New Mexico State Senator Dede Feldman's Blog

Keeping Hope Alive Amidst Political Paralysis: Seven Tips

    Here's the graduation address I gave to UNM Political Science graduates on May 11, 2012.... Hope you like it...

            Dr. (Bill) Stanley, Political Science Department faculty members, graduates, family members, friends, thank you very much for the opportunity to share a few  thoughts with you on this very special day which comes for me as much at a cross roads as it is for you, and our country.  Because, after 16 years, this year I am ending my political career in the New Mexico Senate.  16 years. That’s an even longer sentence than many of you, who today begin a new phase of your life, have served at UNM.

            First of all, congratulations to each and every one of you—not only graduates, but families faculty, friends and the constellation of people in the community who support you.  Today is a day when I hope you will see just how many people there are out here in the community who are pulling for you, who are proud of you and who believe in you.  And although I know only a few of you, I count myself as one of those.   And I know that my friend and mentor, Gilbert St. Clair, whom some of you may have known as the advisor to your department’s legislative intern program, is one of those too, even though he is not here today. 

             Almost 44 years ago, in another time of political turbulence—called the 1960s, I was in your exact seat.  I had earned a degree in Political Science from the University of Pennsylvania.  And I had no earthly idea what I was going to do. I just knew that I was interested in Political Science—or at least it seemed so much more compelling than anything else.  Politics seemed fast moving, dramatic, uncertain, and above all, important in determining almost everything about our lives from war and peace to death and taxes. I was curious, I was fascinated, obsessed.  I was a news junkie, a groupie for my heroes in the civil rights movement, the anti-war movement and the print media.  I read all about it.

            But I had no earthly idea how I would earn a living with my degree.  And in fact, I couldn’t get a job even with a Master’s degree in Poly Sci.   I veered off into journalism, into high school teaching, into a small public relations company-- whatever it took to earn a few hundred dollars for work I enjoyed. I was thrilled when my first article appeared in the paper.  It was about sludge.  I was thrilled when the first political candidate I worked for won, even though it was only for the school board.   And then-- almost 30 years later-- I found myself running for office, walking door-to-door, loosing, winning, then serving 16 years in the NM Senate.   I just was just following my interest, with no end in sight, no burning ambition. And things happened, just like they will happen to you.

            Now, I don’t know if political science is your passion, or even your interest.  But it’s not a bad place to start, growing into a world of rapid change.  You’ve seen a little of this rapid change already as the events of 9/11 shocked our world, and later when the political optimism brought on by the election of the nation’s first black president  descended into partisan bloodletting and political gridlock.   Meanwhile, the truly big economic and environmental problems your generation will face—wait in the wings while we try to overcome our political differences and develop the will to move forward together.

            You will be crucial in that endeavor. I am counting on you.  You know how it’s supposed to work—at least in theory.  As we go into this year’s election season—which promises to be more divisive, more expensive than ever, due to Citizens’ United and the huge amount of undisclosed cash it has unleashed--- you have had a little training. You know how to check the facts, detect the lies, spot the spin and, for those of you who participated in the 2008 election, or the Occupy movement, or even the Tea Party,--how to join together in social networks, on street corners, at Starbucks, or outside the state capitol in Santa Fe. These things may seem small but they are what make a difference.

            But that doesn’t mean you will do it. You may be turned off by a system where nothing important gets done and money talks with a forked tongue. And it’s no wonder that most people throw up their hands and that our country is suffering from a spiral of cynicism-- where every institution, every leader (except, of course, John Stewart and Steven Colbert) inspire suspicion, --not trust.

             But I am here to help you keep hope alive. And link your future to our country’s revival.   Now, at this moment in history when jobs for college graduates are hard to come by, and the prospect of the economic prosperity that our parents knew remote.

            Here are my top seven tips on how to be all you can be while getting our community, our state and our country off the dime and back on track.

            Number 1: Put it in perspective, dude. You might think that 2012 is a pretty tough year to graduate from college.  But what about 1861, 1933 or even 1942 when graduates faced the draft, the war, the depression?  All things change and change quickly. The war in Iraq is over, for us.   Osama bin Laden is dead. Technology and information are the keys to prosperity, not manufacturing. China is on the rise. Today’s recession will be a memory in a decade.  Stay loose, stay flexible, keep your powder dry.

             Number 2: Have strange bedfellows.  Now that may sound a little tacky, but it is the key to getting things done in the community and the political arena. And it will add more than zest to your friendships, to your projects and your work. Not all of your friends have to agree with you. The degree to which we retreat to our comfort zone is the degree to which we, as a nation, will not arrive at a budget compromise, we will not address forest fires, water shortages, or bring down health insurance premiums.  But if we all get out of our economic or partisan silos, we have a chance to discover our common values. My own experience in the NM Senate, passing campaign finance reform, graduated drivers’ licenses, tobacco taxes and other public health measures, convinces me that these common values are still there-- if we are willing to talk, to compromise and to lay down our arms once the election is over.   This is something I learned from former Sen. Billy McKibben, Sen. Alan Hurt, Rod Adair, Stuart Ingle and others-- all diehard conservatives who have been my allies on important bills—in spite of what their Governor, their party, and sometimes even their constituents, threatened.

             Number 3:  Don’t be afraid to have heroes. I know it sounds corny.  And  look for them in unexpected places… outside the movie theater or the sports field.  I found one, unexpectedly at my doorstep two years ago.  Her name is Jennifer Weiss, and she brought a group of parents to visit with me about the alarming epidemic of heroin overdoses among our high school students, and the abuse of prescription drugs like oxycodone and other opiods.   Jennifer’s own son, Cameron was then in the throes of the addiction, and Jennifer had organized other parents to cope, to break through the stigma, to lobby for treatment programs and prevent future addicts.  Jennifer lost her son to an overdose last fall—but she has not stopped fighting, not stopped appearing on TV and radio, alerting others to danger, pointing the way to a solution. I’ve found other heroes, too, on my travels on the internet, young people who created hugely important tools that help us determine what is really going on in our political life with websites like FollowtheMoney.org, or Fact Check.org which helps us check on the truth of campaign rhetoric. Now another old hero of mine, Kathleen Hall Jamison, a professor of Political Science at my alma mater has teamed up with them to create Flackcheck.org which exposes the psychological manipulation behind TV ads.     It is because of people like Jennifer and web innovators like these that I have hope for the future.

             Number 4: Follow your bliss.  Steve Jobs dropped out of college, took a course on the only thing that fascinated him—calligraphy. He fooled around with computers, he got fired, he figured out that calligraphy was related to design, to fonts, to keyboarding.  He succeeded.  I was writing articles on sludge and loosing a city council election by 9 votes.  Tavis Smiley was in prison.  We all failed, but, as Tavis Smiley says in his new book  we failed UP.  Our failures, our diversions contributed to our successes. And we all followed our bliss.

             Number 5: Remember that this is New Mexico. We have always pieced things together here with a pragmatic, can-do spirit that stretches resources and comes up with truly creative solutions. We are different. We build our homes out of the earth, we cooperate to irrigate our fields, we speak different languages, we have the landscape and the mountains, from whence cometh our strength. Look around every once and a while and remember where you are.

             Number 6: Don’t forget that you  have the decoder ring.  Education. And that is power, power from the knowledge you have worked hard to accumulate, from your continued curiosity and energy. As the life of Jennifer Weiss bears out, courage and character count, one person can make a huge difference and even small gestures of kindness have impact beyond imagination.  Don’t be afraid to exercise your power by participating in public life, expressing your ideas, doing a lot, or just a little.  Because the world is made up of the little things, and no one makes a greater mistake than those who do nothing because they can only do a little.

              Finally, Number 7:  I hope you will develop what William Sloan Coffin called a Passion for the Possible knowing that the ideal may be just beyond your grasp but the good is near at hand and there are many opportunities out there to fulfill your dreams if you know how to roll with the punches.  And there will be punches, there be losses. There will be roadblocks and gridlock.  But things change, the road opens up, history does not run in a straight line.  There is no longer a straight and narrow path to one job, with one skill set and one set of lifelong expectations.

               I think you know that, many of you are returning or non-traditional students and that is precisely why I have faith that you will be there when the road does open up and you will find a way to contribute and succeed in today’s challenging atmosphere.

            Congratulations again on your tremendous achievement and thank you so much for letting me share this great day with you.

Last year’s Fire Season May Only be a Warm-Up for this Summer, says Valles Caldera Chief Scientist

Bob Parmenter, Chief Scientist for the Valles Caldera Preserve in the Jemez, where the largest fire in the state’s history burned over 30,000 acres last June, says that we may just be in “half time” before another devastating fire season.

New research shows that we’re in a two-year drought cycle, he says, and La Nina is now setting us up perfectly for more major fires.

 

I hope we can use this “halftime” to give us another tool to fight fires: the ability for the Governor and local governments to ban and restrict the sale and use of fireworks in times of extreme fire danger. If you agree, sign the petition at http://www.change.org/petitions/new-mexico-legislators-ban-the-sale-and-use-of-fireworks-in-times-of-drought.

Change Takes Time

 

 

    Nov. 4, the day after the day after.....Earlier this week, walking the North Valley for Rep. Martin Heinrich, I came across this sign.  It reminded me that we are all on a windy path, with fits and starts, reversals, then sudden accelerations. And we can’t give up hope just because it’s taking a long time.

 

One reason I supported Martin Heinrich was that he didn’t back down from the sudden accelerations that the Obama administration started in the past two years.  These are not just the big-ticket items like health care and financial reform.  They are long-delayed items like the Lilly Ledbetter Act, which makes it harder to discriminate against women in the workplace, and a law making it harder for credit card companies to surprise you with sudden interest rate increases.  They are laws that give our college students hope and opportunities like the revamp of the student loan program and the increase in size of AmeriCorps and other service projects.  

Rachel Maddow mentioned these on her TV program the night before the election and I agree.  The Democrats could easily have kept their power dry, hoping not to offend anyone, but instead they chose to go for it. They used the political opening created by the 2006 & 2008 elections to enact some truly landmark legislation.  The impact of that legislation will not be felt for years from now—but if we can hold the line—there will be a tremendous benefit.

The same is true at the state level.  I’ve often fought official opponents to children’s’ and public health protection who say that state regulation won’t do anything but enlarge government and impede individual freedom.  That was the argument against changing the system of licensing young drivers back in 1999, when I and a number of traffic safety advocates (including the Automobile Association) said that the way to bring down the high crash rate for teens was to make them spend more time behind the wheel –practicing with an adult-- before giving them a full license.  With much difficulty, we prevailed, and even got then Gov. Garry Johnson to sign the bill.   

And now it’s beginning to pay off, eleven years later. Even the SF New Mexican, which railed against the “Nanny State" (I was the chief Nanny), now admits it was wrong in this article from a few days ago. Here’s the article…

 Graduated-license laws help cut teen driving fatalities

The New Mexican

Sunday, October 31, 2010 - 10/28/10

   
We're not major proponents of nanny government — and we're longtime supporters of teenagers' rights and responsibilities. But turn-of-the-century proposals to make teens work their way into adult driving privileges had plenty of appeal — the biggest being the chance that such an approach would save lives.

And it has: The U.S. Centers for Disease Control, the people who keep all kinds of grim statistics, reported recently that fatalities among teen drivers are down by a long ways: Between 2004 and 2008, they had fallen by one-third.

There might be other reasons for that encouraging news: safer cars, maybe even sky-high gas prices. But the feds give most of the credit to what are now known as graduated-license laws.

New Mexico was among the earlier states to impose rules on under-18 drivers. We made licensing a three-stage process:

• Six-month instructional permits, for which youngsters 15 and older, and their parents, must apply, and which involve tests and state-approved driver instruction, as well as 50 hours of supervised driving practice, among other requirements — including driving only when there's someone 21 or older on board.
• Provisional licenses, which depend on compliance with the instruction-period rules and passing a road-skills exam. For the next year, unless there's someone 21 or older along for the ride, the holder can't have more than one other kid in the car who isn't an immediate family member. And, with few exceptions, no driving between midnight and 5 a.m.
• Full licenses come only after completion of the two earlier stages — with clean driving records.

That's a far cry from what middle-aged Americans had to do for a driver's license — and for the many super-responsible teens we know, the requirements might be onerous.

But they're working — in fact, in places like New York and New Jersey, where the rules are even stricter, the fatality rates are lower. And in Wyoming, where kids are behind the wheel earlier than nearly anywhere, the teen fatality rate is highest.

That makes graduated licenses look pretty good — and makes a strong argument for demanding 'em nationally.

Politically, they might not be popular — and who wants to be the spoil-sport who ramrods them through a legislature?...

 The moral of the story is —like the sign says—Don’t Give up….Change Takes Time in Santa Fe as in Washington.  We might look like “spoil sports” now, but give it a few years.

           And as the leadership changes in the Statehouse, we hope that some common sense will prevail and not all reforms will be thrown out the window.  Some of them might save lives and money in the long run.

 

 

 

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. 

 

Blue Cross Rate Hike Approved in Settlement, but Questions Remain

 Individuals holding Blue Cross/ Blue Shield policies will get another rate hike, this one of 21.3% (retroactive to April 1), after a settlement was reached Monday between the company, the PRC’s insurance division, the Attorney General’s office and the lone plaintiff in the rate case. 

The settlement, was announced by Insurance Superintendent Mo Chavez, before I had a chance to request a delay until new federal regulations regarding state rate setting in conformance with the recently passed federal law came down.  The announcement also came in advance of a public hearing on the matter, which had been requested by the Public Regulation Commission.  Members of the public, doctors and policyholders, who came yesterday to give input on the rate hike had the rug swept out from under them, since the decision was already made. 

It was a strange turn of affairs. Representative Danice Picraux and I, who have been following these issues for over a decade as Chair and Vice Chair of the legislature’s Interim Health and Human Services Committee, had submitted at letter earlier (see below) in which we questioned the narrow criteria upon which the decision was made—i.e. the solvency of the company and the presumption that almost any rate increase is reasonable or else the company will leave rural New Mexico in need.   Even given these criteria, we wondered about the information provided by the company to make the rate decision.  Were profit margins, the level of reserves, the loss ratios independently confirmed?  Was any of that information claimed as proprietary? What cost containment efforts had been made?  What is the rate of increase in actual medical costs compared to the rate increase requested?

And most important, is all that information accessible and available to the affected public? In time for meaningful input?

We didn’t get the answers those questions or the many others raised by members of the public.  In fact, the audience was discouraged from asking questions, although Chavez said he would meet individually with questioners afterward to give specific answers.  

Too bad all the compelling testimony was for naught.  Dr. Christopher Fletcher, a family practice doctor from Santa Fe, and a self-styled loyal Blue Cross provider, spoke about his low reimbursement, “birthday surcharges” and his own experience with his BCBS policy.  He noted that medical costs had gone up only 5-6% in the past few years-- a far cry from the 21.3% rate increase this year, and the cumulative 72.4% Blue Cross rate increase in the last four years. 

A local business owner, Carl Rasik, asked just how he was supposed to stay in business with a $1450 monthly health insurance premium—now with a  $1,000 deductible.  And a representative from Consumers Union cited the $6.7 billion in surplus held by the company’s parent, HCSC, and questioned its policy of closing its less profitable insurance pools, and creating new ones for healthier customers, thus creating what she called “death spirals,” where rates skyrocketed.

The whole thing has convinced me that we need to broaden the criteria underlying rate setting as states like Pennsylvania have done and insure a more transparent process. That will take changes to state law. I’m going to be working on this in the coming months, hopefully with the help of the insurance commissioner and the attorney general.

After all, New Mexicans are spending a higher percentage of their income on health insurance premiums than almost any other Americans, according to the Agency for Healthcare Research’s Center for Financing, access and Cost Trends.

And yet we can’t act to control rate increases as we phase in the new federal health care reforms?  Whoa. There’s something wrong with this picture.

April 22, 2010

File No. 202.182475.1

VIA ELECTRONIC MAIL

Morris J. Chavez, Superintendent of Insurance Division of Insurance Public Regulation Commission P.E.R.A. Building

P.O. Box 1269 Santa Fe, NM 87504-1269

Re: Rate Hearing for Blue Cross/Blue Shield Individual-Plan Rate Increase Request Dear Superintendent Chavez:

We are writing to request your urgent consideration of several important matters that have come to our attention regarding the Blue Cross/Blue Shield of New Mexico's ("BCBSNM") request for an increase of 24.6 percent in individual-plan premium rates and the hearing you have scheduled on this matter for Monday, April 26, 2010.

Firstly, we request that you postpone the hearing on BCBSNM's rate increase until federal regulations pertinent to your decision on this rate increase request are issued. As you know, the recently passed federal health care reform legislation, the Patient Protection and Affordable Care Act ("PPACA"), Public Law, 111-148, contains provisions relating to federal review of rate making, including the issuance of regulations for the federal Department of Health and Human Services' annual review of rate increases in premiums.1                 These regulations are due to be issued by the end of this month, April 2010. It is only reasonable that your hearing be informed by federal law pertinent to your decision making process.

As a matter of due process and affording the public adequate opportunity to provide input through access to relevant materials, we further urge you to postpone this rate increase hearing. A visit to the Public Regulation Commission's ("PRC") web site has revealed that the PRC has not posted any information there regarding this hearing. The page titled "Insurance Hearing Calendar" was last updated in February 2009.2     No memoranda or other materials pertinent to this matter are readily available to the public on this site, either.

In the event that you decide to go forward with the hearing scheduled for Monday, April 26, we request that you postpone the issuance of your decision until the regulations issued pursuant to Section 1003 of PPACA have been released.

Once you hold the hearing, we ask that you consider several factors that our review of the New Mexico Statutes and relevant regulations. We understand that you have to determine whether the rate increase is necessary in terms of whether BCBSNM would remain solvent if it were denied. Yet we ask you to recognize the leeway, pursuant to state law and the regulations promulgated by the Division, that you have when considering whether BCBSNM's rate increase request. The rating standards contained in Subsection B of Section 59A-17-6 NMSA 1978 statethat "[i]n a competitive market, rates are presumed not to be excessive." We understand that, in New Mexico's rural areas, BCBSNM is the only insurer providing coverage in the individual market–that other insurers have very little presence in many areas. Have you examined the coverage of BCBSNM, versus other insurers, in the individual market throughout New Mexico? Is this a competitive market? On information and belief, we would argue that it is not. Hence, we argue that the presumption should not be that a proposed rate is reasonable and not excessive.

In determining whether rates are reasonable and whether a rate increase is necessary for solvency, do you have adequate information? Has BCBSNM accurately and transparently accounted for its current costs? When you request information as to its finances, does it claim that certain relevant information is proprietary? If so, then should not the presumption be that it has not complied with the disclosure requirements that would allow you to make an informed decision as to solvency?

What is BCBCN's administrative loss ratio for these individual plans? What costs can be cut before rates need be increased? What portion of administrative losses go to executive compensation? What amount of premiums goes out of state? We argue that excessive executive compensation and other cost containment measures should be addressed before any rate increase is improved.

Is BCBSNM using good assumptions to projected future costs? How much in premiums does BCBSNM hold in reserve? Two months' worth? Six months'? Twelve months'? Is the amount in reserve reasonable in terms of projected costs?

In considering reasonableness of proposed rates, what are the needs of New Mexicans when balanced against BCBSNM's? We argue that a rate is excessive in a noncompetitive market when large profits are maintained while many more New Mexicans go without insurance due to the increase.

We thank you for your consideration of these many points. In sum, we request that you postpone the April 26 hearing or, barring that, the issuance of your decision until federal regulations have been promulgated. We ask that you consider "competitiveness" in light of the lack of other insurers in rural New Mexico. Finally, we ask that any solvency review include factors such as BCBSNM's level of transparency and the interests of New Mexicans.

Sincerely,

Danice M. Picraux, New Mexico State Representative, District 25       

Dede Feldman, New Mexico State Senator, District 13

 

 

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