BY MAIRE O’NEILL
Mary Feldblum, the executive director of the Health Security for New Mexicans Campaign, has been working on the issue since the 1990s and finally it looks like the Health Security initiative in New Mexico could come to fruition in the next three to four years. Feldblum recently addressed the recent League of Women Voters Lunch with a Leader meeting and explained why Health Security is important and what is expected to happen on the issue in 2021.
In 2019, the legislature appropriated almost $400,000 to study the economic feasibility if Health Security. There have been three studies that to date and more than 170 organizations have joined the campaign which has been endorsed by 37 cities and counties over the years, Feldblum said. She said the Health Security Act (HSA) that was introduced in 2019 would have created a plan that would cover all New Mexicans.
“There are groups that would not be included like the military, military retirees and federal retirees, and then there are two groups that can voluntarily join; these are large companies that can self-insure like Los Alamos National Laboratory or PNM. They come under a federal law and the states can’t regulate them and certainly they can voluntarily join. Then we have the tribes that are sovereign nations and I think we are the only coalition in the country that has the All Pueblo Council of Governors endorsed us. They can decide whether or not to join,” Feldblum said.
She noted that the services offered would be no less than what state employees have, including acupuncture and good mental health services. People would have complete freedom of choice of doctor and hospital under the plan and be able to cross state lines for services at MD Anderson in Texas or the Mayo Clinic and other facilities.
In the upcoming legislative session, the 2021 Health Security Planning and Design legislation, a board will make decisions about the plan’s design elements following the guidelines of the 2019 HSA. Ultimately the legislature will be asked to establish a commission consisting of consumers, business owners, healthcare providers and representatives of healthcare facilities that is not a state agency. A majority of the commission members would come from outside Albuquerque and Santa Fe.
Feldblum said people ask her about Medicaid and the HSP.
“Medicaid is a state program so there would have to be a waiver to include Medicaid. There are over 800,000 Medicaid recipients that it would be important to put into this plan and it does seem very doable to accomplish. The other group is Medicare. Medicare is very complex. It’s a federal program first of all – an entitlement program – so nobody could ever in any state touch your Medicare,” she said. “..The bill clearly says that anything we have under a Medicare must be protected and it is a very complicated process because of the Part A, Part B, Part D, employer supplements, plus individual – it’s interesting that two of the studies that have been done on the HSA both excluded Medicare for different reasons. I think the sponsors of the upcoming legislation think this is complicated so let’s get started with the other groups that are eligible and will be included in this plan, and with public comment work out what will happen and how we could really help Medicare recipients.”
Feldblum said there are provisions in the bill that will help Medicare recipients even if they’re not included. She said that includes the hospital global budgets the plan will implement that will allow hospitals to have a stable revenue source which she said is really important for rural hospitals especially. She said another issue in the bill is the bulk-purchasing of drugs and that New Mexico pharmacists support and would apply to everybody which would greatly benefit Medicare recipients.
“It’s going to take some time to work this plan out. Recently there has been a fiscal analysis which has concluded like the other two studies that were done, that if we pool almost all New Mexicans into one health risk pool, that we are going to see healthcare costs bending the curve with rising health costs and those savings can amount to $1.5 billion to $2.6 billion in a five year period,” Feldblum said.
She said the Health Security Planning and Design Act is not the old HSA.
“It’s going to lay out a process that involves the public, physicians, hospitals and the legislature in developing the design details of the plan so that by the time all the design details are worked out (and it will take several years to do this) enrollment can be taking place and physicians can be paid. That’s a lot of steps that will have to be taken. What’s very exciting is that no state in the nation has gotten this far. There have been bills in other states but nobody has said, ‘Let’s roll up our sleeves and do this. Let’s figure out the details’. What’s advantageous is we can do it for New Mexico the way we feel is appropriate for our state,” Feldblum said.
Also addressing the LWV was Dr. Rick Madden, a family physician who has been practicing in Belen for almost 36 years and has no plan to retire. Madden noted that being a family physician gives a perspective about health care systems and how healthcare is actually carried out. He said the current system doesn’t cover enough people and doesn’t cover people equitably, and that patients deal with the inefficiencies and absurd complexity of the medical system when they have an ailment but doctors deal with it 24/7.
Madden listed several examples of issues that face people with their healthcare. One was that drug costs for patients are high and don’t correlate with research and development costs. He said for example, contrary to advertising claims, Omeprazole is as good as its next generation cousin Esomeprazole.
“It came out as the next best thing but they only tweaked the molecule and it doesn’t have any advantage over the original but they gave them a new patent,” he said.
Madden said a patient’s insurance coverage may look good until it’s needed but it may be full of holes the patient didn’t know much about such as what durable medical equipment is covered and which doctors are covered within a hospital.
“You can go to a hospital that’s covered but you don’t necessarily have doctors that are all covered by your insurance such as the emergency room doctor, the pathologist, the anesthesiologist,” he said.
He said there are burgeoning health measures that physicians have to report to get paid.
“How are our patients doing – they don’t really actually correlate in a lot of efforts with much of our real effort. But it feels to us doctors, nurses and physicians assistants like people are meddling in our stuff and that we actually have to toe that line to get paid. And then an MRI at one place may cost $500 and $400 at another place. I think those are pretty common examples that we experience all the time and it’s just to me inexcusable,” Madden said.
He also described what he called the economic rules of the dysfunctional medical market.
“One is that more treatment is always better. Incentives are to defer to more treatment and default to the most expensive option. Another is that lifetime treatment is preferable to a cure so that you keep people coming back. Amenities and marketing matter more than good care. As technologies age, prices can rise rather than fall,” he said.
He said there is no free choice and that patients are stuck and they’re stuck buying American. More competitors vying for business doesn’t mean better prices, he said. It can drive prices up, not down.
“Economies of scale don’t translate to lower prices. With their market power, big providers can simply demand more because there isn’t a marketplace,” he said.
Another issue Madden said is there is no such thing as a fixed price for a procedure or test.
“If you look at your medical bill from a hospitalization or the emergency room, and you ask why in the world is that that price. And you talk to somebody next to you who had the same thing and had a different price. Or you see the explanation of benefits and you ask why was it discounted that much. Well, somebody else didn’t get that discount. And the insured pay the highest price of all. There are no standards for billing,” he said.
One medical center he mentioned had 900 beds and 1,100 billing clerks.
“There’s money to be made in billing for anything and everything. Prices will rise to whatever the market will bear not just for pharmaceuticals,” Madden said. “The system is something that can be improved.”
He believes the HSP Feldblum has been working on for these decades is something that really needs to be pushed as a way to cover working people.
“I see it in my practice every day – that people haven’t had coverage and they have coverage under Affordable Care Act expansion and they were able to see me and get the care they needed. They didn’t have to go to the emergency room because they had access – there are many things about access that we need to improve because people still go to emergency rooms inappropriately when it’s not truly an emergency but it’s the easiest first choice for care,” Madden said. “I just want to make the pitch that that helps in so many ways. We’ve seen a glimpse of it through the Affordable Care Act but there are things that have not been done because the Affordable Care Act was a compromise and the compromise has things that need to be fixed still. The HSP in my mind would be a way to help all of our state improve healthcare through better access and much more efficient expenditure with higher quality. “
District 5 Sen. Leo Jaramillo noted the large immigrant community in Rio Arriba County and asked if undocumented immigrants will be able to be part of the HSP. Feldman responded that they definitely would be able to participate – that the HSA provided for residents to be covered and did not require citizenship. She said this has been a very important provision in the HSA.
Feldblum stressed that passing the Health Security Planning and Design Legislation will make New Mexico the first state to invest in a publicly accountable and transparent process to create its own health plan that will automatically provide comprehensive and secure coverage for the overwhelming majority of state residents as permitted under the Affordable Care Act.
“We have now reached a critical stage. More than ever, support and active involvement is needed so that Health Security will become a reality,” she said.
For more information on the Health Security for New Mexico Campaign, go to https://www.nmhealthsecurity.org/blog/2020/12/4/2021-legislative-session.