Throughout his presidency, Donald Trump has been active in stoking fears about undocumented immigrants and – what he maintains are – weak and inadequate immigration laws. Much of his rhetoric has been centered around the southern border of the U.S. and the caravans of migrants attempting to enter the country from Latin America.

Trump has gone as far as declaring, on Twitter, a “National Emergy [sic]” due to “criminals and unknown Middle Easterners” approaching the U.S. on foot from the south, a statement made nearly four months ahead of the his controversial declaration of an official national emergency at the southern border.

And yet, the president has presented the matter in a one sided light such that many Americans are unaware of the tens-of-thousands of U.S. nationals who enter Mexico to obtain cheaper healthcare – a group of people seeking to escape the inordinate cost of medical care within the  U.S.

To enter Mexico, U.S. citizens require only a passport as long as the individuals stay within the Mexican border zone – usually defined as the region within 20-30 km of the border. While those entering Latin America from the U.S. are able to do so with ease and relative comfort, the inverse situation is more difficult. In 2006 President George W. Bush signed into law the Secure Fence Act and the construction of fences along the southern border began – significantly reducing migration into the U.S. from Latin America.

According to the U.S. Customs and Border Protection website, the number of refugees from Latin America crossing the border every month ranges from 20,000 to 60,000. Yet, according to Mayor Christian Camacho of Los Algodones, a town in northeastern Mexico approximately 16 km from Arizona, nearly 6,000 “dental refugees” from the U.S. enter the town every day to receive treatment at a cheaper cost.

The majority of those who travel to Los Algodones do so because they cannot afford dental care in the U.S. Many belong to middle-income families, an income demographic generally considered to be financially sound despite its struggles with stagnating incomes, dwindling job prospects and increasingly bleak opportunities for youth.

Nearly one third of U.S. residents either do not have health insurance or have insurance they consider to be inadequate. This means that around 80 million people nationwide live without security in the knowledge that, should tragedy strike, appropriate care is available for them and their families.

The cost of healthcare in the U.S. has garnered international attention in recent years and organizations like the Peterson Center on Healthcare are highlighting the system’s inadequacies.

A report released last year presented data showing that the cost of most major surgeries and prescribed drugs is higher in the U.S. than in comparable countries. It also reported that the U.S. has fewer physicians per capita than comparable countries – including Australia, Canada and Germany.

Some blame these costs on legal changes made by the current Republican administration. Others cite cuts made to the Medicare budget under the Obama administration as the problem. During his presidency, Obama made these budget cuts to provide funding for the Affordable Care Act – otherwise known as Obamacare.

Despite the importance of having trained physicians and accessible healthcare, the huge costs associated with medical school and the inability of many middle-income families to afford insurance is resulting in declining health conditions nationwide.

For many families unable to afford care within the nation’s borders, cities like Los Algodones provide salvation.

“We’re helping the United States take care of the people they are not able to,” said Camacho, the town’s mayor.

Regular visitors to Los Algodones have coined the name “Molar City” for the town. This name has gained prevalence and city officials have invested in the domain name MolarCity.com to advertise to their growing consumer base in the U.S.

The site proudly advertises its purpose to connect with potential customers across the border and displays slogans such as “Molar City IT IS THE MOST SAFE BORDER OF MÉXICO as safe as Disneyland” and a pop-up which appears as one enters the site proclaiming “In Molar City all dental treatment are about 70% to 75% less than in the United Sates and Canada. Make an appointment today!! [sic]”

The emergence of phenomena like that seen in Los Algodones – a city which has diverted the majority of its resources into dentistry to tap into an underserved North American market – are symptomatic of wider issues present in both countries.

As these issues meet at the border, they are exacerbated for everyone.

Professionals within Latin America are incentivized to appeal to North American customers who are generally able to pay more for services than locals. These costs are still cheaper than the increasingly unaffordable health care in the U.S. which attracts customers. Soon towns become like Los Algodones, which boasts that a visit is “more than just a visit to the dentist, it is like the Holidays, Delicious Food, Great Drinks is a big party. [sic]”

The in-your-face campaigns and apparent acceptability of this phenomena attract U.S. residents who flood into Mexican towns to take advantage of cheaper healthcare, and those resources are diverted away from the Latin American populations that require them.

The result is that millions of people in Latin America are without health care because those resources are being used to serve tourists from the U.S. who cannot afford to see professionals in their own country.

This mass exodus of people from the U.S. into Latin American countries to utilize services which most Americans believe should be provided by the government both highlights the inadequacy of the national system and exposes the hypocrisy of assertions against migrants entering the U.S. to use services here that they cannot get in their own countries.

Trump’s executive order upholds the ACA but calls federal agencies such as the Department of Health and Human Services to interpret Obamacare’s stipulations as loosely as possible. Agencies are to “waive, defer, grant exemptions from or delay implementation of any [ACA] provision or requirement,” according to the order.

According to a 2015 Gallup poll, Obama earned an 80 percent approval rating among members of his own party compared to a 14 percent approval rating among Republicans. Similarly, the ACA was supported by most Democrat congressmen and women; yet, the piece of legislation failed to receive a single Republican vote. Today, Republicans call Obamacare a failure and claim to be ready to replace the act with a superior alternative. Though the Republican’s plan has yet to be clearly articulated, based on their ongoing complaints of the legislation, several themes and possible policy routes have emerged.

In an attempt to implement universal insurance coverage, the Democrat’s plan was three-fold: regulate, mandate, subsidize. The ACA regulates insurance companies’ right to deny coverage to individuals with preexisting conditions, mandates that all individuals purchase insurance or incur a penalty and implements subsidies for these required insurance plans for those who can’t afford to pay. Many Republicans protest that the individual mandate should be repealed because it is an example of a big, intrusive federal government. Proponents of the ACA argue that without the requirement to purchase insurance, adverse selection prevails. This means that individuals with preexisting conditions will be more likely to purchase insurance while healthy individuals will be less likely to purchase a product they regard unnecessary. Subsequently, insurance companies raise premiums to cover their costs since more sick people are taking money out of the insurance pool than healthy people are contributing. Barring discrimination based on preexisting ailments, which conservatives largely support, becomes less relevant when these same individuals have to pay more for their insurance service.

Republicans also object to the federal subsidies for the ACA that largely fall on individuals from top income brackets. Instead of sending taxes to the overbearing federal government, there are conjectures that an Obamacare replacement will include a conversion of Medicaid into block grants, giving more autonomy to individuals and states to provide medical services. For instance, repealing the ACA would result in an average tax cut of 32,820 dollars for the top one percent of Americans. Republicans such as Tennessee State Representative Geoff Duncan plan to supplement these tax breaks with tax credits for what he deems the “four big C’s”—corporations, churches, charities and citizens—when they make donations to qualified rural hospitals. As for Medicaid reform, the ACA expands Medicaid funds that states can choose to accept or deny. Republicans claim that allocating identical fixed sums of money to each state will make states less dependent on the federal government and more able to serve the people who are closest to them. Block grants would make states more flexible and capable of creating “innovative Medicaid programs that will better serve their low-income citizens,” says Trump. However, Democrats decry rolling back ACA’s expansion of Medicaid funds and any transition away from Medicaid as an open-ended entitlement. Block grants would not require states to spend money on vulnerable populations and would force states to either find alternate sources of financing or cut medical services for those most in need.

However, until recent polls most Americans opposed the ACA. CNN’s new poll this month shows that only 22 percent of those polled saw their lives improved because of the ACA. A mere 14 percent of respondents declared health care as the most important affair facing the U.S. Yet, the ACA has helped insure 20 million Americans, and the nonpartisan Congressional Budget Office estimates that an Obamacare overhaul could cause 18 million of these Americans to lose their insurance in 2017 alone.

Any substantive changes to the ACA will require congressional action. However, Trump’s first executive order has already spurred uncertainty in the insurance market in which federal agencies, states, average citizens and insurance providers now must operate.