+ Why do we need the NM Health Security Plan?

While hundreds of thousands of New Mexicans have gained health coverage since passage of the Affordable Care Act (Obamacare), there are still problems to address: increases in premiums, deductibles, and copays; rising costs for prescription drugs; and smaller networks that limit patients’ choice of health care provider are just a few of them. And COVID-19 has revealed some of major gaps in our current system—not the least of which is that people who become unemployed all too often also lose their insurance coverage. As of August 2020, 11.9% of New Mexicans under 65 were uninsured (up from 10.5% in fall 2019), and many others are underinsured.

But our state has a clear path forward—setting up its own health plan that would include most New Mexicans, regardless of age, health, and employment status. The Health Security Plan is based on the old-fashioned concept of insurance, where the young, the old, the healthy, and the not-so-healthy are all in one large insurance pool. The risk is shared, while administrative costs are reduced. Our current segmented system of hundreds of insurance plans is complex and costly for all of us. Doesn’t it make sense for a state with a small population to set up its own plan?

The Health Security Plan will offer comprehensive benefits and freedom of choice of health care provider and facility, even across state lines. It will be our plan, run like a coop and overseen by a independent citizens’ commission.

For more about the problems with our current system, check out the collection of articles on our Studies & Articles page.

+ Who will be covered by the Health Security Plan?

Almost all New Mexicans will be covered, regardless of age, health status, and employment status. Federal retirees, active-duty and retired military, and TRICARE recipients will continue with their current coverage, and tribes (as dependent sovereign nations) can opt into the plan. Health plans that are covered under a federal law called ERISA can voluntarily join the plan. (Large-company plans and union plans are often ERISA plans.)

No more shopping around for plans. Most New Mexicans will be automatically covered!

+ What services will be covered by the Health Security Plan?

Covered services will be at least as comprehensive as those currently offered to state employees, including extensive preventive care, medical and hospital care, mental and behavior health care services, acupuncture, and chiropractic treatments.

Dental coverage could be purchased as a supplemental policy, as is the case with state employees. It is expected that dental coverage will be phased into the Plan in future years. (Anyone with Medicaid coverage that includes dental care will continue to have dental services covered.)

+ Will I be able to stay with my doctor?

No more networks! New Mexicans covered by the Health Security Plan will have complete freedom to choose any in-state, licensed health care provider, hospital, pharmacist, or clinic. The Health Security Plan is also authorized to contract with providers and health facilities across state lines.

+ How much will my Health Security Plan coverage cost?

A 2020 study funded by the NM legislature concluded that the Health Security Plan would reduce rising health care costs, saving up to $2.7 billion in a five-year period. This is the third New Mexico study that has come to this conclusion.

How much you will pay will depend on the findings of the fiscal analysis that is required prior to setting up the Plan. There are a lot of critical decisions to be made before the Plan can begin enrollment. The 2021 Health Security Planning and Design Board Act creates a publicly accountable and transparent process that will address these many operational details. Prior to Plan implementation, the legislature and the governor must approve a cost analysis of the Plan as designed and how it will be funded in real (not projected) dollars.

Only Health Security Plan members will pay. Premiums will be determined by income (with caps), not by age, gender, region, or health status. Premiums may be increased only with the approval of the superintendent of insurance (a public process). Employers may opt to cover all or part of an employee’s premium. Employers whose employees are covered by the Health Security Plan are also required to contribute to the cost of the Plan.

If Affordable Care Act subsidies and federal tax credits remain available, they will help also be included.

+ Will there be deductibles and copayments?

There will be no deductibles. There will be no copayments for preventive care. The Health Security Commission, after public hearings, will determine under what conditions, if any, copays would be required, and how much those copays would be. (See FAQs below for more information about the Commission.)

+ How will the Health Security Plan keep down medical costs?

Costs will be controlled in part through budgetary planning that takes into account technology, an aging population, and other factors. A Quality Improvement Program must be established, with provider input, to ensure best medical practices and patient safety.

Hospitals, clinics, private-practice physicians, pharmacists, and other providers will negotiate budgets and fees with the Health Security commission. The NM Health Security Plan will pay the bills. The Plan may contract with a private company to process claims, but only if the claims are processed in New Mexico.

The Health Security Plan will buy pharmaceutical drugs and medical equipment in bulk to reduce costs.

Administration will be streamlined because almost everyone will be covered by the same health care plan, with one claims form. Savings will result from the elimination of duplicative administrative costs built into the present system of multiple insurance plans. Money that was formerly used for insurance company marketing, commissions, out-of-state investments, and profits will be made available for health care services. In the sixth year of operation, the administrative costs for the Health Security Plan will be limited to 5% of its annual budget.

+ What about surprise out-of-pocket costs?

No more surprise billing! The Health Security Act specifically prohibits any health provider or health facility that has an agreement with the Plan from charging patients more than the covered rates. (And remember, this includes out-of-state providers and facilities that the Health Security Plan—like any insurance plan—will have negotiated fees with.)

+ I understand that automobile insurance and workers compensation premiums will be reduced under the Health Security Plan. Why?

If you are in a car accident and break your leg and your plan covers the care you need for the broken leg (which the Health Security Plan would do), you would not have to file a health claim with your auto insurance company. There is no need to pay for duplicate health coverage, so the health portion of your auto insurance premium can be reduced.

For employers participating in the Health Security Plan, commercial auto insurance and workers compensation premiums will be reduced, since the plan will be paying the health portion of these bills.

+ What will happen to medical records?

Federal and state medical privacy laws will apply. However, because almost all New Mexicans will be in one confidential medical database, providers (including emergency room staff) will know what tests you have taken, what meds you are on, and other critical medical information. This should lead to better and more coordinated care for patients and should also save the Health Security Plan money, as there should be no duplication of services. The centralized, confidential database will also be useful to pharmacists, who will immediately have your prescription record.

+ Who will run the Health Security Plan?

An independent citizens' commission will be responsible for the operation of the Health Security Plan. Its meetings will be open to the public, its budget will be public, and it won’t be able to make changes or additions to the plan without public input. Think of it as a cooperative. (See the next FAQ for more information on the Health Security commission.)

+ How is the Health Security Commission formed?

First, a geographically representative nominating committee will be chosen by majority and minority legislative leaders of both houses. No one with insurance interests can sit on the nominating committee or on the Health Security commission. The nominating committee will select candidates for the commission. Ten of the 15 commissioners must reflect consumer and business interests (with at least six of the ten reflecting consumer interests); the other five commissioners will represent provider and health facility interests. The commissioners will be selected from public education districts across the state in order to make sure that the commission is geographically representative. Most importantly, all members of the nominating committee and the commission must be eligible for or enrolled in the Health Security Plan.

+ How can I sign up for the Health Security Plan?

The Health Security Plan is not yet active. The 2021 Health Security Planning and Design Board Act will set up a board with the expertise to make decisions on some of the key details of the Health Security Plan. The Planning and Design Board will be in place for two years and will then hand things over to the Health Security Commission to finish the design phase and start enrollment in the Health Security Plan.

+ How can I help make Health Security a reality?

1. Be as informed as you can. Sign up for our email list. Then sign up for a workshop or informational meeting on Health Security!
2. Talk to everyone you know about Health Security. Tell them why you think it will work for all of us in the state. One of our biggest challenges is lack of awareness about this important New Mexico alternative.
3. Let your legislators and the governor know that you support the Health Security Plan, and ask them to support it too.

+ Is it legal for New Mexico to create its own plan?

There is a Waiver for State Innovation provision in the Affordable Care Act that allows a state like ours to develop a plan like Health Security and still receive federal dollars. The Health Security Plan meets the criteria for such a waiver, and the US Health and Human Services Department (which must approve any waivers) is likely to be supportive under the Biden administration.

+ What's the difference between the Health Security Plan and Medicare for All?

Medicare for All would create a national health plan. There are two Medicare for All bills in Congress, one in the House and one in the Senate. There are some differences between them (the Kaiser Family Foundation has a great comparison tool). Congress is able to change federal laws, so it could mandate the automatic inclusion of Medicare and Medicaid, for example. It could also require companies that are self-insured and come under the federal ERISA law (and so are exempt from state laws) to be included as well. State plans cannot change federal laws, so they have to work within the existing legal frameworks. Therefore, the Health Security Plan allows ERISA plans to voluntarily join the Plan, but it cannot require them to join.

With the current makeup of the Senate, the likelihood of Congress passing a Medicare for All bill is probably low in the near future. Moreover, there is a big advantage for our state to create a plan that works for us. In the United States, the states have often been leaders in reform. Passage of laws at the state level has been an effective way to pressure Congress to pass national laws for civil rights, women’s suffrage, labor reform, etc. Canada’s national plan came after the different provinces developed their own plans. (It was the poorest province, Saskatchewan, that started the ball rolling!)

+ What about Medicaid Buy-In?

The Medicaid buy-in proposal would allow New Mexicans who are not currently eligible for Medicaid to buy into this public insurance program. (Medicaid is a federal program, administered by the states, that provides health care coverage to lower-income and disabled Americans. Under the Affordable Care Act, Medicaid was expanded to include those earning up to 138% of the federally designated poverty level; this amounts to $36,156 for a family of four. Medicare, in contrast, is a federal program that provides health care coverage to older Americans, beginning at age 65, and some younger Americans with disabilities.)

After passage of the Health Security Planning and Design Board Act, it will take three to four years for the Health Security Plan to be up and running. In the meantime, it's important for as many New Mexicans as possible to have health coverage. That's where Medicaid buy-in could help. There are an estimated 214,000 people without health care coverage in our state. Allowing people to pay into the Medicaid system to gain access to good health coverage would help close that gap. People would pay a premium, as they do with private insurance, to buy into Medicaid.

+ I'm covered by Medicare. What would the Health Security Plan mean for me?

In order for Medicare recipients to be included in the Health Security Plan, agreements will need to be reached with the federal government to safeguard recipients’ rights. Negotiations will also need to be undertaken regarding Medicare supplements (whether from a former employer or purchased individually) so that retirees do not lose any benefits they are entitled to.

For these reasons, Medicare recipients might not be included in the Plan right away.