Now that the U.S. Supreme Court has given its final blessing to the Affordable Care Act, some health care advocates in New Mexico think it’s time to move beyond the law, which is working to greatly expand the costly and confusing private insurance marketplace.
For the past few years, a coalition of individuals, local governments and businesses have gotten behind the idea that the state of New Mexico should be the insurance provider for its 2 million residents, and not just for health care but for automobile and workers’ compensation coverage, as all three are related to health security.
One effort to analyze if that is even possible in New Mexico, the Health Security Act, is being supported by a nonprofit called the The Health Security for New Mexicans campaign. The measure got bottle-necked in the state Senate after it passed one committee in the 2015 session.
Mary Feldblum, executive director of the group, argues that as more and more consumers turn to the health exchange to purchase private insurance, they learn it is confusing and not very consumer friendly. It also costs more than a not-for-profit insurance model, which would be governed by a public board, much like a co-op, and not have to manage a business with an eye toward shareholder returns.
Under the Affordable Care Act, also known as “Obamacare,” individuals and business owners can receive subsidies to purchase health insurance from private companies. Most people are now required to have health insurance or pay a fine. With that monthly premium, many consumers are surprised that certain services still cost money or are not covered.
“Private insurance has for years hidden the costs,” Feldblum said. “A lot of people are in shock. They think they have coverage, they think they have insurance, and they are surprised by how much they have to pay. The weakness of that system is really starting to show,” she said.
The Health Security Act would take the profit that goes back to large insurance companies and put those dollars into providing services.
Initial estimates are that businesses, local governments and individual consumers would pay less under the measure, but no one knows for sure. The measure to move ahead with an extensive actuarial study has gained support from some 30 municipalities in the state, including Roswell, Deming, Grants, Las Cruces, Santa Rosa and Rio Rancho, and 15 counties, including Luna, Guadalupe, Sandoval, Bernalillo and Hidalgo.
If approved, the legislation calls for the completed analysis before anything would change. The measure would be a lower-cost benefit package and an easier-to-understand insurance product.
“Nothing will happen unless it’s more affordable,” she said. “We do not want New Mexico to have egg on its face,” she said.
She said a comprehensive insurance policy for the state with all residents included could utilize the bulk purchasing of drugs to reduce costs. It can also decide on issues that today frustrate consumers, such as whether to limit “balance billing,” which can happen when companies send a bill to patients because a service is not entirely covered or was handled by a provider not under contract.
And one way for-profit insurance companies increase profits is by narrowing the network of services and providers.
The public board would also decide on a policy of copays, but there would be community input on the decisions. “There is a whole school of thought on when a copay is a good thing,” she said.
Feldblum said the concept of the Health Security Act goes back to 1992 and was first advanced by former lawmaker Max Coll along with state Rep. Luciano “Lucky” Varela. It is still possible under a provision of the ACA that allows smaller states to innovate and experiment with different insurance models outside a health exchange.
Over the past few years, Feldblum has gone all over the state to receive input. This has resulted in changes to the proposed legislation that are uniquely New Mexican – such as how to integrate state retirement plans and Native communities, and mandates that the board have representation from across geographies.
“This is like a co-op. There would be a nominating committee, open meetings; public input is critical,” Feldblum said.
There are also proposals on how to incorporate Medicaid and Medicare patients.
Most important, she said, the plan would belong to New Mexicans, who could choose to invest any excess premium money in health care needs and services for the underserved.
“This bill is a recipe, and we can put it together to make it great,” she said. “We can be a model for other smaller states.”
Date: July 6, 2015