New Mexico State Senator Dede Feldman's Blog

For NM Kids with Pre-Existing Conditions, Help is on the Way

The new Federal Healthcare Reform will allow children with pre-existing medical conditions access to insurance come September 23rd. On that date, health insurance companies will no longer be able to discriminate against children with pre-existing conditions such as diabetes, cerebral palsy, cancer, and countless other chronic diseases.

According to a new study out today by Families' USA, there are 64,000 of these children and young adults under 24 years of age who could be denied coverage in New Mexico. This figure represents 7.7% of the population under 18 years of age, and doubles to 16.6% for those between 18-24 years old. Pre-existing conditions cut across all ethnic and income groups.

Dede joined children's advocates and Dr. Benjamin Hoffman, President-elect of the NM Pediatric Association, Thursday to celebrate the expanded coverage and the end to unfair insurance practices. 

"Ultimately, this will lead to more regular checkups and curb rising health care costs caused by chronic and serious disease. We will all benefit", said Senator Feldman

See Senator Feldman and Dr. Hoffman's comments below, or to see the entire study,  click here.

State Legislator to Aid in Implementation of HC Reform

Note:  I was recently appointed to the executive committee of this group of legislators,along with Rep. Sharon Treat, of Maine, and Sen. Karen Keiser, of Washington. For more information call Sen. Dede Feldman 505-220-5958.

Daily News

White House Gives State Lawmakers Nod To Help Shape Reforms

Posted: May 12, 2010

Following a nod from the White House two weeks ago, state legislators are setting up a nationwide-group that is expected to play a key role in the federal government's implementation of the new health reform law, particularly when it comes to policies affecting states. By forming the group, state lawmakers who informally helped shape the federal law will now be ensured a seat at the table as HHS writes implementing regulations, sources say.

The Working Group of State Legislators for Health Care Reform had already existed as a loosely formed informal group of state lawmakers – a group the White House had encouraged to form about a year ago in support of health reform, said Iowa Democratic state representative Jack Hatch. The group has always been self-directed, despite being formed at the administration's urging, and now has White House support to expand and take on a more formalized role.

White House officials were pleased that state lawmakers wanted to play a role in the reform law's implementation, Hatch said, so they gave the go-ahead to the group. The group will form an executive committee and within a month the group is expected to come up with a handful of policy areas on which it will work with HHS and others. Representatives of the group will meet quarterly in Washington with Congress, the White House, HHS and others involved in implementation. They already have been participating on weekly phone calls that include insurance commissioners, Medicaid directors, and HHS officials.

At present, the group has nearly 90 representatives from 32 states, and plans to expand its membership to all 50 states within two to three weeks, Hatch said. Members are state legislators in key positions, such as chairs of committees with jurisdiction over finance, health or insurance policy.

As a second mission, the group is creating a peer-to-peer education program that will allow states to borrow successful approaches from one another. Five to six focus areas will be identified, Hatch said, and will likely include high-risk pools and exchanges.

One of the first areas the group is likely to tackle are the short-term high-risk pools the law mandates for residents who cannot find affordable insurance. Sharon Treat, a Maine Democratic state representative who also is director of the National Legislative Association on Prescription Drug Prices, said this is a good example of the kind of issue the new group will deal with.

She pointed to ambiguities in the reform law's mandate in this area. For example, she noted that the Maine legislature created a public-private Dirigo Health Agency in 2003 to provide health insurance for people with pre-existing conditions who could not otherwise find affordable health insurance. It's not a high-risk pool, but it serves much the same purpose, Treat said, and it's not clear whether it fulfills the high-risk pool requirement under the new health law.

HHS gave states several options for high-risk pools, including establishing a new pool to supplement any special insurance programs they already maintain for high-risk residents.

A less-formalized version of the state legislators' group played a role during the congressional debate. It offered political support for health reforms and became involved in helping shape the legislation that ultimately became law, Hatch said. For instance, the group pushed for cost containment, which eventually led U.S. congressional staff to come up with the Independent Payment Advisory Board. The group also was instrumental in getting the reform law to limit the cost of insurance plans offered in the state exchanges to 9 percent of family income. The state lawmakers also advised the U.S. Congress on the level of funding that states would need and encouraged measures requiring minimum standards for plans in the exchanges. (Not all efforts were successful. The group pushed hard for a public option.)

Once the reform legislation was signed into law, Hatch and others decided to approach the White House about formalizing the group so states could influence the law's implementation.

U.S. Congress left it to states to reform much of the health care system. States must set up the insurance exchanges, oversee Medicaid's expansion, integrate Medicaid with the exchanges, apply new income eligibility standards and enforce the new insurance regulations.  States will vary in how they handle implementation, a House Ways and Means staffer said. States that already were operating managed care programs will likely fare the best because they will be able to absorb at least some of the new Medicaid recipient with contractors that run the managed care projects. --John Wilkerson

 

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.