New Mexico State Senator Dede Feldman's Blog

Happy Thanksgiving: Update

Let Them Eat…. Pizza and Fries—Really?      Just when you thought Congress had hit rock bottom, came news last week that US School Lunch guidelines willcontinue to feature French fries and pizza (with the tomato paste counting as a vegetable). Congress caved to the frozen pizza and French fries lobbyists—a weighty force in DC. Click here for details.  The news came as I attended a national legislative conference held last week in the Duke City about the epidemic of obesity among school children and the coming diabetes epidemic that the Institute for Medicine now says will hit 2 out of 10 Americans by 2030.       Here in New Mexico we’re already on the front lines, with 33% of our children obese or overweight.  Among Albuquerque public school students, the rate is 34%, or 22,000 children in grades K through 8. Here are two maps of Senate District 13 showing that 19-25% of local 8th graders are extremely obese, and that 35% or more 5th graders are overweight and obese.           Obesity is currently costing New Mexico $329 million in medical costs each year, but the good news is that the National Conference of State Legislators brought their conference here, because we are beginning something about it.  Schools like Griegos Elementary are holding fun runs, and trying to integrate more physical activity into each day, despite the lack of funding for PE. Students and teachers are planting community gardens at Alvarado and Kirtland elementary schools and students in the Valley cluster enjoy fresh fruit and vegetable snacks from New Mexico several times a week, thanks to a pilot program I started a few years ago.  But there’s much more to be done.   Republican Party Seeks to Overturn State’s Campaign Contribution Limits—Groups Fight Back      New Mexico’s hard-fought measure to limit campaign contributions and the influence of big money on politics, which I co-sponsored in 2009, is the target of a lawsuit brought by the Republican Party, the oil and gas industry and Sen. Rod Adair.  The lawsuit is part of a nationwide effort spearheaded by Indiana lawyer James Bobb in advance of next fall’s elections.  The suit is aimed at the contribution limit of $5,000 to parties and political action committees—both the source of big money in campaigns.  Bobb was the lawyer in Citizens United, which determined that individuals and corporations could make unlimited contributions to support or oppose candidates as long as they don’t contribute directly to them.        Sen. Adair was the lone vote against the 2009 bill in the Senate, which brought reform to one of the last states to allow unlimited contributions.  I read the brief and was amazed at its audacity.   It repeatedly states that the reason for the suit is because the Republican Party, Adair, Harvey Yates (head of the oil and gas association) “are ready, willing and able” and want to make and accept contributions greater than $5,000 RIGHT NOW.        So much for one person, one vote.      Meanwhile, there’s action on a national level to halt the systematic effort to dismantle campaign finance reform and prevent big donors from crowding out the rights of ordinary folks who cannot make huge contributions.      Citizens are beginning to fight back against the 2010 Supreme Court ruling in Citizens’ United which removes controls on special interest spending and gives corporations the same rights as individuals. A recent public opinion survey by Hart Research found that 57% were dissatisfied with our political system, and 79% favor a constitutional amendment that would overturn the ruling and make clear that corporations are not people, and Congress has the authority to limit corporate spending on elections.      Amending the US Constitution is a long process but it has been done many times.  Sens. Tom Udall, Dick Durbin, Jeff Merkley, Chuck Schumer and Sheldon Whitehouse are starting the process by collecting petition signatures.    Sign here to allow Congress to regulate the big money.  Another organization in town recently is pushing for a broader amendment to ensure corporations are not considered people. For more information go towww.freespeechforpeople.org.   The Health and Human Services Interim Committee, which I chair, has heard a season’s worth of testimony about the alarming increase in drug overdoses, (New Mexico is now number one) prescription drug and teenage heroin addiction, Native American suicides, and more.  We’ve heard about health insurance rates, “medical homes,” and other ways to bend the rising curve of health care costs. We have followed the new administration’s approach to health care reform (an Office of Health Care Reform has now been set up and New Mexico is applying for a $34 million grant to set up a health care exchange).  We continue to wait for even a barebones plan to “modernize” the Medicaid program, as promised by the Human Services Department in June.      The final meeting of the committee will be held Nov. 30-Dec. 1. Still hanging in the balance is how to structure a Health Care Exchange, a marketplace for health insurance policies that is a major component of health care reform.  The Governor vetoed my exchange bill in March. Stay tuned for action on this item during the upcoming session.   Neighborhood News: Local Heroes       I continue to be so proud of Griegos Elementary.  They are the only school in New Mexico to receive the US Dept. of Education’s Blue Ribbon Award for the 2011 school year.  It’s a tribute to several years of hard work by the students, teachers, family and staff.  Principal Tom Graham deserves extra credit, too.      I am likewise proud of the Alvarado Neighborhood’s Joining Hands project, now on display in the new education building at the Rio Grande Nature Center where Candelaria dead ends into the river.  Kathy Chilton and Lauri Dickenson know how to make beautiful lemonade out of lemons.  The lemons here were the contentious feelings about the state construction project—and the lemonade consists of the beautiful montage of hands attached to neighbors of all sizes and stripes.  No two are alike!  The exhibit will be on view until Dec. 18, Saturdays and Sundays 2-4 p.m. Free!  Visit this web page for more info.

A September 2001 Letter to My Constituents-- Ten Years Later

Bloggers Note: Ten years ago, the New Mexico Legislature was in a special session to do redistricting, as we are now. Here, for history's sake, is a letter that I wrote my constituents at that sad time to tell them how we reacted to 9/11 in Santa Fe. 

Sept. 25, 2001

 Dear Friends, Neighbors and Constituents,

 I set out to write this letter to you two weeks ago to bring you up to date on the special redistricting session which started earlier this month. On that very day, September. 11, our session was shaken by the unbelievable events in New York, Washington and Pennsylvania.  Shortly after the first reports came in, a bomb threat forced evacuation of the Capitol.  Precinct boundaries and district lines quickly fell by the wayside. As the State Police circled the building, many of the Senators and Representatives gathered outside, listening to car radios, wondering, like all Americans, what was next. 

I got a rare telephone call from my teenage daughter.  She wanted to know what was happening to our country.  Throughout that terrible day, I remember how the New Mexico sky remained heartbreakingly blue, a reminder of just how far we were from the chaotic scene of death and destruction to the East. 

 Within the space of a few hours, the Governor and leaders of the House and Senate decided that while safety might dictate adjournment or recess, duty and honor demanded that we conduct business as usual, without bowing to intimidation.  We quickly met in joint session, a small show of solidarity and courage in the face of the unknown.

 The outpouring of food, financial aid, and blood donations from New Mexicans in the days that followed is now well known.  In short order, clergy from the Santa Fe area organized a ceremony of prayer and remembrance in the Capitol rotunda on Friday Sept. 14, which drew Santa Feans of all stripes.  There were Sikhs from Northern New Mexico, young Native American drummers, Catholic bishops, Jewish rabbis, plaza vendors, and many who simply walked in from the street.  Secretaries and state office workers, many of them waving small flags, packed the balconies overlooking the rotunda.   The tremendous display of unity amidst all of our differences—here at the Capitol and later in Yankee Stadium-- reaffirmed my deep belief that our diversity is our greatest strength.

 We now stand in the difficult position of insisting on justice at the same time as demanding that the rule of law be maintained.  I hope that we can transcend the urge to unleash the fury of our military power upon the world, and become the thing that we hate. Our country must set an example—of judicious wisdom, firm solidarity, and determination that we will not allow any rogue nation or group to determine our behavior. But we must also choose the way of humanity and peace.  I am very proud of the rescue workers from Albuquerque who went to New York and the Pentagon last week, as well as the firefighters and emergency medical technicians who stand ready to do the unthinkable here in New Mexico.  They are our local heroes

 Please call, write or e-mail me to find out about the results of our redistricting session.  In brief, the Senate plan we sent to the Governor created a new seat on the West Side of Albuquerque and in the Torrance County area, where population has grown.  My own district grew to the North and East to approach the ideal population for a Senate District, approximately 43,000.  However, because the plan did not create new Republican seats,  it will likely be vetoed by the Governor.  There is already court action, and I anticipate more.

 Meanwhile, I would like to extend my heartfelt sympathy to those who lost loved ones on September 11 and especially to our children who will remember this day long after we adults are gone.  We must all work very hard to make sure that hatred and bitterness do not have the last word.

 With great pride and gratitude for being a part of this caring community, I send my warmest regards. 

 Sen. Dede Feldman

 

 

 

 

 

Justifying the Unjustifiable, Looking into the Abyss

            The current standoff in Washington has seniors, retirees and many others here in the North Valley worried.  A few days ago, a checker at my local supermarket, John Brooks, at 12^th and Candelaria, called me over as I was buying some fruit for a potluck I was going to that afternoon.

            She recognized me from my campaign walks through her neighborhood. 

            “Senator Dede, What are you doing to us?” asked Maria Soderstadt, a cashier who has been working at John Brooks for as long as I can remember.  “Retirees can’t take this anxiety. Social Security---that’s our money.  We paid it and now we depend on it. 

            “I am 70 years old,” she continued. “ I work everyday.  Every part of my body hurts, but I work.  I’m not so much worried about me, but my sister…she gets $500 a month I Social Security and she lives on that.  It’s not fair to take it away. “

            There are millions of Maria Soderstadts out there across the country wondering how their leaders deserted them, and how they could possibly play this risky game with the lives of America’s most fragile citizens.

            And I had a tough time explaining. I am often called upon these days to justify the unjustifiable.

            I’ve always believed  (and I’m in the Democratic mainstream here) that the greatness of any society is judged by how it treats its most vulnerable citizens.  So it’s a particular affront to me, too, to see huge program cuts going forward, with nothing gained in return, except maybe a temporary hike in the debt ceiling.

            I hope that’s not where we end up—and so do the majority of the American people.  Polling data from almost every source shows a majority people want a balanced approach, with tax increases on the wealthy along with program cuts, and that a plurality will blame the Republicans for any default.  But no matter, that still leaves seniors, people with disabilities, children, as well as ordinary folks like you and me with checking and savings accounts holding the bag. 

     Federal Medicaid Cuts Loom

            If we use the Ryan budget as a guide, the biggest bite may come out of the hides of Medicaid recipients—and states who would have to pick up the pieces for nursing home residents and the disabled, especially.  Rep. Christopher Van Hollen, of Maryland, has a good take on this at in yesterday's Baltimore Sun at http://www.baltimoresun.com/news/opinion/oped/bs-ed-medicaid-20110725,0,1063569.story             

Families USA recently put out a report, which quantifies the jobs, lost in New Mexico with federal Medicaid cuts.  It is not a pretty picture.  They even have a Medicaid calculator where you can calculate the economic loss to the state at www.familiesusa.org.  

 

More Veto Reactions from Sen. Tim Keller and Dede Feldman

Here are two releases that TIm and I put out on Friday April 8, after word came of Gov. Susana Martinez' vetoes.  

SEN. KELLER DISMAYED BY GOVERNOR’S VETO OF TRANSPARENCY AND ACCOUNTABILITY BILLS

 Albuquerque, NM - Governor Martinez had an opportunity today to create more transparency in how the state does business.  Unfortunately, the Governor has vetoed multiple bills that would, after years of fighting with the previous administrations, finally move the need on good government in our state. 

 Keller noted, “She supported two accountability bills (HB 64 – Larranga/Keller) and SB 44 (Keller), but what a missed opportunity for her to deliver on what New Mexican’s clearly spoke in favor of with their votes last November.  It seems that it doesn’t matter who is the Gov’s chair, they will to protect their power regardless.  We can’t properly govern out state without the right information, and we can hold anyone accountable without knowing results of our efforts.”

 “All of these bills were bi partisan and overwhelmingly supported.  The legislator is elected, and charged by our constitution to make laws, that should mean something.  These are in step with the Governor campaign results, New Mexicans clearly wanted these signed.  Unfortunately something else seems to have driven these veto decisions.”

 •SB 25 Economic Targeted Investment Oversight (Keller): The State Investment Council will establish a formal structure and performance metrics for all the ETIs (NM private equity, film fund, etc) to be reviewed separately by a state investment council (SIC) subcommittee. 

 •SB 17 /64 Remove Governor from the SIC (Keller/Neville): the number one recommendation by the Ennis Knupp research completed in 2010 was to remove the Governor as chair of the State Investment Council (SIC). 

 •SB 47 Tax Expenditure Budget (Keller): Requires tracking of all revenue foregone by various tax carve outs, deductions and incentives and track the benefits associated with each policy to the economy (jobs created, businesses grown etc).  This is used in 42 other states in one form or another.  LFC estimates we have 108 tax carve outs, at least $1.3 billion in total exemptions, incentives and tax expenditures.

 •SB 187 Program Evaluation and Accountability (Keller/Bandy): would have created legislative office of accountability and enable the Legislative Finance Council to receive and protect confidential information necessary for its important oversight function.  The bill originated from recommendations made by the Legislative Structure and Process Study Task Force.

 New Mexicans can no longer afford to be manipulated on these important issues; get the politics out of investments and taxes. 

Governor’s Exchange Veto May Mean More—not Less--Federal Control of Insurance Marketplace

     Governor Susana Martinez’s veto of SB 38 &370 will leave the state with less time and fewer alternatives to a federally controlled Health Insurance Exchange, said the measure’s sponsor, Sen. Dede Feldman.

     “We have lost an important opportunity to set up a competitive New Mexican marketplace that gives consumers clear choices and brings down premium costs for small businesses here,” she said.

        SB 38 was supported on a bi-partisan basis in the Senate because it was a non-political entity set up outside of state government, utilizing the leadership of the Health Insurance Alliance and the New Mexico Insurance Pool, two entities previously created by the legislature to help businesses and families unable to get—or afford—insurance.   Funding for the Exchange would have been provided by the federal government through 2015.  After that, the Exchange would have to be self-sustaining through assessments on member organizations.

            Last year, New Mexico received $1 million to begin planning for a state exchange, and work is already underway, said Feldman.  “But further funding is dependent on the legislature setting up a governance structure, which SB 38 would have done.” she said. 

            It may be impossible to set up a web site, and a complicated IT system, which integrates private insurance and Medicaid eligibility by 2013, the date that the state exchanges must be “standing up” according to the federal Patient Protection and Accountable Care Act. 

            “It will really be difficult without federal funds,” she added.

            Feldman said that SB 38 &370 was the product of a nine-month task force on health care reform that included legislators, administrators, and stakeholders from the insurance, business and consumer sectors. 

            “I am just not sure whether there is an appetite to go through this process again during a special or short session,” she said.

            “We really tried to negotiate with everyone during the process,” said Feldman.  “At this point our best option may be to work with our Congressional delegation on a federal- and not a state- insurance exchange that will work to lower costs for consumers and businesses.  As a state, we may not have as much input, but it may be a better deal for consumers and businesses, since national—and not local insurance plans will dominate a national exchange, and they might offer lower prices since they can pool more policies together. “

            For more information, call Senator Feldman at 220-5958.

 

 

 

 

Veto Reactions April 10, 2011

    Bloggers Note:  Here's Health Action New Mexico's Reaction to Friday's  veto of SB 38 &370, which I co-sponsored with Sen. George Munoz :   

GOVERNOR MARTINEZ VETOES NEW MEXICO INSURANCE EXCHANGE ACT

Delay to Implement May Cost New Mexico Millions of Dollars in Federal Exchange Establishment Funds

 

Today Governor Martinez announced her veto of SB 38/370, the New Mexico Health Insurance Exchange Act passed in the recent legislative session with bipartisan support.

State health insurance exchanges are a key component of the federal health reform legislation passed in 2010.

 

State exchanges are consumer-friendly, web based marketplaces that provide health insurance in a combined risk pool for small businesses, sole proprietors, and persons buying insurance in the individual market.  Also included would be persons currently uninsured due to affordability or pre-existing conditions. Federal subsidies for insurance premiums will only be available to those purchasing health insurance on the exchange. The state exchanges will begin functioning in January, 2014.  The federal government will set up the exchanges in states that do not have their exchange ready by January, 2013 including an IT system that can coordinate with Medicaid and other related services.

 

 

The vetoed SB 38/370  NM Insurance Exchange Act was a merged amended bill representing hours of compromise between various stakeholders weighing in on the best solutions to set up an exchange in New Mexico.  The bill built upon the expertise in New Mexico of setting up two state high risk pools and the NM Health Alliance for more affordable health care for small business.  It incorporated the recommendations of the SMJ1 Health Reform Task Force set up by the NM legislature in the 2010 session and the Executive Health Reform Task Force set up by the Governor in April of 2010.  Stakeholder groups of insurers, providers, small business , consumers and advocates weighed in on those recommendations over 8 months for both task forces.

 

“As a consumer organization committed to health care coverage for all New Mexicans, we are very disappointed not to see this legislation signed, ”  said Barbara Webber, Executive Director of Health Action New Mexico.  “A state exchange is especially important for New Mexico which has the 2^nd highest rate of uninsured persons in the country.  One out of four New Mexicans is currently uninsured and most of them hold jobs.  New Mexico is also a small business state for whom more affordable health coverage is very important” elaborates Webber.

 

State health exchanges will provide affordable health care to small businesses in New Mexico in three ways: 

• First, already in 2110, the new law starting providing tax credits to small businesses of up to 35% for health coverage provided to employees.  This tax credit for over 20,000 small businesses will increase once the state exchanges are started in 2014.
• Secondly, the exchange will put employees of small businesses as well as people who buy on the individual market in a combined risk pool so they will have the discount advantages of large group plans. 
• Thirdly, it will provide subsidies to employees getting their insurance through the exchanges who are 400% below the poverty level.

This leveling of the playing field for small business means they can recruit and retain employees who otherwise sign on with large employers to have access to health insurance.

 

“We are glad that Governor Martinez supports an exchange framework as noted in her veto letter.  However, we are concerned that by vetoing the exchange bill at the juncture, Establishment Federal funds will now be delayed for New Mexico at a cost of millions of dollars.  Furthermore, the milestones to maximize benefits for setting up an exchange in New Mexico might not occur in a timely manner” said Webber.  This would mean that the federal government would set up the exchange for New Mexico.

“We hope that Governor Martinez will work collaboratively with all stakeholders in the complex task of creating the state exchange.  Health Action New Mexico and consumers look forward to being part of the process.”  

Sen. Feldman's  reaction:  It may be time to work with our Congressional delegation to have the US Health and Human Service Agency in Washington set up an exchange for us. That's the position we're in now. Under the new law, failure to have an exchange standing up by 2013, will mean loss of federal planning dollars and a default to a federal exchange.  Who knows maybe the costs would be lower and choices better using a federal pool.  It's all up in the air, in light of the veto.  

Let me know how you feel-- a state or federal health insurance exchange???

 

Stewart Udall: He was a Friend of Mine

    The folksong  "He was a Friend of Mine" sung by several Udall children and their friends, was a great theme for the moving celebration of the life of Stewart Udall, former Secretary of the Interior, defender of Navajo uranium miners, and father of the current environmental movement.  The three hour memorial Sunday June 20 was held at the Paolo Solari Amphitheatre under the blazing solstice sun. Friends from all stages of Udall's life, including Bruce Babbitt, Native Americans, two US Senators, renown authors, professors and environmental activists spoke from the heart.  

    As for so many others in the audience, Stewart was a friend of mine-- and a mentor.

    Most recently, during the meetings of the Governor's Ethics and Campaign Finance Task Force several years ago, he keep my spirits up with his steadfast advocacy of public financing of elections and his warnings about the corrosive impact of money on the political system.  Earlier, when I met him in 1988, during his son's  (unsuccessful) run for Congress in the Albuquerque area, his broader view brought me, the be-leagured press secretary for candidate Tom Udall, down to earth.   Amidst a barrage of negative advertising vs.Tom from opponent Steve Schiff, Stewart quoted Mark Twain....   "It takes  only a minute for a lie to go around the world, but it takes an hour for the truth to get its boots on." 

    I will not summarize Stewart's celebration here  (he planned it-- down to a four minute limit for each speaker)  but here are a few quotes from the occasion. 

    Advice from Stewart: • Don't let indecision and regret take away your life-- move on

•As you age, compare who you wanted to be with who you are now

•Consider how you are viewed by your family and friends

    Herbert Brown, long time advocacy partner:  " He was where power, advocacy and literature intersect."  A mountain climber, he was always reaching for a handhold a little higher.   

    Blogger's note: his results:  The Clean Air and Water Acts, The Wilderness Act, a expanded National Park System, the Endangered Species Act, the National Trail System, the Land and Water Conservation Funds, and the Wild and Scenic Rivers Program.   

    Robert Stanton,former director of National Parks and  now Deputy Secretary of the Interior Department l:  "I still have the letter in which Secretary Udall, my Secretary, appointed me as the first African American park ranger in Teton National Park.  This was at a time in the early sixties when I could not be served lunch at restaurants in my home state, on account of my race."  

    Patti Limerick, University of Colo. Western Historian, who visited Udall in his later days, for walks around Santa Fe,  recalled how he he would say,  "Now we can pick up the pace," just as she thought he was finishing. 
 

    Friends of Stewart's recounted his  advice and a posed a question left in his wake:  

    " Never Neglect the Mystery"   and Will You take care of the earth? 

    From James McGrath:  Stewart's memory will green the earth-- more than once." 

New Health Care Reform Law Targets New Mexico’s Health Workforce Shortage

Here's the complete version of the article that appeared in today's Albuquerque Journal ( May 4, 20100) which I wrote along with Dr. Dan Derksen, of the UNM Medical School.  He's a Family Doctor and knows a lot more than I do.  

     A little over a month ago, President Obama signed H.R. 3590 the “Patient Protection and Affordable Health Care Act” and H.R. 4872 the “Health Care and Education Reconciliation Act” into law.   By 2014, it is estimated that 240,000 New Mexicans will be eligible for private insurance through insurance exchanges and another 125,000 through Medicaid expansion in our state. That’s the good news.

But will we have enough health providers to care for an additional 365,000 (out of our estimated total of 450,000) uninsured that will have health insurance? By 2025, there will be a shortage of 40,000 primary care physicians in the United States and up to a million nurses.  New Mexico’s current primary care physician shortage is 400 and will grow to 950 in 10 years.  A recent study by the Commonwealth Foundation ranked New Mexico last in access to health care of all states, and last in access to preventive services. That’s the bad news.

While opponents of the bill have said that this shortage dooms health care reform, they overlook some important elements of the new law that have not received the media attention they deserve.

       Provisions in the federal legislation that begin this year will help states build the health professional workforce over the next four years to prepare for insurance coverage provisions that begin in 2014.  

Many of these provisions were inserted by our own  Senator  Jeff Bingaman who is familiar with our shortages—and successful pilot projects-- here. 

First, the bills allocate $125 million over 3 years in grants, and another $230 million over 5 years in direct and indirect graduate medical education funding for “teaching health centers” based on models pioneered in New Mexico (La Familia and St. Vincent’s in Santa Fe, Roswell, Albuquerque’s South Valley Health Commons, and in Hidalgo County) in partnership with UNM. Training in these community-based centers increases the retention of UNM medical school graduates who practice in New Mexico two- to threefold. Retention of UNM graduates has been a problem in the past-- currently approximately 25 percent remain in the state. This new funding could help start new primary care residency programs in community health centers and rural hospitals in places like Silver City and Farmington. 

 

Second, the bill creates a National Health Workforce Commission to design funding and incentives, and to evaluate the implementation and revision of federally funded programs, grants, and regulations related to the nation’s health workforce including nursing, dental, and medical professionals.  We need it.  What we are doing now is not enough.

              Another very important provision will increase Medicare, Medicaid and Children's Health Insurance Program payments for primary care services by 10%. Commercial insurance payers follow Medicare’s lead in paying for primary care so this is an important change and it will actually save money in the long run, since regular, routine care through a family physician, nurse practioner or other primary care provider prevents illness, manages chronic disease and curtails costly health catastrophes.    

The new payment schedule will also encourage medical students to go into primary care, instead of more lucrative specialties to which many are drawn to pay off medical school debt.

         Other provisions of the law will spur models that reward coordination of care – such as the Patient Centered Medical Home. These more-coordinated, multi-disciplinary “homes” are beginning to spring up in New Mexico after the passage of state legislation sponsored by Rep. Danice Picraux and supported by the NM Medical Society in 2009. They are popular with patients who get more wrap-around, appropriate care that fits their lifestyle and pocketbook.  Although these homes are sprouting in other states, New Mexico is very well positioned to take advantage of the new law’s provisions.

       Another provision creates a Primary Care Extension Program, links with academic institutions, creates hubs in communities, and uses health extension agents, to expand primary care training and services. 

       Professional health training is expensive for the New Mexicans who wish to become nurses, physicians, dentists, physician assistants, dental assistants, or pursue other health professions careers.  The new law expands loans, scholarships and grants to encourage health professionals to practice in health professions shortage areas.

At the state level, we currently have a law on the books which subsidizes tuition for medical students who commit to working in primary care in New Mexico’s rural areas.  But, with the current budget crisis, there is no state funding.  The federal law could fund this and other student programs and help fill the pipeline with much needed health providers.

As an added bonus, the National Center for Rural Health Works estimates that one primary care physician generates about $1.5 million in revenue, $0.9 million in payroll, and creates 23 jobs.  Thus adding the 400 primary care physicians needed in New Mexico would create over 9,200 jobs and generate much needed tax revenue for the state.  Four hundred by 2014 – that’s a goal worth shooting for – and now within reach if we act quickly to take advantage of health workforce provisions in the health reform legislation. 

Senator Dede Feldman is the vice-chair of the New Mexico Legislative Health and Human Services Committee.  Daniel Derksen, M.D. is a family physician, senior fellow in the Robert Wood Johnson Center for Health Policy and Professor at the University of New Mexico. 

 

Report from Santa Fe: Health Care Reform Alive in New Mexico

 Health care reform has stalled, then started again at the national level, but here in New Mexico we are slowly but surely putting the pieces into place.  Yesterday the Governor signed a measure (HB12) that would direct at least 85% of premiums paid to health insurance companies go to medical care, rather than administration and profit.  It’s something that we’ve been trying to do for five years, and this year we did it, with the help of some of the big HMOs who has backed this all along.  We also banned insurance companies from using gender for rating purposes (SB 148), hopefully leveling the playing field and preventing discrimination against women.  Some women in NM are now paying 120% more for insurance premiums. Thanks to Sen.Nancy Rodriguez and Rep. John Heaton who sponsored the measures, the Human Services Department and the Governor who signed both of them.

         These two issues were included a national plan, in both of the Senate and the House reform proposals, passed last year.  Many of the reforms proposed in Washington were based on things that states have started in the past few years, bearing out the old adage that the states are the “laboratories of democracy,’ where innovative ideas are put into practice first and, in effect, become pilot projects for later adoption at the national level.

         We’ve already done some of the other things that Obama is now proposing in the wake of his C-Span health care summit with Republicans. We allow 20-somethings to stay on their parents’ plans, even if they are not full time students, until age 27.  We do not allow health care insurance companies the unlimited ability to rescind policies when subscribers become sick and we have been piloting a new, lower-cost model of delivering care that (thanks to Sen. Jeff Bingaman) was proposed for funding in the US Senate bill. It’s called the Medical Home.  Thanks to a measure that passed the legislature last year, there are several “Medical Home” pilots in Taos and Silver city, designed to hook up patients with primary care providers, and wrap a coordinated web of prevention and services around the patient. Some of these are clinic-based; others involve teams and rural providers. The idea is to provide the right care at the right time at the right price.  This year’s legislature expanded on the idea by adding prescribing pharmacists and osteopaths to the team.

         Since New Mexico has the second highest number of people without insurance, in the past few years the state has tried to maximize it’s Medicaid program to provide coverage to as many people as possible.  Low-income women and children have been the primary recipients, but now working adults can receive coverage under the State Coverage Insurance (SCI) Program.  This is a program where employers, employees, the state and the federal Medicaid program each contribute to allow people who earn a family income up to $36,600 for a family of 3 to buy health insurance at an affordable rate.  The SCI program is New Mexico own public-private option and it is working—almost 40,000 people are enrolled.  

         The trouble is that with the state budget under extreme duress, there is pressure to cut the Medicaid program, even though it brings in a hefty match of three federal dollars-to-each general fund dollar.  Enrollment in the SCI has already been suspended and the whole Medicaid program has only been able to approach an even keel because of stimulus money that will run out at the end of the year.

         With financial troubles everywhere, every state is in the same predicament, which is why all eyes are on Washington.  Sen. Bingaman assured New Mexico health officials in December that help was on the way-- either in a Jobs or Health Care bill— and the budget passed in the Special Session assumed $80 million from the feds for this purpose.

But there has been no commitment yet. The plan Obama floated before the recent summit includes an 8% boost in the Medicaid matching rate for certain medical services for states like New Mexico which have already invested in helping the uninsured. 

That would be a big help in a year where New Mexico legislators and health policy makers are embarking on a process of “restructuring” Medicaid to fit shrinking revenues to an expanding number of needy recipients.

And, when and if, health care reform does pass in DC this year, New Mexico will be ready with a Health Care Reform Working group to make sure our own innovative high risk insurance pool and state insurance exchange are ready to roll.  That’s thanks to another measure (SJM 1), which I sponsored in the recent legislative session.

 

A variation of this article appears in this month’s Prime Time Monthly

                 

   

As Health Care Debate Enters Crucial Stage, Sen. Feldman Heads to Washington

    I’ll be heading to Washington early next week, along with legislators from other states, who have been designated to lobby the Senate on behalf of the White House Working Group of State Legislators for Health Care Reform.  The other legislators include Sen. Karen Keiser, of Washington, Rep. Sharon Treat, of Maine and Rep, Krysten Sinema, of Arizona.

            The visit comes as Democratic Senators, unable to muster 60 votes for a pubic option, are considering alternatives, including a private national plan administered by the Office of Personnel Management (OPM), which administers the Congressional health plan, and a buy-in to the Medicare program for people aged 55-64.

Our group had earlier gathered signatures of 1,000 state legislators to support a robust public option, and during the summer and fall have been holding town halls and other events to support reform. 

Many of us are chairs of health committees and involved in Medicaid or our own “public option” programs like the state coverage insurance (SCI) program here.  We’re focused on how these reforms are going to be implemented – since it’s the states that will be catching the ball from Washington. 

We’ll be meeting with the White House staff and visiting with Senators and their staffs, including that of Senator Bingaman and Sen. Udall.

I’m going to be stressing the urgency of “bridge” funding to carry our Medicaid and SCI programs forward until the full reforms kick in.  Due to our current budget crisis, we’re on the verge of ending SCI, and “restructuring” Medicaid, which means cuts in benefits, more co-pays, fewer programs, and lower reimbursements for providers.  Other states are doing the same thing.

As far as alternatives to the public option go, I hope they can save as much money-- $25 billion, according to the CBO— as the public option as well as increase competition and keep insurance companies premiums down.  Most important, these policies must be affordable, which means that middle-income people must have adequate subsidies to purchase them. 

The questions we’re going to be asking are whether these alternatives will really be national in scope, simple, portable and not just a costly, high-risk pool for those who can’t get coverage elsewhere. 

 Medicaid Matters

 I just attended the public hearing on Medicaid “restructuring’ Friday morning I’d say there were 200 people there, many of them disabled, or parents of disabled people. Each had a story on how cuts to therapies, increased co-pays, and reduced spending on behavioral health or other programs would not just decrease their quality of life—but threaten their very lives.  It was very sad. But it doesn’t change the fact that the Human Services Department is short $325 million due to huge increases in Medicaid enrollment, decreases in the matching rate from the feds, and the fact that the stimulus money keeping them afloat will end next year.

While waiting for the federal reforms to kick in (if they pass), the department is looking to restructure the program by scaling back benefits to the those now offered through the State Coverage Insurance Program (SCI).  This will mean a loss of vision, dental benefits (except as riders) and co-pays and premiums for the same services now covered fully.  At the same time the department proposes to allow employers to “buy in” to Medicaid and create new programs for children and adults not currently covered.   The restructuring does not apply to community based waiver programs like the DD, Medically Fragile, the HIV/Aids, and Mi Via waivers.

Here are some comments from the crowd.

“George Orwell is alive and well when cuts are called expansions.”

“This is an embarrassment.  We are not being responsible when we are even considering a 50% cut in these benefits.”

“When I hear about the 40% tax breaks given to the wealthy a few years back and then think about these little children now, it breaks my heart.”

To comment on the proposal or get information go to medicaid.comments@state.nm.us or write Medicaid Coverage Concept, HSD Medical Assistance Division, PO Box 2348, Santa Fe, NM 87504-2348.

 

 

 

This Video from our neighborhood will bring tears to your eyes

"Yes, Obama, we can!" -- 8 year old Fernando Malik Barrios recited this speech by heart at a north valley neighborhood fundraiser at Katie and Andrew Stone's for Obama. Fernando shows how inspired the next generation of Americans is for an Obama presidency. Rebecca Jo Dakota, formerly the head of the NM Commission for the Status of Women, now the director of AIBA, a chamber of commerce for for small, independent businesses caught it on tape, and edited it with a real speech by Obama. It will bring tears to you eyes. Please pass it along in any direction. -- dede