A Light Legislative Session

March 7 was the last day for the governor to sign—or veto—bills passed by the 2018 legislature, bringing this year’s legislative season to a close. What happened regarding health care reform this session? In a nutshell, not much.

• While there were concerns about major cuts to Medicaid, the Medicaid budget survived in relatively reasonable shape.
   
• We were watching two health-care-related memorials—which, unlike bills, do not need the signature of the governor and do not have the force of law.
   
  • HM9/SM3, which passed the house and the senate, asks the Legislative Health and Human Services Committee to explore the economic feasibility of a Medicaid buy-in option. Such an option would allow low-income, uninsured New Mexicans who are not eligible for Medicaid to purchase coverage administered by Medicaid.
     
  • SM7, which passed the senate, requested the Superintendent of Insurance to convene a task force that would examine options to strengthen the increasingly fragile individual insurance market. The memorial pointed out that congressional and presidential actions to weaken the Affordable Care Act have led to a 34% increase in individual health insurance premiums in New Mexico for the 2018 plan year.
     
• Senator Jeff Steinborn’s 2017 bill requiring agencies to engage in bulk purchasing of drugs was not found to be relevant to this budget session and therefore was not able to be heard. The bill, which passed both houses in 2017, was vetoed by the governor last year.

Health care costs and coverage issues clearly remain major concerns, and they have emerged as campaign issues for this election cycle.

With the 2018 session behind us, we’re gearing up for the elections—as well as for the 2019 legislative session, when Health Security will be introduced.

Your participation at our statewide strategy meeting is important. Please plan to join us in Albuquerque on April 28!

Attacks on Obamacare Not Over

The Affordable Care Act—Still Vulnerable to Attack

While the latest attempt* to repeal and replace the Affordable Care Act (Obamacare) has been abandoned, Republican efforts to dismantle the ACA are unfortunately far from over.

First, there are many ways to sabotage the ACA without an outright repeal. In fact, one of President Trump’s first actions in office was an executive order intended to stop enforcement of the individual mandate—the ACA’s requirement that everyone either have health insurance or pay a fine.

And the president’s unwillingness to commit to paying ACA subsidies to insurers (so-called cost-sharing reduction payments) has contributed to a 36% to 41% increase in premiums for next year’s policies available through New Mexico’s insurance exchange (Albuquerque Journal, 09/21/17).

As people drop coverage because they can no longer afford it, or because they think they will no longer have to pay a penalty if they are uninsured, the insurance exchanges set up under the ACA will become even less sustainable.

Second, the push to repeal continues. Even though outright repeal is dead for the moment, Republicans in Congress are already preparing for their next attempt to kill off the ACA. 

—Washington Post, 09/28/17

Sen. Graham, co-sponsor of the failed Graham-Cassidy repeal bill, said earlier this week, "We are coming back to this after taxes" (USA Today, 09/26/17). Some members of Congress apparently don’t want to wait that long. As Congress moves to tackle tax reform, there is talk of continuing with ACA repeal efforts as part of the tax reform process. (See this Politico article for more details.)

This fixated effort to virtually destroy Medicaid and throw millions into the ranks of the uninsured will not stop. Even the united opposition of the insurance industry, hospitals, doctors and nurses, and advocacy organizations like AARP has not put a damper on this desire to follow through with what was promised for seven years—the repeal of Obamacare.

* The Center on Budget and Policy Priorities put together a summary of exactly what the Graham-Cassidy bill would have done—from rolling back the Medicaid expansion to dramatically weakening protections for people with preexisting conditions.

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On the home front, there continues to be growing interest in Health Security. Our basic flyer is a great handout for friends and colleagues who want more information.

And if you belong to an organization (social, professional, political, or activist!) please let them know about Health Security. We are always happy to give a presentation, and working through organizations is often the most efficient and effective way to reach a new audience.

Guess Who Supports Large Health Risk Pools?

We don’t know whether the disastrous Senate efforts to “repeal and replace Obamacare” are really, really dead. Like zombies, bills can resurface.

What intrigues us is that those opposed to the Senate bill have come from a very diverse range of organizations: the American Medical Association, the American Hospital Association, AARP, unions, many advocacy groups, and (hold your breath) the insurance industry!

The insurance industry has been surprisingly public and vocal in its opposition to the Republican proposals to allow insurance companies to offer cheap, bare-bones policies and to abolish the individual and employer mandates to purchase insurance. (And, of course, they oppose all the proposed reductions in federal dollars for Medicaid and for subsidizing the policies bought by individuals on the state-based insurance exchanges—dollars that end up in their pockets!)

We want to alert you to a fascinating letter addressed to the Senate majority and minority leaders (Sens. Mitch McConnell and Chuck Schumer) and signed by two large insurance associations: America’s Health Insurance Plans and the Blue Cross Blue Shield Association.

Talking about Sen. Ted Cruz’s “Consumer Freedom Option” in the Republicans’ Better Care Reconciliation Act (the bill prior to the “Skinny Repeal” bill that failed last Friday), the letter states that offering bare-bones policies, “is simply unworkable in any form and would undermine protections for those with pre-existing medical conditions, increase premiums and lead to widespread terminations of coverage for people currently enrolled in the individual market.”

Their explanation as to why a bill with this provision is “unworkable” is based on a principle that is fundamental to the success of the Health Security Plan: large risk pools. In the letter, they refer to a recent report from the American Academy of Actuaries. The report succinctly explains the benefits of large risk pools:

Basically, pooling those with higher costs with those who are healthy results in spreading out the costs. “In general, the larger the risk pool, the more predictable and stable the premiums can be.”

The key to a stable risk pool, then, is not separating the healthy and the not-so-healthy into two separate pools. Such a separation (which the bare-bones policies allowed under the “Consumer Freedom Option” would permit) will inevitably result in higher premiums for the sick and those with pre-existing conditions.

Since what is being proposed by the Senate Republicans is a voluntary system (no more mandates to purchase insurance), many of the healthy will choose not to purchase insurance. Others will purchase the cheap, bare-bones policies. Those who have greater medical needs will have no choice but to remain in more expensive plans with more comprehensive coverage.

If an insurance pool, even a large one, attracts a disproportionate number of individuals with costly medical conditions, premiums will be higher than if that risk pool included an “average population.”

Does this not sound like a justification for the NM Health Security Plan? With almost all New Mexicans covered under one plan, the risk would be shared. And, under Health Security, premiums would be based on income, not health status.

No one is immune from a potential health disaster due to illness or an accident. Therefore, sharing the risk is the core concept of insurance.

It does not take a brainy economist or actuary (or a brain surgeon!) to understand that premiums will be more “predictable and stable” under such a system.

A large risk pool—like the Health Security Plan's—would also simplify life for the state’s health care providers and hospitals, which currently have to deal with so many plans with different copays, deductibles, and covered services.

What Have We Been Up To Lately?

Our Work Continues

While we've been keeping abreast of what's been happening at the national level, our work is right here in New Mexico. Exactly what have we been doing since the legislative session ended in March? Take a look below.

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Presentations and meetings with groups around the state—newly active groups, religious groups, provider groups, neighborhood groups.

Want to arrange a presentation to your group? Let us know.

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Bill workshops in Albuquerque, Las Cruces, and Santa Fe

A bill workshop in Santa Fe, hosted by DSA Santa Fe and held at YouthWorks.

At our bill workshops, people learn how to navigate through the Health Security Act to find answers to their questions. These workshops are a chance to really delve into the details that participants want to know about. They also give attendees experience reading and understanding legislative language.  

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Statewide strategy meeting in Albuquerque

Health Security supporters came from as far away as Española and Taos to the north; Gallup to the west; and Silver City, Hillsboro, Las Cruces, and Roswell to the south for this one-day event. Santa Fe, Placitas, Albuquerque, Corrales, and Belen were also represented!

Participants introduce themselves at the beginning of the statewide meeting.

The statewide meeting started off with inspirational words from Pastor Roger Powers of St. Andrew Presbyterian Church, who spoke about the moral imperative of providing health care and the need to pass this legislation. 

Next up was an interview of Health Security Act sponsor Rep. Debbie Armstrong, conducted by none other than Max Bartlett, the Campaign’s chair. Debbie shared her insights about the 2017 legislative session.

Sen. Bill Tallman speaks from the legislative panel.

After her interview, Debbie was joined by three other legislators—Rep. Joanne Ferrary and Sens. Jerry Ortiz y Pino and Bill Tallman—for a panel (moderated by Campaign executive director Mary Felblum) that focused on next steps and effective ways to move the Health Security Act forward. 

Bill Jordan, of New Mexico Voices for Children, then spelled out the current health care situation, both in the state and nationally.

One of the afternoon breakout groups.

After lunch, breakout groups came up with action priorities for the next year, and those who were newer to the Health Security Plan had a chance to learn more about this paradigm-shifting approach.

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Growing Support

Our email list and our membership continue to grow: new member organizations in 2017 include New Mexico Voices for Children, Street Safe New Mexico, and the Northern New Mexico Central Labor Council.

In addition, the New Mexico Medical Society recently passed a resolution to encourage private foundations to fund a financial analysis of the Health Security Plan.

Help Health Security gain even more support by talking to your friends, neighbors (and anyone else you meet!) about this New Mexican solution.