Blogger's note: Two December developments: KUNM has started running periodic commentaries from me...here's the first one.... The Con Alma Foundation surprised me Dec. 6th with the Hero of Health Award. I thought I was just giving a speech on Health Care in New Mexico, which is posted here.
This year's New Mexico Campaigns Have Consequences-- Beyond Who Wins
New Mexico may not have been a swing state this year in the presidential election, but someone upped the ante when it came to the legislature. SuperPacs poured almost $4 million into roundhouse races, most of it for TV ads and hate mail asking questions like… “Should we stand with the Victims… or the Child Killers?.... The Governor’s PAC, Reform New Mexico Now, spent almost $2 million to take out Senate leaders and win back the House with ads like these. The Patriot Majority, the Democrats SuperPac, did damage as well. The money for both came from out-of-state oil companies, unions and rich donors …. the cash unleashed by the disastrous Citizens United ruling.
In 1996, when I first ran for the New Mexico Senate, I was proud to raise $50,000. This year, Sen. Tim Jennings spent almost $400,000. Michael Sanchez, another target, spent almost $300,000.
TV ads pushed the costs through the roof. The contribution limits --passed by the legislature a few years back-- could have held down the costs—but they collided with the deluge of cash from out of state-- and everything went HAYWIRE.
The candidates themselves became less and less important. Both Democrats and Republicans in key House races told the independent PACS to “butt out”—but it was too late. By law, the PACs can’t coordinate with the candidates. So, the onslaught continued.
A whole new type of election is emerging, where districts, and local candidates,…count little compared to the hyper-partisan priorities of the Super-Pacs.
That’s bad news for legislators who go to Santa Fe to solve problems and serve their constituents—not just take sides and score points. This year’s campaigns will make it harder to find common ground with the executive, to listen and to reach consensus -- even with the best of intentions.
I’m hopeful that legislators will keep working on alternatives like public financing, shorter campaign seasons, and controls on independent spending. And I’m glad that ordinary citizens are pushing for a constitutional amendment to overturn Citizens United…. Without some major changes, more gridlock and acrimony are headed our way.
Con Alma Remarks: All Health Care is Local
Santa Fe, December 6, 2012
Thank you Delores, thank you Con Alma for the great privilege of being here to night to cheer on the recipients of this year’s awards as we head into a year that promises to be filled with the most rapid change in our health care system that we have seen in a generation. Now, more than two years after its passage—Obamacare is the law of the land, and states everywhere are finally grappling with the decisions they need to make and the money they will have available—if they so choose-- to cover the millions of people now without insurance.
I think – years from now-- we will look back on this period as a turning point, a turning point equal to the beginning of Medicare or Social Security, both of which were dogged by fierce resistance for a few years but which now are accepted as part of the fabric of American life.
And you are on the cutting edge in New Mexico—because no matter what comes out of Washington and even Santa Fe—all health care is local. It happens when the doorbell rings and a promotora or a home healthcare worker arrives to help a stranded grandparent caring for a disabled child. It happens when the phone rings at a suicide prevention center and a young person talks a peer out of doing something unthinkable. It happens when a dietician finally connects with elementary students and they develop healthy habits instead of the endless cycle of junk foods and TV watching.
But that’s not to say that you should just focus on your own projects. There are some important trends that are just beginning and you need to figure out where you fit in, and how you can turn them in the right direction. The Medicaid program is changing. The administration—and the legislature-- is deciding whether to expand the program which now covers 550,000 people-- mostly seniors in nursing homes, children and people with disabilities. The decision is crucial. The health of 150-190,000 New Mexicans hang in the balance. Last summer’s Supreme Court Decision upholding health care reform left it to the states whether to expand their programs. The Governor needs to hear from you what we hear at a recent meeting of the Health and Human Services Committee. The federal government is paying the bill for the expansion completely for the first six years and after that the state will have to pay only 10% of the cost. When you consider the economic activity, the new taxes and the 6000 jobs that the expansion will create there will be little net new cost to the state—maybe $20 million in 2020. It sounds like a lot but it’s really a small amount in comparison to the cost of other programs and for what we’d get. Hospitals, clinics that stand to gain paying customers are already on board. So are counties who will have to pay less for indigent care. But ordinary people need to weigh in too by calling and writing the governor’s office and telling her that it would be insane not to expand Medicaid. The legislature will have bill on this during the upcoming session, too. Keep your eye on it. Call the governor at 476-2200.
You know I’ve found that Medicaid is a not a sexy topic to talk about in speeches—even to groups who are quite involved. People’s eyes tend to cross at the mention of FMAP, the matching rate at which the feds fund the state, or FPL—the Federal Poverty Level, which determines eligibility for the program. But it is of crucial importance to our state—and we are now emeshed in a major reform of the program, quite unrelated to the question of whether it is going to be expanded or not.
During the next year, the administration will be creating a new program—Centennial Care--- which it says will streamline and modernize the bureaucratic system, which is now operated by a slew of managed care companies. How this turns out will be crucial to New Mexico. If done correctly it could provide a proving ground for new models of care that promise to do what we need to do in the broader health care system, namely: improve the quality of care while bringing down the cost. Centennial Care might lead the way with its emphasis on care coordination (some of us used to call this case management) and by rearranging the payments and reimbursements to providers to eliminate duplication and reward good outcomes.
We all need to monitor—encourage, and fine tune— the medical home and accountable care organizations that are sure to spring up in the next few years. And we need to hold the Department accountable for how Medicaid will serve Native Americans and people with mental health and substance abuse problems. The Behavioral Health System is still in crisis--- and the verdict is very much out on whether the department’s decision to put those services back into the overall Medicaid program will work…. Or whether the money for this vulnerable population will somehow disappear into the bureaucracy of the overall Medicaid program.
So, and this is my conclusion, the devil is in the details. The details of whether the new Medicaid contracts will put the funds for behavioral health in a lockbox; the details of whether the new Health Insurance Exchange will be more than a brokerage to help insurance companies sell their products at whatever price they can get, the details of how and whether New Mexico can create a new health care workforce which will include some unconventional practioners—telephone operators who extend care to a worried mother, dental therapists who reach out into the reservation, or health coaches who keep diabetics on track.
(Actually those last ones are not details but important new trends that just might involve some of you as we enter the brave new world of health care reform.)
Thanks so much for the opportunity to speak tonight. Congratulations and good luck with your projects.