Budget crisis requires health care reform, advocates say

ALBUQUERQUE –  Health care reform would seem to have fallen off the political map in New Mexico. Gov. Bill Richardson has barely mentioned the subject since he called a special session of the Legislature in the summer of 2008 to ostensibly consider reform. Now legislators face the prospect of opening their 2009 session next month with a projected budget shortfall of $400 million this year–an amount that won’t be reappearing next year either.

Yet the state’s health care reformers say their proposals make even more sense during a budget crunch and a recession, given the need of businesses and consumers to control spiraling health care costs.

“There is tremendous interest in both the advocacy and constituent communities to focus on health care reform during the upcoming session,” said Roxanne Spruce Bly, executive director of Health Action New Mexico, in an interview with the Independent. “For many voters, health care was a top priority and a key reason why they supported change at both the national and state level.”

Indeed, achieving universal health care was not only a major plank during the Democratic presidential primary, it was also a major issue in 2008 during the short legislative session and the special session.

Still, the results were minimal. There has been no movement on bills that would ensure New Mexico’s 400,000 uninsured people gain access to health care, or that would contain the rapidly increasing costs.

“The time to act is now,” Bly said. “In 2006, New Mexico commissioned a study which showed that if we continued to do nothing, the cost of our health care system will increase from $6 billion to $8 billion by 2011.

“A $2 billion cost increase on working families is devastating. It results in increased premiums, higher co-pays and deductibles, and higher costs to employees who pay a portion of their premium — taking up a larger portion of working families’ disposable income,” Bly said. “Businesses will be less able to afford coverage for their employees, which limits their ability to remain competitive. All of these factors have a direct impact on our state’s economy.”

At a standing-room-only public meeting of Health Action New Mexico last week, state Sen. Dede Feldman, D-Albuquerque, explained, “We’re at a weird juncture. We’re seeing progressive forces sweeping the country. At the same time, we no longer have the money to think big. Health care reform has slipped from the top of the agenda to way down. The economy seems to have swept away all other concerns.”

Sen. Jerry Ortiz y Pino told the gathering of more than 100 people that the looming budget fight would pit conservatives who “want to cut” against progressives who “want to find” the revenue needed to fund public programs. Heath care, he predicted, would be where much of the wrangling would occur, specifically regarding Medicaid.

The reformers want a more ambitious agenda in the 2009 session, seeking to take the first steps toward implementing a new system over the next three years. There is not yet consensus on the best way to do that, however.

The 2006 state study looked at the financial feasibility of a number of different proposals for insuring New Mexicans. Out of the plans studied, The Health Security Act was found to be the most cost-effective way to provide universal health care in the state. But rather than endorse the act, the state committee that commissioned the study recommended the creation of a Health Care Authority that would implement incremental measures to advance the state toward covering more of its citizens.

The creation of a Health Care Authority was subsequently introduced in a bill by state Rep. Danice Picraux, D-Albuquerque, alongside other health care reform bills, during the 2008 session.

At last week’s meeting, Picraux said her goal is changing the system, not just expanding coverage.

“Medicare, for instance, was a game-changer when it passed,” she told the the gathering of more than 100 people. “We should be talking about healthy lifestyles, services, and prevention rather than just coverage.”

Bly told the Independent that an authority would be an overarching body made up of individuals with hands-on, in-depth knowledge of the system. They would be “systems thinkers” who would utilize the expertise of advisory councils to develop an action plan for creating the “best health care system” for New Mexico.

“We have been tinkering with our current system for over 30 years and nothing has changed,” Bly said. “Simply exploring ways in which health care is financed is not enough. We must look at opportunities for structural change.”

The idea of an authority is similar to the health care commission that would be established by the Health Security Act – a plan that many say, if passed by the Legislature, would be that game-changer that advocates talk about, much like Medicare was more than 40 years ago.

While the act is often referred to as a “single-payer” system, Mary Feldblum, executive director of the Health Security for New Mexicans Campaign, said it’s more accurately a statewide cooperative insurance plan overseen by a non-governmental organization.

“A single-payer system is thought of as a state agency that covers all citizens through the tax base. The Health Security Act, though, calls for the development of a cooperative to which employers and individuals pay premiums, and it also draws in existing government funds such as Medicaid dollars,” Feldblum explained.

“From this pool, an annual budget would be developed in conjunction with health care providers,” she said. “The end result is a huge reduction in costs across the spectrum. Under this approach, private insurance would play a supplemental role just like it does for senior citizens who use Medicare.”

The act can be adopted, she said, even in a time of budget woes because it calls for an initial year of planning to figure out how to make the financing work. If at the end of that year the financing plan isn’t approved by the Legislature and the governor, the act contains a “sunset” clause. The second and third years would see the creation of a non-governmental commission to oversee the plan.

“This is about shifting the paradigm,” Feldblum said, “just like Medicare did for seniors when it was passed in the 1960s. At the time, there was opposition to it, but it’s now considered a significant part of the social safety net. And the supplemental insurance market that has developed for seniors alongside the Medicare system has also proven to be quite lucrative for private companies.”

At the Health Action meeting, state Rep. Mimi Stewart, D-Albuquerque, urged participants to communicate their views to their legislators during the session in order to build momentum for reform.

“Hearing from our constituents during the session is very important. It reminds us why we got elected, that this is not a game,” Stewart said. “It’s serious stuff that affects people’s lives.”

Indeed, New Mexico continues to be at the bottom of the ladder when it comes to health care. Almost a quarter of the state lacks health care insurance.