Healthcare Reform

Table of Contents:

Updates:

  • New Mexico says yes to the Medicaid Opportunity! Beginning in January 2014, Medicaid will be available to 170,000 more low-income New Mexicans. Click here to learn more and find out how you can get involved! (Jan 2013)
  • Check out the most recent video from the Kidswell Briefing!
  • New Mexico health insurance Exchange needs strong consumer protections. In January, the U.S. Department of Health and Human Services issued a conditional approval of New Mexico’s application to build a state-based health insurance Exchange. But there are serious questions about whether the Exchange will meet the needs of low-income New Mexicans. Read the Op-Ed by Center Executive Director Kim Posich about why New Mexico needs an Exchange that puts the rights of consumers first. (Jan 2013)
  • Ensuring affordable coverage for all New Mexicans. While a health insurance Exchange will expand access to health coverage in the state, there are serious questions about whether this coverage will be affordable for low-income families – even with the subsidies the new federal law provides. Through the New Mexico Legislative Finance Committee, we recently released a report that addresses the affordability of coverage for low-income working families and analyzes the Basic Health Program, a potential solution to this problem. (Dec 2012)
  • Looking for more information about healthcare reform implementation? Visit the KidsWell Campaign website to find valuable information on state efforts to implement national healthcare reform.

Healthcare Reform in New Mexico

Affordable Healthcare Options for Low-Income New Mexicans

Beginning in 2014, Medicaid will cover nearly all low-income New Mexicans with incomes up to 138% of the poverty level. People who have incomes above that level will receive federal subsidies to help them purchase coverage on an Exchange, as long as they make less than 400% of the poverty level. See a chart of income levels based on the latest poverty level guidelines.

Despite this assistance, we remain deeply concerned that tens of thousands of low-income New Mexicans will remain uninsured because their incomes are too high for Medicaid and yet too low to afford coverage through the Exchange, even with the help of subsidies. For example, a low-income mother of two children needs an income of more than $3,000 each month to make ends meet in New Mexico. At 150% of the poverty level, she is making less than $2,500 each month and would not be able to afford private insurance premiums. Even with the help of federal subsidies, she could still be responsible for paying up to $1,104 in premiums each year for coverage on the Exchange and would be expected to pay an average of $461 each year in out of pocket costs for medical bills. See our factsheet on affordability under healthcare reform for a summary of the problem.

The Center is urging state policymakers to consider alternatives that would make coverage more affordable for low-income families with incomes between 138%-200% of the poverty level. Surveys have shown that affordability is the most important factor that determines whether or not families obtain healthcare coverage. One option is a Basic Health Program where the state negotiates with insurance plans to provide lower cost options to low-income New Mexicans. See our factsheet explaining how the program works and our presentation about affordability concerns under healthcare reform. Other options include establishing a state-funded premium assistance program or structuring the Exchange to ensure that at least one low-premium, low-cost-sharing plan is available to low-income individuals and families. The Center is exploring these alternatives, which could save low-income families thousands of dollars each year.

In the 2012 Legislative Session, the Center successfully advocated for the legislature to adopt a memorial, sponsored by Senator Michael Sanchez and Representative Gail Chasey, to study a Basic Health Program in New Mexico and the affordability of coverage for low-income New Mexicans. In December 2012, the Legislative Finance Committee released our report in response to that memorial. The report analyzes the affordability problem, looks at the Basic Health Program and other solutions, and recommends next steps to policymakers.

Some other major changes under healthcare reform include:

-       Large Employers Must Cover Their Employees: All large employers with over 50 employees must purchase coverage for their employees or pay a significant tax penalty.

-       Subsidies to Help Individuals and Small Employers Purchase Coverage on a Health Insurance Exchange: Every state must develop an “Exchange” by 2014 – an online marketplace where people can shop for health insurance. The Exchange will ensure that insurance companies provide transparent and easy-to-use information about their health plans so that people can compare prices and plans. Households up to 400% of the poverty level will receive federal tax credits and subsidies to help purchase insurance through the Exchange. Small employers will also receive tax credits for up to 50% of premiums they pay for covering their employees through the Exchange.

-       Basic Health Program for Low-Income People: States may set up a “Basic Health Program” for low-income people who earn less than 200% of the poverty level but whose incomes are too high for Medicaid, rather than have these individuals enroll in the Exchange. These individuals would still have a variety of health plans to choose from, but they would pay less in premiums and out-of-pocket costs than for coverage through an Exchange. A Basic Health Program would be mostly funded by the federal government.

-       New Rules for Insurance Companies: Many new rules have already gone into effect for insurance companies. For example, insurance plans can no longer deny children coverage due to pre-existing conditions, and children can stay on their parents’ plans until age 26. New rules on “Medical Loss Ratios” require health plans to spend a larger percentage of money from patient premiums on healthcare rather than administration or profits. If insurers don’t spend enough on actual healthcare, they have to send rebate checks back to their customers – the first round of rebates, sent out in 2012, totaled $1.3 billion nationally. In 2014, even more protections will take effect. For example, insurers will not be allowed to deny anyone coverage due to pre-existing conditions and women can no longer be charged higher prices just because they are women.

Our Advocacy on Healthcare Reform:

New Mexico has yet to make the promise of healthcare reform into a reality. If the state does not move forward immediately, New Mexicans could face major barriers to getting free and low-cost coverage. The Center is working to ensure that low-income New Mexicans can access affordable healthcare by focusing on the following areas:

Affordable Healthcare Options for Low-Income New Mexicans

Assuming New Mexico says yes to the Medicaid opportunity, Medicaid will soon cover all low-income New Mexicans up to 138% of the poverty level. People who have incomes above that level will receive federal subsidies to help them purchase coverage on an Exchange, as long as they make less than 400% of the poverty level. See a chart of income levels based on the latest poverty level guidelines.

Despite this assistance, we remain deeply concerned that tens of thousands of low-income New Mexicans will remain uninsured because their incomes are too high for Medicaid and yet too low to afford coverage through the Exchange even with the help of subsidies. For example, a low-income mother of two children needs an income of more than $3,000 each month to make ends meet in New Mexico. At 150% of the poverty level, she is making less than $2,500 each month and would not be able to afford private insurance premiums. Even with the help of federal subsidies, she could still be responsible for paying up to $1,104 in premiums each year for coverage on the Exchange and would be expected to pay an average of $461 in each in out of pocket costs for medical bills. See our factsheet on affordability under healthcare reform for a summary of the problem.

The Center is urging state policymakers to consider alternatives that would make coverage more affordable for low-income families with incomes between 138%-200% of the poverty level. Surveys have shown that affordability is the most important factor that determines whether families obtain healthcare coverage. One option is a Basic Health Program where the state negotiates with insurance plans to provide lower cost options to low-income New Mexicans. See our factsheet explaining how the program works and our presentation about affordability concerns under healthcare reform. Another option could be to set up a premium assistance program where the state would provide assistance for lower premiums and out-of-pocket costs for coverage on the Exchange. The Center is exploring these alternatives that could save low-income families thousands of dollars each year.

In 2012, the Center successfully advocated for the legislature to adopt a memorial, sponsored by Senator Michael Sanchez and Representative Gail Chasey, to study a Basic Health Program in New Mexico and the affordability of coverage for low-income New Mexicans. The Legislative Finance Committee is currently working on that study.

Effective Outreach and Enrollment System for Medicaid and the Exchange

Over half a million New Mexicans will become newly qualified for Medicaid and for Exchange subsidies on January 1, 2014. The state is responsible for enrolling everyone in these programs and making sure people know about their healthcare options. If the state does a good job, the enrollment process will be easy to understand and will reach low-income communities throughout the state. But if the state does not make strong progress, then the system could be difficult and confusing, which could mean people are uninformed about their options, are required to turn in unnecessary paperwork, and are bounced around to different programs without assistance. This would only perpetuate the serious disparities in healthcare coverage for low-income New Mexicans, between rural and urban areas, and for racial/ethnic minorities in the state.

The Center advocated for the New Mexico Legislature to pass a memorial sponsored by Representative Mimi Stewart that requests that the state plan and develop a streamlined enrollment system for Medicaid and the Exchange. See our factsheet about the memorial, which was successfully passed by the House. The memorial calls for one single application for both Medicaid and the Exchange that is easy to use and available in multiple languages. It asks the state to help people without computer access and provide alternatives for people who may not be able to produce certain documents. The memorial also calls for statewide outreach and a community-based navigator program, and asks for the state to collect data on enrollment rates and disparities in accessing coverage or services. Under the memorial, the interim Legislative Health and Human Services Committee will be seeking periodic reports from the state’s Office of Healthcare Reform and Human Services Department on their progress.

The Center will be monitoring the development of this enrollment system and providing policymakers with information about best practices in these areas. In April 2012, we helped secure a presentation by experts at the Georgetown Center for Children and Families about developing a navigator program in New Mexico that was attended by over 40 state legislators, legislative and Division of Insurance staff, advocates, healthcare providers, and experts. We are also specifically examining ways to ensure the enrollment system does not discourage immigrant families from applying for coverage.

In addition, we will be monitoring the state’s progress on developing an Exchange that effectively enrolls low-income people into Medicaid if the person is eligible. We wrote an in-depth report in 2011 about how New Mexico can best develop an Exchange to meet the needs of our population. The Center also worked extensively in 2011 on legislation to set up a consumer-friendly Exchange in New Mexico where insurance companies would be prohibited from serving on the governing board of the Exchange. That bill was vetoed by the Governor. See the factsheet and Q&A we distributed about this bill.

In 2012, we successfully advocated for the New Mexico Legislature to pass a memorial, sponsored by Senator Tim Jennings and Representative Miguel Garcia, calling on the Human Services Department to provide periodic reports to the Legislature about the state’s activities under a $34 million Level One Exchange Establishment Grant that the state received from the federal government. The first report under the memorial to the Legislative Health and Human Services Committee is scheduled for June 25, 2012.

Native Americans and Healthcare Reform

One serious challenge for the state will be to ensure that Native Americans are guaranteed healthcare coverage through Medicaid, the Exchange, and any other coverage program established by the state under healthcare reform, such as the Basic Health Program. Although the federal government has the obligation under numerous treaties and by statute to provide healthcare coverage to all Native Americans, it has never fully delivered on this promise. As a result, Native Americans suffer rampant disparities in accessing healthcare.

The Affordable Care Act is a step in the right direction towards improving this situation and includes a permanent reauthorization of the Indian Health Care Improvement Act. However, there are still significant gaps in the law that will leave many Native Americans uninsured. Indian Health Services (IHS) is still not adequately funded and will not be delivering the full array of healthcare services that are needed. The federal government will not pay the full cost for coverage through an Exchange. Since Native Americans are not required to purchase insurance under the law, it is likely that tens of thousands of people will be left without coverage at all.

The Center developed a presentation at the request of a local Native American advocacy group to outline concerns and opportunities for advocacy with the Exchange and Basic Health Program, and we continue to provide trainings upon request. We are examining state-level solutions to ensure that all Native Americans in New Mexico have access to stable healthcare coverage, for example, by reducing or eliminating premiums through the Exchange or Basic Health Program. We worked on a memorial for the state to study a Basic Health Program that includes a requirement to study coverage for Native Americans and the possibility of eliminating premiums and cost-sharing for them.

We continue to push the state to do more outreach and improve its enrollment strategies for reaching Native American families who are eligible for Medicaid. We worked on a memorial that calls for the state to consult with tribes and off-reservation Native American representatives, among other groups, when developing the enrollment system for Medicaid and the Exchange, and will be advocating for the state to deliver on this. And we worked extensively on a bill to set up an Exchange that would have required Native American representation in its governance and advisory structure.  That bill was vetoed by the Governor. See the Center’s report about how to best implement an Exchange in New Mexico that includes recommendations for expanding coverage in Native American communities.

Immigrants and Healthcare Reform

For lawfully present immigrants, federal healthcare reform – which goes into effect January 1, 2014 – both expands access to health insurance and requires people to maintain coverage. However, undocumented immigrants are excluded from both the benefits and the mandate to get coverage under health reform. For a summary of how healthcare reform impacts immigrants, take a look at this factsheet by the National Immigration Law Center. For a more in-depth explanation of how healthcare reform will expand access to healthcare for lawfully present immigrants, see the Healthcare Reform and Immigrants section of our Immigrants and Healthcare page on this website.

The Center is advocating for the state to address the concerns of immigrants and their families as it develops enrollment and consumer support systems under healthcare reform. Immigrants and their families will need these systems to be language accessible for people with limited English proficiency, and they will need consumer assistance workers (called “navigators”) who are familiar with the complex eligibility rules that determine which immigrants are eligible for Medicaid or for subsidies to help purchase coverage through the Exchange. In addition, paperwork requirements are often more confusing and burdensome for immigrants. Under healthcare reform, the state has an obligation to minimize these paperwork requirements and to work with families to help them prove immigration status and income so that paperwork does not become a barrier to obtaining coverage.

Trainings about Healthcare Reform under the Affordable Care Act

The Center provides trainings upon request about the Affordable Care Act and the new options that will be available through Medicaid, the Exchange, and other alternatives like the Basic Health Program. Please contact us at (505) 255-2840 or email kelsey@nmpovertylaw.org if you would like to set up one of these trainings. We provide trainings in English or Spanish to groups of 10 or more people, and can customize our trainings for community members, advocates, healthcare providers, community health workers, policymakers, or others.

Kidswell Project:

Our partner, KidsWell, has created an informative and easy to use website that provides state-by-state summaries of health care reform implementation and campaigns impacting children’s health. We refer to the information on kidswellcampaign.org regularly and hope you will, too.

KidsWell’s website is a helpful place to find the latest information about successful implementation of health care reform. The National Spotlights feature provides up-to-date maps showcasing developments in health policy reform that are particularly relevant to child health advocates. There’s also a new, powerful health care reform search tool that will help you find all the latest health care reform information. You can search by keywords, state, topic, issuing agency and other criteria. KidsWell’s database is updated each week so you know you’re getting accurate, recent data.

As part of the national campaign to implement health care reform on behalf of children in all fifty states, KidsWell is a crucial resource we rely on and we encourage you to, as well. Please visit KidsWell’s site often and you’ll get the most up-to-date information relevant to our cause.

Resources:

Factsheets:

Will Healthcare Be Affordable for New Mexicans After Reform?  (June 2012)
Basic Health Program in New Mexico (March 2012)
Support A Streamlined Enrollment System for Healthcare Memorial (February 2012)
Support A Health Insurance Exchange for New Mexico (February 2011)
Q&A: Health Insurance Exchange Talking Points (February 2011)

Reports/Presentations:
Presentation: Basic Health Program and Affordability Concerns in New Mexico (April 2012)
Presentation: Exchange and Basic Health Program for Native Americans in NM (Feb 2012)
Health Insurance Exchange in New Mexico: Report for Con Alma Blueprint4Health (Sept 2011)

Comments/Letters:
Comments to NM Office of Health Care Reform on Blueprint Application for State-Based Exchange (Dec 2012)
Comments to HHS: New Mexico Blueprint Application for State-Based Exchange (Dec 2012)
Comments to HHS: Proposed Interim Exchange Regulations (May 2012)
Advocates letter to Federal Government: Concerns about New Mexico’s Healthcare Exchange Establishment Grant (Nov 2011)
Comments to IRS: Proposed IRS Exchange Regulations from Aug 17th (Oct 2011)
Comments to HHS: Proposed Medicaid Regulations from Aug 17th (Oct 2011)
Comments to HHS: Second Set of Proposed Exchange Regulations from Aug 17th (Oct 2011)
Comments to HHS: First Set of Proposed Exchange Regulations from July 15th (Oct 2011)

Media:
Op-Ed: Insurance Exchange Needs More Consumer Protections, by Executive Director Kim Posich (Jan 2013)
Article: State Slow Planning Health Insurance Exchange, Albuquerque Journal (April 2012)
Op-Ed: Build Health Care Exchange Now, by Staff Attorney Quela Robinson (April 2011)

Links:
Healthcare.Gov KidsWell Campaign
Georgetown Center for Children and Families
Kaiser Family Foundation Health Reform Source
Community Catalyst ACA Implementation