along his wife, Erica, and used his airline miles to pay for their flights on his days off.

“We bought 36 insulin pens for about $16 each, and when I gave them to Jake, he said he wanted to share them with some other families,” Threlkeld said. “That’s when we found out how great the need was out there. Erica and I decided then to help do something about it.”

The Threlkelds recently started a nonprofit, Medic(a)tion Found(a)tion, to help people who have been affected by skyrocketing prescription medication costs. With studies showing that the cost of insulin nearly doubled from 2012 to 2016 and now averages nearly $6,000 a year for Type 1 diabetics, the couple decided to donate their airline miles to the cause. And they’re encouraging others to do the same.

“Not everyone is in a financial situation to contribute money, but maybe they have airline miles they aren’t using, or they have some free time to make a trip over the border to buy insulin for families in need,” said Erica Threlkeld, 35, who stays home with her children and also runs a mobile spray-tanning service.

The ultimate goal of the foundation, she said, is to have volunteers make trips to Mexico to load up on affordable insulin and other medications at least every other month.

“People are desperate for insulin at a low cost — there are horror stories about people dangerously reducing the amount they use to save money or having to decide between insulin and paying the mortgage,” she said. “Making a quick trip to Mexico every few months is a simple thing that we can do, and I’m happy to do it.”

After a rape exam, women’s underclothes are often taken as evidence. This nurse buys them new ones.

On their last trip, the Threlkelds used their airline miles to fly to Phoenix, rented a car and drove 2½ hours to the border town of Yuma, Ariz., then seven miles south to one of several pharmacies in Los Algodones, Mexico. The town is popular with Americans looking for discounted prescriptions and eyeglasses, along with cheaper medical and dental care.

“We went up and back in one day and didn’t even need a motel,” said Eric Threlkeld. “It was amazing to spend $620 on insulin that would have cost more than $4,000 back home.”

There are no safety drawbacks to buying insulin pens in Mexico, he said, as long as they are kept below 46 degrees in a portable cooler during the flight back to the United States.

“We brought back the same brand for Reid that he was using at home,” he said. “The only difference is the cost.”

Threlkeld said he feels grateful that he and his wife don’t need to buy insulin for any of their five children.

“People in our country are being held hostage over the high price of insulin and other medications,” he said. “If nothing else, we’re hoping that by starting the foundation, we’ll be bringing some awareness for change.”

On their next trip across the border this spring, the Threlkelds plan to pick up some steroid inhalers for Sara Hancock of Lehi, Utah, in addition to insulin for several families.

Hancock’s 11-year-old son, Caron, has a rare airway condition called bronchomalacia that requires him to use an inhaler that costs $125 per month. In Mexico, she’s hopeful the Threlkelds can buy several months’ worth of inhalers for a fraction of that price.

“We have a lot of medical bills that require us to play the medical lottery each month to decide who gets how much,” said Hancock, 34, who works part time as an airline reservations clerk. “Our system needs to change, but until it does, I’m so thankful for Eric and Erica. It’s awesome that they’re doing this. They’re kind and genuine people who really seem to care.”

For Jake Balle, the couple’s trips to the border will help his family save thousands of dollars a year.

“We have a $6,000 deductible, and every penny until now has gone toward insulin,” said Balle. “Eric and Erica have found a real need and will now be going out of their way to ease the pain for lots of families.”

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YUMA, Arizona (Border Report) — Two months ago, Border Report visited a place where Arizona, California and Mexico are united by the Colorado River.

The area, known as the ‘Yuma Gap,” is where several large apertures can be seen in the border barrier.

Back in December, there were an estimated 6,000 migrants per week walking into the U.S. through this point.

And after crossing the border, migrants would literally stand around on a levee waiting to be picked up by Border Patrol agents so they could ask for political asylum.

“We’re still getting about 1,000 per day,” Yuma County Supervisor Jonathan Lines last week.

Lines stated the area is less impacted now by migrants because the Border Patrol has assigned more agents to the Yuma Sector.

“We’ve had more Border Patrol officers here actually standing along the border having more of a presence as well as additional electronic assets, they’ve been able to interdict and turn people back,” he said

Lines said up to 1,000 migrants per day are still using this point to access the United States.

“I came because I heard the United States offers political asylum,” said an unidentified migrant from Colombia.

He and his family were seen crossing the border early one morning last week.

A steady stream of people would follow throughout the morning, from all over the world, walking along dirt trails that lead from Los Algodones, Mexico through the Yuma Gap into Arizona.

One family ventured into a canal with plans to move farther east into the United States.

The man, likely the father, held a young girl in his arms and jumped into the running water, they were knocked down by the current and the toddler screamed in horror.

Luckily, the man was able to get back on his feet as he tried to get the girl to walk up on the embankment.

After several failed attempts, they were able to get to the other side.

Unfortunately, in the struggle to wade through the thigh-deep water, they lost some of their bags that were swept away.

“I don’t blame anyone for wanting to better their situation and improve their lives,” said Lines. “It’s tragic, you don’t want to see anyone struggling, especially those with small children.”

Lines said the ongoing influx of migrants and their needs is overwhelming the area’s 911 system, hospitals and social agencies in Yuma County.

“With that added, not necessarily burden, but responsibility of helping anybody who shows up is putting a strain on the system,” he said.

Lines is hopeful the Biden administration can do more to slow down the flow of people and narcotics through this part of the southern border.

“We can’t necessarily control this area of the border without a complete wall and because of that we’ve got people who are making their way through the city and not knowing where they are going looking for assistance and taxing an already overwhelmed system,” he said. “And there’s the human element of narcotics that are being smuggled through our fair city.”

LOS ALGODONES, Mexico -- Mark Bolzern traveled 3,700 miles to go to the dentist. The 56-year-old Anchorage, Alaska, native left home this spring, made a pit stop in Las Vegas to pick up a friend, and kept heading south, all the way to Los Algodones, Mexico, a small border town teeming with dental offices.

About 60 percent of Americans have dental insurance coverage, the highest it has been in decades. But even so, the nation's older population has been largely left behind. Nearly 70 percent of seniors are not insured, according to a study compiled by Oral Health America. A major reason is because dental care is not covered by Medicare and many employers no longer offer post-retirement health benefits. What's more, the Affordable Care Act allows enrollees to get dental coverage only if they purchase general health coverage first, which many seniors don't need. At the same time, seniors often require the most costly dental work, like crowns, implants and false teeth.

As a result, many are seeking cheaper care in places like Los Algodones, where Mexican dentists who speak English and sometimes accept U.S. insurance offer rock-bottom prices for everything from a cleaning to implants. Dentists in Los Algodones say a large portion of their clients are seniors.

In the desert outpost near the border of California and Arizona, men in white shirts stand outside of offices with signs advertising root canals and teeth cleanings. Other signs advertise prescription drugs like muscle relaxers at low rates - no prescription needed.

For Bolzern, seeing a dentist in Los Algodones meant a savings of up to $62,000. He was told the extensive dental work he needed - his teeth needed to be raised and he needed a crown on every molar - would cost $65,000 at a private dentist. He looked for lower rates, finding a dental school where the work was less expensive because it was performed by students. But it still cost $35,000.

He paid $3,000 in Mexico and has been back several times.

The cost of dental care has surged in the last two decades and continues to increase at a rate of 5 percent annually. Many dental plans have high deductibles and don't offer extensive coverage. Many people opt out.

Mexico has lower costs because of cheaper labor and fewer regulatory requirements. Residents in border towns like El Paso, Texas and Nogales, Sonora, often make the short drive to the Mexican side for basic medical needs and prescription medications that are much costlier in the U.S. Some businesses even offer shuttle services from the Phoenix area to Los Algodones, a nearly 200-mile ride.

Going abroad for cheaper health care is nothing new. Americans have been doing it for years, for everything from elective, cosmetic procedures to major, life-saving surgery.

Matthew Messina, a practicing dentist and consumer adviser on behalf of the American Dental Association, said Americans who visit dentists in foreign countries should do a lot of research before they go.

Different countries use different types of equipment, and some items, such as implants, may not have warranties. Malpractice lawsuits may not be an option.

Dentists in Los Algodones say they attend less school than their counterparts in U.S. but spend more time practicing clinical work. They say they practice the same safety standards as American dentists and have offices that are just as clean.

José Obed Zuñiga has been a dentist in Los Algodones for a decade and found business was so good he opened his own shop about two years ago.

"Everything, the quality, is very similar to the United States," Zuñiga said. "We see the work from the United States, and it's very competitive."

Aiti Gutierrez left her home in the state of Tamaulipas, Mexico, 1,400 miles away, to practice in a Los Algodones office that has four patient rooms and a lobby with a water-stacked mini-fridge. In the busy season, she sees about a dozen patients a day, and 12-hour work days aren't unusual.

"They like to feel comfortable and that they're safe," Gutierrez said of her clients.

For nearly a decade, Texas has battled New Mexico over its share of the waters of the Rio Grande. On October 25, the two states announced that they reached a long-awaited settlement in the lawsuit, Texas v. New Mexico and Colorado, No. 141 Original.

Though the settlement details are confidential, El Paso Matters reported that it was a “carve-out decree.” That means it resolves only the dispute between Texas and New Mexico, according to Jeffrey Wechsler, special assistant to the New Mexico Attorney General, not federal claims against New Mexico.

The Rio Grande flows nearly 2,000 miles from its headwaters in Colorado’s San Juan Mountains to its mouth near the border cities of Brownsville, Texas, and Matamoros, Tamaulipas, in Mexico. Over the last century, diversions for agriculture and cities such as Albuquerque and El Paso have strained the river. It regularly dries up for a stretch along the U.S.-Mexico border, and this year ran dry in Albuquerque as well.

The No. 141 Original lawsuit—which went directly to the Supreme Court, because it is a conflict between states—pertains to the 1938 Rio Grande Compact, which divided the waters between Texas, New Mexico and Colorado. It requires Colorado to deliver a proportion of the river’s flow, as determined by a system of stream gauges, to New Mexico. New Mexico then must deliver part of its portion to Elephant Butte Reservoir in the southern part of the state, where it is stored for use by the local Elephant Butte Irrigation District, by the city of Las Cruces, New Mexico, and by Texas and Mexico.

Texas initiated the lawsuit in 2013, when it accused New Mexico farmers downstream of the reservoir of depleting the river’s flow with groundwater pumping, thereby preventing Texas from receiving its fair share. But the case’s origins go even further back, to conflicts between local irrigation districts in southern New Mexico and West Texas that began in the 2000s.

The conflict is one of a long chain of water-related lawsuits involving the two states. In 2020, the U.S. Supreme Court sided with New Mexico in a separate lawsuit over the Pecos River. And New Mexico continues to battle with Texas over a pipeline rupture in El Paso that resulted in 1.1 billion gallons of sewage flowing into the Rio Grande.

These conflicts are likely to become even more common in the near future. Like the Colorado River, the Mississippi River and others, the Rio Grande is in dire straits; Elephant Butte Reservoir is currently at just 7% of capacity. Eugene White, a Montana water official who penned a 2020 article about Texas v. New Mexico, said in an email that the case signals a shift “in the court’s willingness to address some of the novel questions posed by interstate water compacts.” The fact that the Supreme Court is taking seriously conflict over a nearly 90-year-old water agreement may open the door for other reconsiderations.

Climate change is a major factor in these new conflicts. A 2013 study drawing on simulations of the Upper Rio Grande showed that decreasing water availability would make it impossible for New Mexico to meet its obligations to the Rio Grande Compact without water cutbacks. On the table in the lawsuit, then, was the question of who had to make sacrifices.

While Texas and New Mexico have come to an agreement over that question, the case isn’t over yet. The United States Bureau of Reclamation — which joined the lawsuit because the region’s irrigation infrastructure was constructed by the agency and because the case relates to federal treaties with Mexico — opposed the settlement because it doesn’t address the agency’s concerns, only the dispute between the states. The federal government must sign off on the agreement, however, so a hearing is scheduled for January 2023 to determine whether the settlement will go through.

The following timeline untangles the case’s confusing twists and turns:

2008: To resolve lawsuits between the Elephant Butte Irrigation District (in New Mexico) and the El Paso County Water Improvement District (in Texas), the two irrigation agencies and the Bureau of Reclamation signed an “Operating Agreement.” The agreement explained how to split water in Elephant Butte Reservoir, and the protocol for carrying over any excess year to year. Neither Texas nor New Mexico were included in the lawsuit.

2011-2012: New Mexico sued the U.S. and the Elephant Butte Irrigation District over the operating agreement which they said was based on “skewed” baseline numbers. They argued that the agreement shortchanged New Mexico and would result in less surface water for the Elephant Butte irrigation district, forcing farmers to rely on groundwater pumping. The lawsuit was put on hold when Texas sued New Mexico.

January 2013: Texas initiated its lawsuit against New Mexico. The case went directly to the U.S. Supreme Court, rather than being heard in lower courts first, because it involves water and a dispute between states. In January 2014, the court granted Texas’ motion to sue.

February 2014: The Bureau of Reclamation joined the case, siding with Texas. The agency claimed New Mexico’s groundwater pumping threatened both the inter-state Rio Grande Compact and the 1906 Rio Grande Convention with Mexico, which requires that the U.S. deliver 60,000 acre-feet of Rio Grande water to Mexico each year. The Elephant Butte Irrigation District and El Paso County Water Improvement District also tried to join the case, but the U.S. Supreme Court rejected those requests.

April 2014: New Mexico filed a motion to dismiss both Texas’ and the United States’ complaints, arguing that under the Rio Grande Compact, New Mexico’s only responsibility is to deliver water to the Elephant Butte Reservoir, not to ensure that it reaches Texas.

November 2014: The U.S. Supreme Court appointed a Special Master, a judge who oversees fact-finding and a trial in water cases to make recommendations to the court. (Only the Supreme Court can make the final decision in the case.) In 2018, the court dismissed this original judge and appointed and a new Special Master, Judge Michael Melloy.

May 2018: New Mexico filed counterclaims against Texas and the Bureau of Reclamation, stating that the state’s groundwater pumping was a result of poor accounting by the federal government that resulted in unfair allocations of the Rio Grande’s water.

October 2021: Farmers, irrigation districts, and federal, state and city agencies gave testimony. A scheduled second phase of hearings that would have included hydrologists’ testimony was postponed when the parties announced plans to settle the case.

July 2022: The U.S. 8th Circuit Court of Appeals postponed the planned October 2022 trial because a “settlement in principle“ had been reached.

September 2022: Because the parties had not reached a settlement by Sept. 23, the court set a trial date for January 2023.

October 2022: Texas and New Mexico announced that they had reached a settlement. However, the U.S. stated that the proposal violated the Rio Grande Compact and didn’t resolve the U.S.’ claims. The El Paso and Elephant Butte Irrigation Districts also opposed the settlement.

January 2023: A hearing is scheduled to determine whether the proposed settlement is legal.

Caroline Tracey is the Climate Justice Fellow at High Country News. Email her at[email protected] or submit aletter to the editor. See ourletters to the editor policy.

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McALLEN, Texas (Border Report) — Migrant aid groups are concerned by reports that the Biden administration plans to expel to Mexico additional nationalities of asylum seekers under Title 42.

Reuters on Wednesday reported that Cubans, Nicaraguans and Haitians could be among migrants sent back to Mexico under Title 42, the public health policy that immediately expels asylum seekers who cross the border to prevent the spread of coronavirus.

Earlier this week, the U.S. Supreme Court decided not to lift Title 42 as courts consider a case brought by 19 states — including Texas — that want the Trump-era policy to remain.

In October, the Department of Homeland Security added Venezuelans to the list of asylum seekers who can be turned back under Title 42 — sending thousands south of the border to Mexico and creating camps of refugees living in tents and boxes up and down the Rio Grande.

That caused a significant drop in the number of asylum seekers legally released into migrant shelters in South Texas, where many Venezuelans typically had been helped.

Now migrant advocates fear that if these additional three nationalities are added to the expulsion list it will add to what they are calling “chaos” created by Title 42, and will result in more migrants waiting south of the border.

Over 3,000 migrants, many from Venezuela, currently are in a makeshift camp in Matamoros, Mexico, just south of Brownsville, Texas, hoping to cross the border to claim asylum if Title 42 lifts.

“Title 42 is an aberration in terms of border policy,” said Robyn Barnard, associate director for refugee advocacy for the nonprofit organization Human Rights First. “It’s done nothing but create chaos in terms of actual border management.”

Barnard was part of a video-conferencing call Thursday with a couple dozen migrant advocacy organizations from across the United States that are part of the Welcome With Dignity Campaign that want Title 42 to end. Many are legal aid groups that say refugees are being illegally denied their right by U.S. and international laws to cross the border and claim asylum.

“Asylum is for people who are fleeing harm and persecution. And so any program that requires a person to stay in their country past a certain date or a certain time free presumes they can stay in their country for several weeks — or months while that petition is pending in the U.S. — fundamentally fails to understand what asylum seekers are facing. They are fleeing harm and they cannot stay,” said Chelsea Sachau, an attorney for Florence Immigration and Refugee Rights Project, which helps asylum seekers in Arizona.

“Title 42 has forced desperate people to take extreme measures,” said Margaret Cargiolo of the Center for Gender and Refugee Studies.

Adding additional nationalities to those expelled under Title 42 would further compound the situation on the Southwest border, they say.

“It’s incredibly disturbing that the Biden administration is considering doubling down using Title 42 against other nationalities including Haitians, Cubans and Nicaraguans,” Barnard said.

“In the wake of this week’s Supreme Court decision, the Biden administration should be redoubling its efforts to end Title 42, not expanding the policy,” said Melissa Crow, director of litigation at the Center for Gender and Refugee Studies. “This move would go far beyond what any court has required, dispelling any pretense that this administration is interested in turning the page.”

This move would go far beyond what any court has required.”

Melissa Crow, Center for Gender and Refugee Studies

Border Report has asked the Department of Homeland Security if they plan to add these three groups to those expelled under Title 42, and if so, when. This story will be updated if the agency responds.

Over 163,000 Nicaraguans were encountered at the border in Fiscal Year 2022, according to data from U.S. Customs and Border Protection. Nicaraguans were the sixth-most group to be encountered on the border, just below Venezuelans, which topped 187,000 encounters.

Cubans were the third-largest group to arrive at the border and over 220,000 were encountered in Fiscal Year 2022, CBP reports.

A white paper published last week by the National Immigration Forum reiterated the “push and pull factors” driving migrants north, which include a history of acceptance by the United States for refugees.

“The U.S. is one of the safest countries in the hemisphere and has the most robust asylum system — it stands to reason those who simply cannot find protection elsewhere would attempt the journey to the U.S. southwest border,” according to the Forum’s report, “Alternative Pathways for Arrivals at the Border: A Holistic Response to Increasing Migration in the Western Hemisphere.”

The paper suggests the Biden administration add programs to increase the number of work visas available to asylum seekers, as well as special parole programs to legally allow more migrants to enter the United States.