Adopting federal healthcare reform presents challenges for NM

More than 150,000 previously uninsured New Mexicans will qualify for health coverage under the nation’s federal health care law, according to recent estimates.

But what happens on the day when that population starts showing up for check ups, pre-natal appointments and diagnoses — all the things that go into health care?

Is New Mexico’s network of physicians, physician’s assistants, registered nurses and other medical professionals ready for the effects of the new law?

“Absolutely not,” Sam Howarth, a deputy director at the New Mexico Department of Health, said last week.

Howarth made the remark at Thursday’s inaugural meeting of a planning group tasked with guiding New Mexico through the process of adopting the nation’s new federal health care law.

And New Mexico’s ability to absorb a significant portion of the state’s more than 400,000 uninsured was one of the larger topics tackled by the group, made up of cabinet secretaries, their deputies and top staff.

Southeastern New Mexico needs more than 50 medical doctors just to address current needs, Howarth said.

Meanwhile, according to a report issued this month by the New Mexico Health Policy Commission, Hidalgo County had no licensed physicians in 2009. Hidalgo County, near Arizona, forms the boot heel of the state, and is a large rural county — 3,440 square miles – with nearly 5,000 residents.

In fact, around 70 percent of the state’s 4,689 physicians were licensed in three counties – Bernalillo, Santa Fe and Doña Ana, where about half the state’s population lives — with just over half the physicians licensed in Bernalillo County, the same report said.

And that doesn’t even get into oral health. Four New Mexico communities have no dentists at all, Barbara Webber of Health Action Network, an organization pushing for accessible health care for New Mexicans, told the Independent on Friday.

“We’re going to have to expand mid-level practitioners as part of the workforce,” Webber said, referring to nurse practitioners and dental therapists, to help fill gaps in the provider network around the state.

New Mexico has large tracts of sparsely populated areas or rural communities without a thick supply of medical providers and that often means hospitals pick up the slack, Jeff Dye of the New Mexico Hospital Association, told the group.

“Indigent care is not going away,” Dye told the group, by which he meant not everyone eligible for insurance will get covered.

And that meant that ‘uncompensated care’ wasn’t going away, either. Uncompensated care is where hospitals, as providers of last resort, provide services for which they aren’t paid.

In 2006, the hospital association estimated that “unreimbursed cost to New Mexico’s Hospitals just for treating people without insurance topped $384 million.”

The new law, in fact, exempts several categories of individuals, including Native Americans, from the mandate that requires Americans to have health insurance, although they have the option of choosing to become insured.

Agencies will have to collaborate on creating a health insurance exchange

The group didn’t tarry long on the state’s ability to absorb its uninsured population, but moved at a brisk pace Thursday, tackling issues big and small in a dizzying mix of arcane policy questions and concerns about how all the changes will affect New Mexicans.

The group must submit to Gov. Bill Richardson by July recommendations on what the state must do to prepare for the new federal law, which amps up the pressure on cabinet secretaries and their staffs to make sense of a law that most experts are still digesting.

“Obviously we are not going to talk about every thing in this act. First of all we don’t understand it,” Katie Falls, secretary of the state’s Human Services Department, joked – sort of – to the group.

Among the biggest tasks New Mexico will confront is the formation of a health insurance exchange at the state level by 2014. A place where people can go to purchase health care coverage, it is at the center of the new health care law.

But first state agencies have to figure out how to work together on myriad interconnected issues, like who is eligible for Medicaid, the government’s low-income health insurance program. Those on Medicaid won’t need to use the exchange, Falls said.

Group members also talked about the importance of keeping each other’s agency informed of funding opportunities through federal grants under the new law. And they discussed briefly the importance of identifying what changes to state law will be needed to meet new requirements in the federal law.

For example, the new federal law will penalize large companies – those with more than 50 employees – that don’t offer health coverage to their workforce or if authorities find that at least one of its employees receives a tax credit to help pay premiums to purchase a health insurance policy.

“Who’s your enforcement?” asked Clyde DeMersseman, general counsel for the state Department of Workforce Solutions. “What is the legislation we might need to in order to comply with these requirements.”

“I assume it’ll be Tax and Rev,” Falls interjected, referring to New Mexico Department of Taxation and Revenue.

“Or Workforce Solutions,” Marilyn Hill, deputy secretary at Tax and Rev, quickly jumped in.

“We’ll need a legislative change,” DeMersseman said.

There were also more practical questions Thursday.

“We’re on a verge of a change in administration and we need point people who will still be around” after the election, said Michael Spanier, the secretary of the New Mexico Department of Aging and Long Term Care.

Spanier was referring to people who would still be in their positions after this year’s election gives New Mexico a new governor.

“We’re talking 2014,” Spanier said, referring to the date when many provisions in the new law go into effect.

Cabinet secretaries and their deputies are political appointees and serve at the governor’s pleasure, as opposed to classified employees, who serve in non-political jobs and aren’t vulnerable to being fired without cause.

“We want someone who is classified,” an unidentified person said to knowing laughter in the room.