New Mexico State Senator Dede Feldman's Blog

As We Enter the Fall season...

Boots, Suits and Citizens...

...It’s the subtitle of the book I’ve just wrapped up about the NM Senate.  It will be out in January (UNM Press) and I hope you’ll pick up a copy.  Writing isn’t quite as glamorous as it looks in this picture, though… it’s all about research and rewriting…. and sweating blood. That’s been my summer. The “Suits” in the title refer to the lobbyists who play a major role at the Roundhouse—for better and worse. They’re also the subject of an interview I did for the NM Mercury recently.  You can access it here http://newmexicomercury.com/blog/comments/insight_new_mexico_dede_feldman

All Politics is Local

Wow.  If anyone thought local elections were not as important as state and national ones, think again.  It was the down ballot officials-- County Clerks and District Court Judges-- who began cracking cultural barriers to same sex marriage when they started issuing licenses a few weeks ago. Who would have thunk it!  A relatively unknown, grandfatherly County Clerk from Dona Ana County started the ball rolling and it was picked up by both Republican and Democratic clerks in Valencia, Santa Fe and elsewhere (but not Los Alamos).  It will be hard to stop until the state Supreme Court issues its long awaited ruling.  Don’t hold your breath for the legislature, though—which is the non-solution suggested by Republican opponents.  We’ve been there, and not done that.  Gridlock prevails on the issue in the Roundhouse, with Republicans unable to pass DOMA and Democrats unable to pass domestic partnerships.  I saw the impasse in person—for 16 years.

 Meanwhile, Operation Rescue has gotten enough signatures to get its anti-abortion measure on the city ballot in November.  It’s another example of how both the left and the right are attempting to make policy at the local level since other avenues are blocked.  But while it’s ostensibly a local effort, Operation Rescue and its ally, “Survivors of the Abortion Holocaust” has brought in outsiders to harass doctors and their families.  One of their actions was in Dietz Farms, where aggressive, chanting picketers carrying megaphones and photos of unborn babies engulfed a UNM doctor’s home. Supporters of women’s health and the right to choose say it’s the kind of action that preceded the assassination of an abortion doctor in Kansas. The city has a law prohibiting this kind of demonstration in front of peoples’ houses, but Dietz Farms is in Los Ranchos, which has none.  Bernalillo County Commissioner Debbie O’Malley and Maggie Hart Stebbins have now introduced a county ordinance, with a vote scheduled for mid-Oct.  For more information and to help defeat the abortion ban, which has only very narrow exceptions for the mother’s health, go to www.respectABQwomen.com.

 …. In other Culture Shifts

AG Eric Holder has told the states that the feds will not interfere with the implementation of state medical marijuana laws or the outright legalization of pot in Colorado and Washington. That’s good news for the approximately 9000 New Mexicans now on the program who have been living in fear that they or their providers could be busted by federal law enforcement.  (It happened in Carlsbad some years ago).  Now the threat is not from the feds but from the NM Medical Board, which earlier this summer tried to enact regulations that would have a chilling effect on doctors who issue recommendations for medical marijuana.  Aimed at a few errant doctors, I believe the board over-reached, trying to trump regulations that we charged the Department of Health with issuing and enforcing. Apparently others felt that way too, and the Board of Medicine had to cancel a hearing on the proposed regs because 400 people signed up for the hearing. It has not been rescheduled, and it looks like the Board may be pulling back on many of its new regs.  The Medical Marijuana bill back in 2007 was a bipartisan triumph for suffering patients, and this is a step backwards taken, some say, at the behest of one vocal doctor who opposed the use of medical marijuana for PTSD. Stay tuned (http://www.nmmb.state.nm.us.)

 

Fiddling and Fighting while Rome Burns: New Mexico’s Crisis in Behavioral Health

Blogger's Note:  Here's some background on the present Behavioral Health Crisis, including a history of the zigs and zags of state policy (keep scrolling). 

The latest acrimonious round in the sad demise of behavioral health services in New Mexico was fought out last week before the legislature’s Health and Human Services (HHS) Committee, and then, in the courts.  The topic was the Human Services Department’s determination that there were “credible allegations of fraud” against 15 non-profits providing mental health services throughout New Mexico. The determination, made by HSD Secretary Sidonie Squier and her staff, triggered an investigation by the Attorney General and will mean that Medicaid funding will be cut off for those agencies within 30 days while the AG investigates, although three agencies have gotten a reprieve from the department. The 15 agencies in question serve 30,000 of the most complex, costly and fragile patients with mental illness and drug abuse. Whether they will be cut off from services—as the July 4^th fireworks between the parties sputters along—is one of the many disputes. 

Secretary Squier says she will bring in five Arizona organizations to manage the private non-profit providers at a potential cost of $17.8 million, replacing the management and the CEOs but not laying off the employees.  “They’re saying that people will go without services but that is not true.  It’s made up by somebody,” she told the committee, in one of many testy exchanges with the committee, which oversees the Human Services Department.   HHS Committee members asked about the Secretary’s legal authority to take over a private business, especially those which also serve private patients.    Diana McWilliams, director of the Behavioral Health Service Division, said that each provider—although paid by the department’s statewide behavioral health organization (Optum Health, a subsidiary of United Healthcare), had a separate contract with Medicaid.

The Medicaid behavioral health contracts have been problematic since 1997 when the Gary Johnson administration decided to deliver both medical and behavioral health services to Medicaid consumers through private managed care organizations (see accompanying chronology). The current contractor, Optum Health, whose contract with the state runs through the end of the year, has had its share of problems.  In 2009 it was sanctioned $1 million by a special master, Alicia Smith, who was brought in to sort out the wreckage stemming from an inadequate IT system used by the company. They were sanctioned again in 2010. When Optum took over the contract from Value Options, the providers (the same ones that Squires told the committee had committed “widespread and egregious fraud”) were simply not being reimbursed for expenses or paid for the invoices they submitted.  At the time many contacted their legislators and some went out of business before the fire was put out.  Part of the short-term fire suppression was that Optum was to pay the providers their invoices in full, with reconciliation of any under and overpayment to come later. 

According to an audit by the Massachusetts-based Public Consulting Group, the 15 providers were overpaid by $36 million during a four-year period from 2009-2012. How much of that was from accidental billing errors, mismanagement or actual fraud is unknown since the audit, which was handed over to the Attorney General, has not been made public. An executive summary of the document was handed out to committee members last week, and it sparked lots of questions, particularly since it is the basis on which all of the providers—in identical letters received at the end of June—are accused of fraud and threatened with defunding.

The  $3 million audit itself and an earlier audit done by a “recovery” contractor for the department in January, were spurred by a new process used by Optum to identify unusual billings and see a broader picture of what Squires called “corruption” over a three year period. Once these records were turned over to HSD, the department began to act according to regulations set down by CMMS—the Center for Medicaid and Medicare Services. Legislators asked why Optum—and the Department-- didn’t use progressive, corrective sanctions on providers during the three year period rather than what some called the “death penalty.”  But they didn’t get the answer they wanted.

“Optum didn’t wait for anything.  All along they were looking into things but they had a new process which allowed them to see a broader picture,” said Squier.  “You have to keep up with the corruption and finally they got out ahead of it.”

But legislators like Senate President Pro Tem Mary Kay Papen of Las Cruces, Rep. Ed Sandoval and Sen. Jerry Ortiz y Pino, both of Albuquerque, who have seen the behavioral health care crisis unfold over the past decade, wonder whether Optum bears a large share of responsibility for the current crisis.

“We have local health providers that are suddenly being branded as criminals and the company that came in and created a chaotic mess is skating on this,” a distraught Ortiz y Pino said just before he was taken to a local emergency room at the mid-point of the three- hour hearing last week.

 Ortiz y Pino and Squires had engaged in an angry exchange in which Ortiz y Pino said, “ “You are destroying the behavioral health system in this state,” and Squires fired back, “ No, it’s the providers who have committed widespread and egregious fraud that have destroyed the system, not me.”  

Ortiz y Pino has recovered from the stress caused by the confrontational July 3rd meeting which ended with the Secretary storming out, trailing staff in her wake.  But the system may not.

Over the past eighteen years, the system has been organized and re-organized going from a fee-for-service system where local providers contracted directly with the state to a managed care arrangement.   Scores of different MCOs, subcontractors, regional behavioral health organizations and 1500 providers have been involved. Behavioral health services have been “carved out” of the Salud contracts.  Waivers have been granted and rescinded. An innovative behavioral health collaborative has been organized to “braid” funding from multiple sources.  Once the hope of consumers, the collaborative has been disappointing, and the department is now contemplating disbanding it.  Medicaid expansion to thousands of adults who will need behavioral health services will start in January under Centennial Care, the department’s latest reorganization of the overall Medicaid program. Behavioral health will once more be carved in, but the details are sketchy.   

Meanwhile, New Mexico continues to rank 51^st in the nation (including the District of Columbia), with the least amount of money spent on behavioral health, a pervasive problem that many say is dragging us down on other national scorecards that rank us at the bottom when it comes to suicide, prescription drug abuse and gun violence.

As anyone who has tried to get a troubled relative into a treatment program will tell you—it’s almost impossible.  The number of providers has declined dramatically over the years each time the system zigs and zags. There are very few child psychiatrists in New Mexico, almost none in the rural areas. And overburdened psychologists and social workers are demoralized.

The ball is now in the court of the Attorney General, who was also present at last week’s legislative meeting.  Gary King says he is not in full agreement with HSD’s handling of the situation and wants to meet with the department quickly to work out a better process to deal with the 15 providers.    For people with mental illness and addiction problems, time is of the essence.

 The Zigzag History of New Mexico’s Behavioral Health System

1997: Medicaid Managed Care Governor Garry Johnson puts the Medicaid program into a new model: managed care, later called Salud.  Private HMOs bid on a contract with the state and receive a per member rate which is used to pay doctors, hospitals and treatment programs which care for both physically and mentally ill Medicaid patients.  Behavioral services are part of the package paid for by the HMOs, which subcontract with specialized Behavioral Health MCOs to provide care for the costly and often chronically ill clients.  These MCOs then work with regional organizations of mental health providers in different parts of the state.  Finally, therapists, treatment facilities and non-profit organizations like Hogares, La Familia or Presbyterian Medical Services see the patients, providing medication, counseling or more intensive treatment. They are paid by the behavioral health MCOs, but reimbursements are meager after each company takes its share for administration and profit.

1998-2000: A litany of complaints pour in to legislators, judges and the New Mexico Congressional delegation from the advocates for the mentally ill and health providers. Desperate patients are not getting treatment they say, because little money is flowing through the hierarchy of insurers to those on the front line.  A number of residential treatment programs close down, and judges become concerned when the only place they can send mentally ill young offenders is jail.

2000: Medicaid Waiver Denied: Congresswoman Heather Wilson, Sen. Jeff Bingaman, district court judges, the Legislative Finance Committee and the NM Health and Human Services Committee hold hearings and town halls on the situation, ultimately asking HCFA, the Health Care Financing Administration, to withhold federal approval for the managed care waiver, which allows the state to receive federal funds.  Responding to the concerns, and an LFC audit, the federal government takes the rare step of withdrawing approval of the entire waiver until the state restores the behavioral health portion of Medicaid services to a fee- for-service system.

2001: Medicaid Waiver Restored—with Conditions.  The incoming George W. Bush administration restores the Medicaid waiver on the condition that profits for MCOs be limited to 18% and that intensive monitoring forestall patient complaints.  Unhappy, the legislature passes a bill to “carve out” the services for mentally ill patients and restore them to a fee-for service model, but Gov. Johnson vetoes the bill.

2004: The Behavioral Health Collaborative is created to make services more responsive to clients, coordinate Medicaid and other federal payments made to various agencies, and purchase services jointly. Services are carved out of the main Medicaid program and a statewide MCO, initially Value Options, then Optum Health, is charged with delivering them through traditional treatment programs and core-service agencies.  The reorganization attracts national attention and initial acclaim, but within a few years local consumer collaboratives pull out and professional psychological associations are complaining of declining reimbursements and other problems.  More facilities close down.

2009: Optum Health takes over for Value Options, which had a contract with the state to deliver services to Medicaid patients.  Immediately, providers experience billing and reimbursement problems as a result of the new contractor’s failure to develop an adequate IT system.  Claims are rejected, resubmitted and rejected again and again until the legislature holds hearings and the department finally acts, appointing a special master to oversee implementation of a more adequate system.  One of the key problems is over and under payments.  Optum is fined $1 million in 2009 and further sanctioned in 2010.   

2013: New Mexico selects four MCOs to provide Medicaid services to an enlarged group of Medicaid recipients under a newly modernized system called Centennial Care, due to start in January 2014.  They are Blue Cross/Blue Shield, Presbyterian Health Care, Molina and United Healthcare (whose subsidiary is Optum).  Behavioral health services are to be integrated with medical care. They are once again “carved in.” To prevent administrative waste, the contract does not permit the contractors to subcontract with behavioral health MCOs. Preparations begin for the new system.

June 2013: Department Claims “Corruption” and “Widespread, Egregious Fraud.” Based on the results of an outside audit, whose results were not made public, HSD determines that there is “credible evidence of Medicaid fraud “on the parts of 15 behavioral health providers.  Secretary Sidonie Squier turns the investigation over to the AG and says Medicaid reimbursements for services to some 30,000 behavioral health patients will be temporarily withheld and Arizona companies brought in to manage the companies. 

Lobbyists and their Employers Spent $488,296 to Entertain, Influence Legislators in 2013

Blogger's Note:  Here's some information I collected from the New Mexico Secretary of State's Office for NM Common Cause.  It's a small piece of the work I'm doing, along with interns Jarrett Hines-Kay and Jonas Armstrong, for a forthcoming Common Cause report on lobbyists.  

            New Mexico lobbyists and their employers spent $488,296.74 to influence, entertain and feed New Mexico legislators, according to reports filed since January with the Secretary of State’s Office.   The amount does not include campaign contributions, which are banned during the session.

 The largest spenders among the lobbyists were:

            •George Brooks, lobbyist for Ski New Mexico Inc, who gave out  $27,750 worth of ski passes to 111 legislators and other officials

            •Michael Bowen, lobbyist for the NM Mining Association, who hosted a $20,954.68 dinner for legislators at the Santa Fe Hilton on behalf of that group and spent $2,500 for the 100 Bill Party at the Santa Fe Convention Center

            •Steven Henke, lobbyist for the NM Oil and Gas Association, who hosted a $17,638 dinner for legislators at the Bull Ring

            •Scott Scanlan, lobbyist for 24 clients including Altria Tobacco, BHP Billiton Oil, Sunland Track and a number of cities, who spent $11,892.30 on meals, beverages at special events for legislators and their staffs at the Coyote Café, Restaurant Martin, Vanessie and the Bull Ring

            •Art Hull, lobbyist for 15 clients including PNM, Devon Energy, Glaxo Smith Kline pharmaceuticals and Fidelity Investments, who spent $10,502 for meals and other events at various locations “to inform and discuss concerns with elected officials.” (No specific legislators or clients were disclosed)

            •John Christopher, lobbyist for Comcast Cable Corporation, who spent $10,277 for a dinner “for all Senators and Representatives” at Restaurant Martin

 

 The largest spenders among lobbyists’ clients were:

    •The Center for Civic Policy, which spent $29,574 on mailers, phone banks and radio ads

    •The NM Golf Tourism Alliance, which spent $28,500 on golf passes for legislators

    •The University of NM, which spent $20,643 including $12,042 for a UNM Alumni Assoc. reception for legislators at La Fonda; $1470.17 for basketball jerseys for senators in the House Senate charity basketball game, and $4,311.39 for “education/advancement/goodwill/hospitality” to various legislators

    •Presbyterian Health Plan, which spent $11,137 on its annual appreciation dinner for legislators at La Posada

    •The Baptist Convention of NM, which spent $7,822-- $4422.04 on a prayer breakfast for legislators and $3,400 on gifts to New Mexico legislators (recipients and amounts unspecified) 

    •The Conservation Voters of New Mexico, which spent $4,710 on a legislative reception for all legislators at the Rio Chama 

 The New Mexico Gift Act, passed in 2007, bans lobbyist gifts of more than $250 to individual legislators and gifts of an aggregate value of $1,000 to any one legislator during any one calendar year.

 Data collection was difficult because lobbyists often report only aggregate expenditures and do not report on whose behalf the expenditures were made or the specific actions being lobbied.    

Health Care Reform: Once Again, The Media is Telling Us the Sky is Falling because of Obamacare… but don’t believe it.

 

Blogger's Note:  A shorter version of this article appeared in the Albuquerque Journal  Tuesday April 16

  Newspapers from the Wall Street Journal to our own Albuquerque Journal have been filled recently with reports of skyrocketing health insurance premiums once the Affordable Care act takes full effect in 2014, or even sooner when policies go up for sale on new insurance exchanges.  And you can be sure that if the rates do go up, your first bill from the insurance company will say… “We had to do it because of Obamacare.” But don’t believe everything you read, including what some are now calling “Rate Crock.” There are many safeguards in place to protect consumers and encourage companies to continue covering their employees.

            The basic pitch of the chicken littles is that new insurance reforms-- like preventing insurance companies from discriminating against those with pre existing conditions, requiring a decent benefit package, and limiting mark-ups on older consumers to three times (instead of five times) what they charge younger people—will cause them to raise premiums.

            That might be the case, but in New Mexico—help is at hand.  Estimates prepared by the Lewin Group for Families USA indicate that about 192,000 currently uninsured New Mexicans, most of the working and middle class, will get premium tax credits to help defray the cost of insurance purchased through the exchange.  The amount of the credit—which is really a subsidy—will depend upon their income.  The smaller the income, the more the credit.  The idea, which is embedded in the law, is that families should not be spending a huge percentage of their income on health insurance. (http://familiesusa.org/help-is-at-hand/new-mexico/)

            For information on how to calculate premiums and subsidies, the Kaiser Foundation has prepared a handy calculator for folks under 65 who will be obtaining their insurance through the new exchanges.    (http://healthreform.kff.org/subsidycalculator.aspx) I plugged a few numbers into the calculator for my 30-year old daughter and found her costs would be much less than what she’s currently paying—contrary to popular warnings that the cost of insurance for young people, especially will skyrocket.  In addition, I read the fine print, which indicated that the Congressional Budget Office  (a non-partisan operation) projects that average premiums under reform for the same level of coverage for a given group of enrollees would be 7-10% lower than under the status quo. Hmm, quite a different story than we are hearing in the media.

            In New Mexico, there’s also the huge group of people (about 150,000) who will be covered by the expansion of Medicaid—where they will not be paying a premium at all.  How will that help keep the cost of premiums down? Reducing the number of uninsured reduces cost shifting—i.e. charging insured patients more to compensate for caring for the uninsured. In New Mexico, health policy experts estimate the current surcharge on individual policies for this is over $1,000 per year.

            For businesses, especially large businesses, the issues are more complex, and what we are hearing from former opponents of the bill is that companies will be dropping their employees from coverage— and sending them to the newly formed health exchanges.  This move would subvert the law’s intention to allow people who like their current coverage to keep it.   The rhetoric we are now hearing certainly would encourage employers to do this. But that would be an ideological—and not a rational act.  For all you policy wonks out there, a health economist at the University of Pennsylvania (my alma matter) explains why in “The ACA doesn’t squeeze employers.” http://ldi.upenn.edu/incidentaleconomist/2013/04/12/the-aca-doesn-t-squeeze-employers#disqus_comments

            There’s one other factor. New Mexico is last in the nation in the percentage of residents who get their health insurance through their employers, according to a study by the Robert Wood Johnson Foundation. Part of the reason is that NM is largely a small business state, where owners are hard pressed to afford to cover their workers.  We’ve tried for years at the state level to get them to do it—without success. Now Obamacare offers them several alternatives.  They can use the exchange to get coverage for their employees, probably at a lower rate since the larger number of employees in the exchange spreads risk for the insurance companies. Or, they can take advantage of a number of tax credits available for small companies.  The Small Business Minority has a nifty calculator, which can be used to figure out how much the credits will reduce the insurance bill.  www.smallbusinessmajority.org/tax-credit-calculator/index.php

         Yes, the new law is complicated—and it will be fine tuned as time goes on. There will be adjustments needed. Risk pools will change. But there are safe guards, and anyway, I wonder where all these dire prognosticators were for the past decade when premiums were skyrocketing with no control, threatening to eat up as much as 25% of family income by 2025.  

Surprise! It’s Deals, Close Calls on the Last Day of Legislative Session

A View from Just Outside the Roundhouse

March 17, 2013

 The last day of any legislative session is always frantic, filled with surprises—from filibusters to conference committee reports that neither chamber has a chance to examine adequately.  I always used to hang on to my desk for dear life afraid someone would come up with a measure that suddenly put a toxic waste dump in my district, or an amendment which undid every bill I ever passed.

But this year—whoa, baby, a tax package-- developed on the ides of March before Saturday’s adjournment by Sen. John Arthur Smith and the Senate Finance Committee.  It was jammed through at the last possible minute as an amendment to the “Breaking Bad” bill produced in the House in the aftermath of the Governor’s veto of it the day before.   For progressives, and others who had feared that Smith might give away the farm to the Governor, this was really “breaking bad.”

Sponsored by Rep. Moe Maestas, the original bill, named after the TV series Breaking Bad, provided tax credits to TV shows that film in New Mexico, bringing more spending and revenue to the state than films. The Governor vetoed Maestas’s bill, because her other tax cuts were not passed, and she loudly threatened to veto the whole budget as well—signaling that a Special Session was in the works.

Now, there’s nothing legislators hate more than a Special Session.  With that knowledge in his pocket--- Sen. Smith went to work Friday night putting together an amendment that gave the Governor the corporate tax cuts she wanted plus something he’d been talking about for years: a return to the state of revenue that had been lost because local governments had been “held harmless” when the gross receipts tax on food was removed back in 2004. (That meant that cities and counties didn’t have to absorb the loss of tax revenue because the state would reimburse them.)

Given the last minute nature of the Senate amendment, city and county lobbyists didn’t have time to respond to the move, which most likely will cause local gross receipts taxes to go up.  Allegedly, there was a provision in the amendment that prohibited the re-imposition of local taxes on food and medicine, but who knew, and anyway, in the eyes of the public, it wouldn’t be the legislature that imposed the taxes, right?  After Senators attached the amendment, and passed the fully loaded bill, it had to go back to the House-- with about 10 minutes to go.  House members hadn’t even read it. There was no fiscal impact report.  In a desperate move, the legislative staffer who drafted it was called in to explain the complex package.  But there was no time.  The question was called and House members voted on the bill without the information, even thought it was actually past noon, the time for adjournment. It passed. The “Hail Mary” pass was complete—and the Governor caught it in the end zone, declaring that there would be no special session after all.   

Back in the Senate, after the Breaking Bad bill went to the House, Majority Leader Michael Sanchez finally called up HB 77, Rep. Miguel Garcia’s bill to require background checks at gun shows-- with about 40 minutes to go.  The bill had attracted nationwide attention as a possible rebuke to the NRA, and garnered support from some House Republicans and the Governor.  But, predictably, it was immediately besieged by amendments from Democratic and Republican opponents alike—doomed because of its scheduling on the floor on the last day of the session, when delay and filibusters are most effective.  The Majority Leader gave the bill a last minute plug—but his words were not as loud as his deeds.  Had the bill be scheduled the day before, the outcome could have been different.

What to make of all this? From just Outside the Roundhouse, it looks bad, and I am most disappointed—once again--- at how the Senate is willing to take a bullet for the NRA, in the face of common sense measures and incredible tragedies.  And who knows whether the content of the tax package was a fair compromise that (as reported) filled some loopholes and instituted combined reporting for big box stores, as well as cutting corporate taxes?  That will take some analysis—analysis that the public and most legislators-- outside of a few insiders – were not permitted to do before they had to weigh in.  Do the means justify the end?  It’s an open question, but I’m sure Gov. Susana Martinez is counting her lucky stars that quarterback, Sen. John Arthur Smith, got to make his pass before the buzzer sounded.

 How Much Power Should One Senator Have?

Once again, a constitutional amendment to allow a vote on whether a small portion of the state’s permanent fund should be temporarily diverted to early childhood education was buried in the Senate Finance Committee.  Chairman John Arthur Smith simply refused to bring the bill up for a vote.  The measure has now passed the House twice, and most observers say it would pass the Senate should it hit the floor. It is, keep in mind, simply a measure to allow the public to weigh in on this important public issue.   Many experts say that the state’s unwillingness to fund early childhood programs in earnest is the key reason our K-12 education system is in trouble.  But no matter. This is the second time that Smith has deep sixed it. And the Senator regularly “pocket vetoes” many other measures—just ask any legislator who can’t get his or her bill through Senate Finance.

            Several years ago, Smith was nicknamed “Dr. No” for his staunch opposition to tax increases and his hostility toward spending by then-Gov. Bill Richardson.  With little countervailing power from other members of the Democratic leadership, Smith is now amassing power beyond the Finance Committee (see above), and the situation may soon resemble the 70s and 80s in the Senate when conservative Democratic senators Ike Smalley and Aubrey Dunn gave the rank and file little say in the budget. Here’s a little piece of history that new Senators might like to know.  Once upon a time another Chairman of the Senate Finance Committee, Aubrey Dunn, tightly controlled information not even sharing fiscal impact statements with members.  Bills were passed so fast that legislators did not have a chance to weigh in with debate on the floor.   Sen. Dunn once passed 21 bills on the floor of the Senate with a single motion, an action that was later ruled unconstitutional by the New Mexico Supreme Court.

            Sound a little like Saturday’s little amendment to the Breaking Bad bill?  Not quite, maybe, but the last minute move, the lack of information, pushes the envelope.  I wonder if anyone will push back?  Someone finally rebelled against Smalley.  His name was Manny Aragon.

Health Insurance Exchange Bill Passes

A lot of water had flowed under the bridge since the Governor vetoed the strong health care exchange bill I sponsored in 2011.  Obamacare has been held constitutional.  New Mexico has received over $140 million for clinics, training programs and other mechanisms to implement the new law in the past two years.  Gov. Martinez has decided that yes, math does trump ideology, and she will expand the Medicaid program.  The compromise health exchange that the legislature just passed ought to be viewed in this context. It’s not what I wanted but it is a better direction than the one the administration was headed in when it unilaterally decided that the Health Insurance Alliance, with its insurance company directors, would simply function as an exchange.  Both the Legislature and the Governor will appoint the board of this exchange, and it will not have a majority of insurance company directors. Federal law will direct much of its functions.  Finally, the exchange can now focus on its computer system, and prepare to offer policies by October.  More than the actual framework of the exchange itself, I’m concerned about outreach and public education for the 70,000-100,000 who could sign up (if they know how to) in the first year.  That means plenty of good “navigators” and a massive public awareness campaign. Stay tuned to see how that works out.   

 

 

Legislature Should Use Medicaid to Help Young Mothers be Better Parents

Blogger's Note: A version of this article appeared in the Albuquerque Journal Jan. 30, 2013 

 In the aftermath of Sunday’s front-page article in the Albuquerque Journal on how 70% of births in New Mexico are financed by Medicaid, we are beginning to hear the conservative refrain. The “takers” are at it again, they say. So many people on “welfare,” so many children hooked on government from birth.  Its like Captain Renault (Claude Reins) telling Humphrey Bogart in Casa Blanca, “Shocked, I’m shocked that gambling is going on in this establishment. “ Of course, as the Captain is speaking, he is   handed a note from a croupier that tallies his winnings.

In New Mexico the “winnings” are the payments for the births that go to the hospitals the delivery room nurses, the doctors, to small and large towns throughout the state who, would be struggling to collect from low-income parents, or paying for the deliveries themselves, were it not for the program.

The winnings are also in the health of New Mexico’s children, about 2/3 of whom are born into families who need a little help. For about two decades, the state has seen it as a good investment here in one of the poorest states of the country, especially when the federal government is paying the lion’s share. Even considering the cost of deliveries, the price tag for prenatal care, childbirth and health coverage for children is relatively modest, in comparison to other program expenses like nursing homes. Without this initial investment the costs to the state in premature births, poor outcomes, special education, even criminal justice, would be much more.  

This summer, the Legislative Interim Health and Human Services Committee heard about another program that, for young children, could increase the return on the investment even more. It’s called home visiting. It’s a voluntary program that is already yielding results for young families in Rio Arriba and Grant Counties as nurses and community health workers visit with first time mothers throughout their pregnancy and during those first crucial months after the birth of their babies.  The trained health care professionals teach parenting skills and assist mothers with routine care, making sure that the baby has all its shots, and that problems don’t turn into domestic crises.  But of the approximately 19,000 newborns on Medicaid each year only about 1100 get the service through a program in the Children Youth and Families Department, which for the most part is funded through private foundations.  At present, there is little state Medicaid funding—with its attendant federal match--and the state is missing a huge opportunity to get more women pre-natal care, increase the number of well child visits, and save money in the long run. 

  The staff of the Legislative Finance Committee estimates the return on investment for home visiting is five dollars for every one invested.  This year’s LFC budget recommends increasing Medicaid funding for home visiting so that 500 more families get this important service. Sen. Jerry Ortiz y Pino is carrying Senate Bill 68 to boost the CYFD programs.  These are modest proposals that deserve your support —particularly if you are shocked, shocked by the number of Medicaid births. This investment may bring them down in the long run, one family at a time, as new parents begin to understand the responsibility of parenthood, gain self-respect and think again about that second or third child. Combine that with a decent rate of economic growth and you’ve got a big payoff for New Mexico.