Governor Vetoes “Junior” Budget Bill Containing Health Security Funding

Bill veto image

Yesterday, Governor Michelle Lujan Grisham vetoed SB 48, the "junior" supplemental budget bill. The $790,000 we had secured to continue the Health Security Plan design process was a small part of that bill.

SB 48 contained more than $50 million in funding for state agency and local government programs and for other projects. The bill gave each legislator the opportunity to direct funding to the programs and projects they felt were most important for their constituents and the state. SB 48 passed unanimously in both houses.

The funding for Health Security was just one small portion of this important bill, which also included funding for local cultural programs, water conservation programs, suicide prevention services, mental health programs, and services for veterans experiencing homelessness. It contained funding for hospital medical equipment, food banks, and media literacy programs, along with money to support health councils and the development of language preservation curricula for Native American students. This is an expansive, 73-page bill, and these are just a few of the programs that were slated to receive funding.

According to the Albuquerque Journal and the Santa Fe New Mexican, there is definite talk among legislators about calling an emergency special session to override the governor’s veto. Three-fifths of each house—25 senators and 42 representatives—would need to agree to convening an "extraordinary session," which has only happened once before. If a special session is called, two-thirds of each house would need to vote to override the governor’s veto in order to restore the funding in SB 48.

We are also working on other ways to continue funding for the design process. We will be sure to keep you updated!

Drowning in Medical Debt

photo of dollars and medical debt

Earlier this week, the US Consumer Financial Protection Bureau shared some sobering news about medical debt in our country.

Two key findings:

  • In total, US consumers have at least $88 billion in past-due medical debt.

  • Who is most likely to be impacted by medical debt? Black people, Hispanic people, older people, veterans, and people in the Southeast and Southwest.

You might be wondering how we got to this point. The Consumer Financial Protection Bureau report has a quick explanation:

"Medical bill amounts can be unpredictable and often vary widely based on patient and provider characteristics. Uninsured and out-of-network patients are often charged prices that are much higher than what in-network insurers pay—even though the uninsured may have little ability to pay. The prices charged to uninsured and out-of-network patients sometimes significantly exceed providers’ costs. Markups are especially high for emergency care, and for-profit investor-owned hospitals charge higher average markups."

The full report can be read here.

Recognizing that the US situation is unique—nobody goes bankrupt over health care in Europe!—can be depressing, but it also reminds us that this is a solvable problem.

How will the Health Security Plan help?

Secure health coverage for New Mexicans will mean that patients don't get hit with large uninsured or out-of-network bills. No surprise billing, no balance billing, and lower costs overall . . . won't that be nice?

There are many reasons why continuing the Health Security Plan design process is critical. Tackling medical debt—and alleviating its devastating impact on New Mexicans' lives—is just one of them.

Legislative Roundup & Next Steps

Legislative Success

We did it!

Our goal this legislative session was to get funding to continue the Health Security Plan design process. $790,000 was approved in the so-called junior budget bill, which is now on the way to the governor for her signature.

This funding will enable the Superintendent of Insurance to move forward with this vital project—to expand needed research topics, hire consultants, and ensure adequate staff to oversee the process.

This is an incredibly exciting step for our state to take!

It Takes a Village . . .

We are grateful to our legislative sponsors, Sen. Jerry Ortiz y Pino, Sen. Harold Pope, and Rep. Dayan Hochman-Vigil, and to all the senators and representatives who donated some of their junior money to make sure the Health Security design process continues.

A special thank-you to Rep. Debbie Armstrong, a longtime Health Security sponsor who we hope will continue to be involved with the Health Security Plan's development even after her retirement from the legislature at the end of this year. She is the one who thought we needed to change our strategy to gain greater support by beginning the design process. And it is working!

And a big thank-you to all of you: Because this was a fast-moving budget session—and one that focused on funding, not the passage of the Health Security Act—we didn’t have multiple calls for action. But we know you were following along and ready to act if we put out the call.

Next Steps

With the 2022 legislative session behind us, what’s next?

  • Working with the Superintendent of Insurance and our legislative sponsors to determine priorities for this phase of the Health Security Plan design process.

  • Continuing our series of informational Zoom sessions.

  • Making sure you are informed about the design process and how you can provide input into the creation of our homegrown plan!

We’re off to a great start in 2022. There is a lot more to do in researching and developing the Health Security Plan. Sign up for our emails to stay posted!

Latest News & Doctors Weigh In

The Latest on the Legislative Session

No word yet on a hearing by the Senate Finance Committee on Senate Bill 80, the $1.5 million appropriation bill to continue the Health Security Plan design process.

However, Sen. Ortiz y Pino and other allies have been working hard to ensure that funding is added to House Bill 2 (the state budget bill) on the Senate side—and yesterday we heard that an appropriation for the design process is now included in the budget! We have not yet seen the language of the appropriation in HB 2, but if funding has been added, there will be no need for a hearing in Senate Finance.

We will keep you posted!


NM Physicians Urge Legislative Leaders to Support Funding

As we wait on Senate Finance and HB 2, we want to share with you a letter signed by 56 physicians from different areas of the state. This powerful letter was sent last week to House and Senate leaders and to the chairs and vice chairs of the Senate Finance Committee and the House Appropriations & Finance Committee.

Dear New Mexico Legislator:

We, the undersigned New Mexico physicians and ordering providers, urge you and other representatives and senators to support the Legislative Health and Human Services Committee’s request for an appropriation of $1.5 million as a supplement to the Office of the Superintendent of Insurance in HB2. The funding will enable the continuation of research needed for the design of the Heath Security Plan for New Mexico.

As you know, the Health Security Plan would provide health care coverage to almost all New Mexico residents. The haphazard patchwork of private market and public options that currently define healthcare has failed our patients, and let many slip entirely between the cracks. As physicians, we believe that health care should be considered a human right, and its guarantee the obligation of responsible societies. We see firsthand the devastating effects of underinsurance and lack of insurance on our patients. Inadequate insurance is a major cause of poor health outcomes for the people of New Mexico, and also leads to expensive and unnecessary overuse of emergency and hospital services to compensate for lack of access, and to treat health crises that might have been averted.

Moreover, the current health care system has failed us as providers. It creates inefficiency and bureaucratic chaos, leading to an untenable administrative burden for our practices, and daily hurdles and challenges to our decisions on behalf of our patients. The administrative costs of our complicated coding and billing are untenable for many small practices, and physicians spend hours of their day on extensive documentation for purposes of reimbursement, justifying orders for routine services and equipment, and insurance-related activities like obtaining preauthorization for tests and treatments.

The siphoning of precious healthcare dollars for costly administrative expenditures to support a complicated, multiple payer system makes no sense for patients, doctors, and hospitals.

New Mexico, like much of the country, is experiencing a progressive failure of its healthcare system, and the pandemic has served only to widen the fault lines. Patients are not getting the care they need, and physicians and nurses are increasingly demoralized and leaving the workforce. In New Mexico, we cannot afford to lose more of our physicians. We believe that New Mexico could once again be at the leading edge, and set an example for other states by creating a simple, streamlined insurance plan that ensures access to care for all its residents, and allows our healthcare workers to focus on the substance of their work – namely, taking the best possible care of our patients.

But it’s important that we get it right. There are many complicated issues to consider, including benefits covered, integration with federal programs, bulk purchasing of drugs, payment models for providers and health care facilities, and the needs and concerns of multiple stakeholders. These must be solved in a way that does not add costly administrative layers, but simplifies our system for patients and providers. The Superintendent of Insurance has conducted important initial research, and we ask that the New Mexico legislature grant the funds to continue it. Our fervent hope is that it will allow development of a plan that is intelligent, compassionate, and realistic, and that greatly improves medical care for New Mexicans.

Thank you for your consideration.

Wow. We are grateful to have such eloquent and dedicated supporters!


Weekly Legislative Update: Tomorrow (Thursday) @ 6:30 PM

The legislative session ends next week, and we'll be holding our final legislative update this Thursday, February 10, at 6:30 PM. It's an online event, via Zoom. Registration is required, so sign up now!

Executive director Mary Feldblum will be discussing our progress at the legislature and will answer your questions about the legislative process and continued funding for Health Security design.

Halfway Through

Legislative Status: Health Security Plan Design Funding

We're now midway through the legislative session, and we've been working hard to ensure continued funding for the Health Security Plan design process.

As soon as we found out that "junior" money (discretionary funding for each legislator) would be available, board members, staff, and close allies immediately contacted supportive legislators to ask them to allocate some of their "junior" funding to the Health Security Plan design process. While we don't have totals yet, we were very encouraged by the number of legislators who expressed interest in contributing "junior" funding!

It was exciting to see Senate Bill 80, the $1.5 million appropriation bill to continue the Health Security Plan design process, pass the Senate Health & Public Affairs Committee last week. Next stop is Senate Finance—the Senate committee in charge of the state's budget.

The state budget bill, House Bill 2, is scheduled to be voted on by the full House today and then will head over to Senate Finance for amendments and approval. (The funding requested in SB 80 would have to be approved by Senate Finance as a supplement to the agency budget for the Office of Superintendent of Insurance.)


Initial Research Reports Posted

Some initial research in the Health Security Plan design process is now available on the Office of Superintendent of Insurance website.

After the legislative session ends, we will be delving into all of the preliminary reports and sharing with you the key findings—as well as what additional research is needed.

Posted so far are two reports on global budgets for hospitals and how this approach might work in New Mexico, along with an overview of current federal health care laws and how the Health Security Act might navigate this legal landscape. These are just the first reports, and important research on provider payment systems is not yet available. Additional materials will be posted when they are ready.


Weekly Legislative Update: Tomorrow @ 6:30 PM!

We'll be holding our second weekly 2022 legislative update on February 3, at 6:30 PM. It's an online event, via Zoom. Register now!

Executive director Mary Feldblum will be discussing our progress at the legislature and will answer your questions about the legislative process and continued funding for Health Security.

SB 80 Passes First Committee

Senate Health & Public Affairs Committee Passes SB 80!

Senate Health & Public Affairs Committee takes up SB 80

Senate Bill 80, a $1.5 million appropriation bill introduced by Sen. Ortiz y Pino and Sen. Pope to continue the Health Security Plan design process, was heard on Wednesday night by the Senate Health & Public Affairs Committee. The bill passed easily, on a 5-2 vote!

SB 80 now heads to Senate Finance. We will let you know as soon as it's scheduled to be heard.

Wednesday's Senate floor session ran quite late, pushing the Health & Public Affairs Committee start time from 1:30 to 4:00. The discussion about Health Security began more than two hours later with some introductory remarks by bill sponsor Sen. Ortiz y Pino, followed by a report from Superintendent of Insurance Russell Toal. The committee then took up SB 80 and heard testimony from several supporters.

A recording of the entire committee meeting is available online, and the part about Health Security begins at 6:16 PM. (Dragging the horizontal slider below the Play button will allow you to skip right to 6:16.)

Initial Reports from Design Process to be Ready Next Week

Superintendent of Insurance Russell Toal presents via Zoom

Joining the committee hearing via Zoom, Superintendent Toal reported on a number of the findings from the research conducted over the past few months by several nationally recognized experts, including two highly regarded experts in New Mexico: Beth Landon, formerly of the New Mexico Hospital Association, and Dr. Jim Peach, of New Mexico State University. He also discussed some possible options stemming from the completed research—which is what the design process is all about.

We were excited to hear from Superintendent Toal that his office plans to release the consultants' reports early next week. They will be posted to the agency's website. We will, of course, have much more to share once the reports are up!

We truly appreciate the time and attention that the superintendent and his office have given to this initial research. This is just the beginning of the process, and it's clear that much more research is needed.

Hearing (and Presentation) Wednesday Afternoon! [UPDATED]

UPDATED January 26, 2022

We’re now in week 2 of the legislative session, and things are happening!

Senate Health & Public Affairs Hearing on SB 80, Plus Presentation by Superintendent of Insurance

Senate Bill 80, the bill introduced by Sen. Ortiz y Pino and Sen. Pope to appropriate $1.5 million to continue the Health Security Plan design process, is scheduled to be heard by the Senate Health & Public Affairs Committee on Wednesday, January 26. The committee meets at 1:30 PM, or half an hour after the Senate floor session ends. SB 80 is currently #7 on the agenda.

In conjunction with the hearing, Superintendent of Insurance Russell Toal will be presenting on progress so far with the Health Security Plan design process. We're excited to hear what he has to share!

To participate in the hearing and listen to the presentation, you'll need to join the committee's Zoom webinar. The Zoom link is https://us02web.zoom.us/j/87967039414, or you can call in at 1-669-900-9128. The webinar ID is 879 6703 9414. Please plan to (virtually) attend! You'll get to hear what the Superintendent has to say—and you'll also have a chance to show your support for the Health Security Plan design process if the committee chair asks how many in the audience support the bill.

We need lots of testimony during the hearing! Remember to keep your remarks brief. In one or two sentences, explain why continuing the design process to create the Health Security Plan is important to you.

Call Your Senator (if they’re on the committee)

If your senator sits on Senate Health & Public Affairs, please call today and ask them to support SB 80, the Health Security Act Adoption Study. If you're not sure who your senator is, use the legislature's handy Find Your Legislator tool to find out.

Senate Health & Public Affairs Committee Members:

  • Sen. Jerry Ortiz y Pino, Chair - District 12 (Albuquerque) 505-986-4482

  • Sen. Bill Tallman, Vice Chair - District 18 (Albuquerque) 505-986-4373

  • Sen. Gregg Schmedes - District 19 (Bernalillo, Sandoval, Santa Fe & Torrance counties) 505-986-4395

  • Sen. Jacob Candelaria - District 26 (Albuquerque) 505-986-4380

  • Sen. David Gallegos - District 41 (Eddy & Lea counties) 505-986-4278

  • Sen. Stuart Ingle - District 27 (Chaves, Curry, De Baca, Lea and Roosevelt counties) 505-986-4702

  • Sen. Brenda McKenna - District 9 (Bernalillo & Sandoval counties) 505-986-4301

  • Sen. Antoinette Sedillo Lopez - District 16 (Albuquerque) 505-986-4389

  • Sen. Liz Stefanics - District 39 (Bernalillo, Lincoln, San Miguel, Santa Fe, Torrance and Valencia counties) 505-986-4377


Junior Comes First

This year, “junior” funding requests had to be submitted early—the Senate deadline was Monday, and the House deadline is today (Tuesday). (The “junior” budget bill is made up of discretionary funding requests from each senator and representative. For more information on “junior” and our legislative strategy, see our January 21 blog post.) Needless to say, we’ve been busy contacting supportive legislators to ask them to commit some of their discretionary funding to the Office of Superintendent of Insurance for the continuation of the Health Security Plan design process.


This Thursday: Legislative Update @ 6:30 PM

Join us this Thursday, January 27, at 6:30 PM for our first weekly 2022 legislative update, via Zoom. Register now!

Legislative Strategy

The Senate in session on Thursday.

The 2022 legislative session began on Tuesday.

Our legislative goal this year is simple: make sure that the state budget includes funding for continuing the Health Security Plan design process.

New Mexico’s every-other-year 30-day legislative session focuses on crafting a budget for the next fiscal year—in this case, the 2023 fiscal year, which begins on July 1, 2022.

There are several ways to get funding into the budget, and our approach this year is multipronged.

The House: The state budget is initiated in the House. The House Appropriations and Finance Committee is in charge of creating the budget bill (HB 2). Our House sponsor, Rep. Dayan Hochman-Vigil, and other advocates in the House will be working to incorporate a small amount of supplemental funding for the Health Security Plan design process into the budget of the Office of Superintendent of Insurance.

While we are hopeful that some funding will be included in HB 2, it will not be enough to fully support the large amount of research and staffing needed.

After HB 2 has passed the House, it's the Senate's turn to put its mark on the budget.

The Senate: Our Senate sponsors, Sen. Jerry Ortiz y Pino and Sen. Harold Pope, have already filed SB 80, a bill requesting $1.5 million to be appropriated to the Office of Superintendent of Insurance to continue the design process. This bill was endorsed by the interim Legislative Health and Human Services Committee.

Unlike the 75-page 2019 Health Security Act, this 1-page appropriation bill does not set up new laws or change existing ones. Instead, it simply serves as a path to getting some funding included in HB 2 to continue the Health Security Plan design process. As expected, SB 80 has been assigned first to the Senate Health and Public Affairs Committee and then to Senate Finance. While Senate Finance may consider the bill at any time, the committee must wait until HB 2 comes over to the Senate before it can approve additional funding to the budget.

Realistically, any funding approved for inclusion in HB 2 on the Senate side will fall well short of the requested amount, as supplements to the budget are rarely very large.

Therefore, we must obtain most of the required funding through “junior” monies.

Junior Funding: In those few years where there is more money available to the state, the leadership of the House and Senate may decide that each senator and representative will be able to devote a certain amount of discretionary funding to the departments and projects they view as most important. These discretionary funding requests are put together in an extra budget bill commonly called HB 2 Junior, or just “junior” for short. In 2021, legislators who donated some of their junior funds made it possible to begin the Health Security Plan design process under the auspices of the Superintendent of Insurance.

We are therefore now asking supportive legislators to consider allocating a portion of their discretionary funds to the Office of Superintendent of Insurance for continuing the Health Security Plan design process.

As you can see, there are multiple paths to pursue to achieve our goal!


Stay in the Loop!

Join us on Thursday, January 27, at 6:30 PM for our first weekly 2022 legislative update, via Zoom. Register now!

And, of course, if you are not already on our email list, please sign up today!

We'll be holding virtual weekly updates throughout the legislative session, just as we did last year. The other two meetings are scheduled for 6:30 PM on February 3 and February 10. Register by clicking on the individual dates.

Getting Ready for the Legislature

Legislature Begins Next Tuesday!

Opening day for the 2022 legislative session is exactly one week from today. The 30-day session runs from January 18 until February 17. This session, we will be seeking continued funding for the Health Security Plan design process.

Leading the charge will be Rep. Dayan Hochman-Vigil in the House and Sen. Jerry Ortiz y Pino and Sen. Liz Stefanics in the Senate. (Our long-time sponsor, Rep. Debbie Armstrong, will be retiring and wants someone else to take the lead. Rep. Hochman-Vigil is a strong supporter of Health Security and is also a member of the House Appropriations and Finance Committee.)

We will let you know when and how you can help this session. If you are not already on our email list, please sign up today!


Weekly Legislative Updates via Zoom

We will be holding weekly updates via Zoom during the legislative session, as we did last year. Join us at 6:30 PM on January 27, February 3, and February 10 for the latest news. Register by clicking on the individual dates above.

And, of course, you can always stay updated right here at our blog.

Design Process News & National Relief on Surprise Billing

Reports from the Design Process to Be Released Soon

In 2021, the NM Office of Superintendent of Insurance contracted with various expert consultants to undertake research that will help New Mexicans make informed decisions about different aspects of the Health Security Plan. Reports were due December 31, 2021, and we expect the Superintendent to release them to the public soon.

Research so far has centered on provider payment methodologies, global budgets for hospitals, and federal laws and waivers applicable to the Health Security Plan.

This is just initial research—much more research and analysis needs to be done before the Plan can be designed!

Design Process Series

The next installment in our Health Security Plan Design series will be held after the session is over.

In the meantime, check out the recordings of our earlier meetings:


National News: Help Arrives on Surprise Billing

The new year brought implementation of a new federal law to protect patients from hospital surprise billing—what happens when an insured patient goes to an in-network hospital but is treated by an out-of-network provider, who then sends the patient a much larger bill than expected. The No Surprises Act is intended to fix this. Read or listen to an interview with Kaiser Health News reporter Julie Appleby on how the No Surprises Act works.

Interim fixes to our current health care system are very important while the Health Security Plan design process moves forward. Ultimately the Health Security Plan—a systemic solution—is what is required to address our ever-growing healthcare crisis.

Listening to Our Health Care Providers

Listening to Our Health Care Providers: What We Learned from the Third Meeting in the Health Security Plan Design Series

On Saturday, December 11, we hosted a very interesting virtual panel of health care professionals from a variety of practice areas in New Mexico.

Their purpose: to describe the administrative frustrations they face every day that impact patient care and contribute to burnout. Watch the recording here.

To fix this broken system, we need to have a full picture of what the problems are. The panelists and additional contributors helped to draw out some of these serious challenges, and we are grateful for their participation and their willingness to share their experiences and insights.

Our next session in the Health Security Plan Design Series will explore different provider payment methodologies that may help to solve the problems health care professionals and patients now face. We will let you know as soon as it’s scheduled.

What We Learned: Administrative Hassles That Impact Patient Care

Some of the issues that came up again and again in the meeting were:

  • time-consuming prior authorizations for tests, procedures, and referrals

  • constantly changing formularies (lists of which procedures and medications a particular insurer will cover)

  • billing codes that do not reflect the level of complexity in medical encounters, particularly in behavioral health, where the same billing code is used for relatively simple cases and for extremely difficult and complicated cases

  • higher pay for procedures than for time spent problem solving and counseling patients

  • complex bill coding systems that require coding specialists to properly file for reimbursement and that can be manipulated to maximize payments

  • inequality of payments for family practice practitioners v. specialists, and for nurses and nurse practitioners v. physicians who are doing the same procedures

  • opaqueness and instability of pharmaceutical pricing, and the outsized role of pharmacy benefit managers (companies that manage insurers’ prescription drug programs)

  • pay-for-performance programs and quality-of-care metrics that have high financial and time costs but do not serve individual patients well

What We Learned: The Effect on Patients

All of these issues have a real impact on patients:

  • Patients struggle to get the care they need, waiting for prior authorization from their insurer before they are able to see the specialist that their health care provider has referred them to, or get the test or medication that their health care provider has prescribed.

  • Patients are too often unable to afford the pharmaceuticals they are prescribed, or need to constantly switch their medications because of which drugs their insurer covers that month.

  • Patients may never get the chance to have an in-depth conversation with their provider, who is incentivized to offer (and bill for) a procedure rather than sit down and initiate a life-changing discussion that could help a patient change their daily habits to benefit their health.

There were many more issues discussed during the meeting. We encourage you to watch the recording to learn more!


The December 11 meeting was moderated by Donna Dowell, CNP, a certified nurse practitioner in Placitas.

The panelists:

  • Danny Cross, RPh, independent pharmacist in Carlsbad

  • Kathy Fresquez-Chavez, DNP, FNP-C, MSN, independent provider in Valencia County

  • Lara Goitein, MD, pulmonary and critical care physician in Santa Fe

  • Rick Madden, MD, family physician in Belen

  • Thomas C. Thompson, PhD, MP, ABN, ABMP, clinical and neuropsychology-prescribing psychologist in Las Cruces

Additional health care professionals who attended the meeting also spoke about the challenges they encounter. Gloria Doherty, PhD, MSN, RN, ACNP-BC, talked about several issues facing nurses and nurse practitioners, as well as larger issues in the system; Bernadette Luján, DOM, shared what she experiences as a doctor of oriental medicine; and Ricardo Gonzales, PhD, contributed the challenges he sees as a clinical psychologist practicing in northern New Mexico.

Panelists Announced for 12/11 Meeting

The third Zoom meeting in our Health Security Plan Design series will focus on how health care professionals get reimbursed for the services they provide—and the issues they encounter with the current process. Register here.

Our five panelists all live and work in New Mexico, and they'll be speaking from personal experience. We are so pleased that they are willing to share their perspectives.

  • Danny Cross, RPh, independent pharmacist in Carlsbad

  • Kathy Fresquez-Chavez, DNP, FNP-C, MSN, independent provider in Valencia County

  • Lara Goitein, MD, pulmonary and critical care physician in Santa Fe

  • Rick Madden, MD, family physician in Belen

  • Thomas C. Thompson, PhD, MP, ABN, ABMP, clinical and neuropsychology-prescribing psychologist in Las Cruces

The meeting will be moderated by Donna Dowell, CNP, a certified nurse practitioner and the Campaign's former media coordinator.


Walking the Reimbursement Maze: Challenges Faced by Health Care Professionals—the third session in our Health Security Plan Design series—will be held Saturday, December 11, 10:00–11:45 AM. For more information, see the initial post on the meeting. Pre-registration is required.