Making the Papers: Our Latest Op-Ed

Our recent op-ed has been published from Las Vegas to Roswell!

Read on …

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Health Security – How to Slow Rising Health Care Costs!

by Mary Feldblum, Executive Director, Health Security for New Mexicans Campaign

It’s depressing. Health costs are rising – impacting patients, employers, and providers. What can be done?

The Health Security for New Mexicans Campaign, a diverse coalition of 170 organizations and thousands of New Mexicans, has developed a homegrown solution. The Health Security Act would enable New Mexico to create its own health plan, guaranteeing comprehensive coverage and provider choice (no more networks) for most residents.

Three independent studies concluded that this plan would dramatically slow health care cost increases, and this is due to more than the advantage of large enrollment numbers. There are countries that guarantee health coverage, spend far less than the United States, and have better health results. How do they do it?

• Standardized health professional payment systems. (Instead of 20 different fees for the same procedure.)

• Set budgets (global budgets) for hospitals, providing a secure revenue source. (No more pages of inexplicable charges. No surprise bills.)

• A program that negotiates drug prices.

• IT systems that provide a patient’s medical history wherever they receive care.

• One set of comprehensive covered services.

Surely, addressing these areas is critical to solving our health crisis.

What is New Mexico doing?

The Health Security Act, which sets out guidelines for the Plan, does not provide details about how the Plan will work. In 2021, the legislature appropriated funding to the Office of Superintendent of Insurance (OSI) to oversee the design of the Health Security Plan.

In 2022, $790,000 was allocated to OSI to continue this work.

In May, Sen. Ortiz y Pino and Rep. Hochman-Vigil shared with Insurance Superintendent Russell Toal a list of six topics that we and our sponsors identified as critical to addressing rising costs. They seemed acceptable to Toal. They included conducting a cost analysis of the privatized Medicaid managed care program, gathering annual NM health expenditure data to evaluate the cost impact of any new policies, and developing:

• a global budgets program for hospitals

• a standardized payment system for health professionals

• a program that lowers drug costs

• an inter-operational IT system

Based on statements by Toal and Human Services Secretary David Scrase, the administration is focusing on helping more New Mexicans sign up for coverage through Medicaid and beWellnm.

While important, covering more people will not address the systemic problems of why costs (and premiums) are rising. It will not result in simplifying a complex system that frustrates providers and patients alike. Moreover, focusing on current health care access issues should not preclude simultaneously moving ahead with long-term systemic solutions.

Last year, OSI did an excellent job of hiring experts whose reports included options that should be pursued during this second year of design.

Unfortunately, there has been almost no discernable action on five of the six priority topics. (A request for proposals for a global budgeting study was released on September 30.)

New Mexico cannot afford to continue patching up a flawed system. Interim solutions are important, but costs will continue to rise unless we establish policies that enable us to take control of an out-of-control system.

The design process provides an opportunity for New Mexico to come up with a coordinated solution that will work for our state and our residents.

Please ask your state representative and senator to support the Health Security Plan design process!

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Versions of this op-ed have appeared in the Roswell Daily Record, the Santa Fe New Mexican, and the Las Vegas Optic, as well as the Corrales Comment and The Paper.

While the op-ed was published before the elections, the message remains: We need our state senators and our reelected and newly elected state representatives to stand up for Health Security and the continuation of the design process. The 2023 legislative session is just two months away!

Design Process Update: Concerning News

The Superintendent of Insurance has been responsible for managing the Health Security Plan design process since 2021. While his office did an excellent job last year, there has been no discernable action yet on this year’s priority topics, even with much more money allocated to the design process and with funding set aside to hire staff for this project.

It’s now September. It appears that the Superintendent has too many other obligations to devote the necessary effort to this.

The bottom line: A new board is needed to take over the design process.

It is time for the legislature to create a board of experts that will be able to explore and assess various options, with the help of consultants, and make recommendations to the legislature concerning the solutions and approaches that have the greatest benefit for New Mexicans and the highest chance of success.

Introducing legislation to create such a board will be proposed at the Legislative Health & Human Services Committee meeting on September 15. Scroll down for more information.

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Register Now! Health Security Webinar, Sept. 13

Campaign member organization Retake Our Democracy will be holding a webinar on Health Security on Tuesday, September 13, 6:00-7:30 PM. This event will feature Campaign executive director Mary Feldblum and key legislative allies Sen. Jerry Ortiz y Pino and Rep. Dayan Hochman-Vigil.

For more information, visit Retake Our Democracy's Actions & Events page. To register, click here. You must register in order to attend.

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Legislative Health & Human Services Committee Meeting, Sept. 15 in Gallup

The Campaign has been invited to present on the current status of the Health Security Plan design process to the interim Legislative Health and Human Services Committee at its three-day meeting in Gallup. Our executive director is now scheduled to speak at 11:30 AM on Thursday, September 15. The full agenda can be found here.

This is a crucial opportunity to make it clear to committee members why systemic health care reform is vital for the health of our residents and our state. Simply plugging the holes in our system is not going to solve the serious crisis we face. At this meeting, we can help the committee understand how important it is to continue the design process of our own New Mexico health plan, as well as correct some misinformation that is circulating about the design process being "just another study" and the plan itself being unworkable.

This is also a critical meeting for us because we are seeking the committee’s endorsement of 2023 legislation to create a board of experts that, with public input, will be authorized to continue putting together the key pieces of the Health Security Plan design jigsaw puzzle. With no progress being made on the design process by the Office of Superintendent of Insurance so far this year, getting this legislation passed will be vitally important.

What You Can Do & Upcoming Events

What You Can Do Right Now

Speak up at candidate meetings. It's an election year! If you attend candidate get-togethers, fundraisers, or forums, don't forget to express your support for Health Security—with a short explanation about why you think it is important—and urge the candidate to publicly support it as well.

Set up meetings with groups and local organizations in your community. If a group of people in your community or an organization you belong to would like to find out more about this exciting phase of the Health Security journey, email us to set up a meeting or presentation. We need to keep spreading the word!

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Upcoming Event #1: Health Security Webinar, Sept. 13

Campaign member organization Retake Our Democracy will be holding a webinar on Health Security on Tuesday, September 13, 6:00-7:30 PM. This event will feature Campaign executive director Mary Feldblum and key legislative allies Sen. Jerry Ortiz y Pino and Rep. Dayan Hochman-Vigil.

For more information, visit Retake Our Democracy's Actions & Events page. To register, click here. You must register in order to attend.

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Upcoming Event #2: Legislative Health and Human Services Committee Meeting, Sept. 15

We have been invited to present on the current status of the Health Security Plan design process to the interim Legislative Health and Human Services Committee at its September 15 meeting in Gallup.

Between legislative sessions, the interim Legislative Health and Human Service Committee goes on the road. Here, they are meeting in Albuquerque in July.

This is a crucial opportunity to make it clear to committee members why systemic health care reform is vital for the health of our residents and our state. Simply plugging the holes in our system is not going to solve the serious crisis we face. At this meeting, we can help the committee understand how important it is to continue the design process of our own New Mexico health plan.

This is also a critical meeting for us because we are seeking the committee’s endorsement of 2023 legislation to create a special board that, with public input, will be authorized to continue putting together the key pieces of the Health Security Plan design jigsaw puzzle.

Sign up for our email alerts for updates on this and other events and happenings.

Designing a Health Care System That Works

There are so many ways to do this!

Taking a look at the Commonwealth Fund’s International Health Care System Profiles makes it abundantly clear; there is no one way to structure a universal health care system.

Here in New Mexico, we’re busy figuring out the many details for our own state-based plan, using the 2019 Health Security Act as a guide. It’s like a jigsaw puzzle, with many pieces that all need to work together.

When solving this puzzle, certain pieces are more important to address first. The following three were chosen for the first year of this design process:

1. Federal laws and waiver requirements, to ensure that federal funding continues and recipients do not lose benefits

2. Global budgets for hospitals, to provide guaranteed revenue for health care facilities, many of which are financially stressed

3. Standardized payment systems for health care professionals, to enable providers to spend more time on patient care and to reduce health care system costs

Six pieces of the system are being addressed this year:

1. Global budget working group, to build on last year’s research on this issue

2. All-payer rate system, to look at setting up a system that sets uniform reimbursement rates for health care professionals

3. Prescription drug affordability, to explore how to develop a prescription drug program that lowers prices for patients

4. Medicaid expenditure data, to understand the cost of the Medicaid managed care program, which covers 900,000 New Mexico residents

5. Inter-operational IT system, to explore how to create an inter-operational IT system that applies to all New Mexico insurers and health care providers

6. State health expenditure data, to find out how much we are actually spending on health care in our state and exactly what we are spending it on

We’ve created a new webpage dedicated to the Health Security Plan design process. Bookmark it today to stay up to date!

What's Happening with Health Security Design?

Year 2: What’s Going on Now

Earlier this year, the legislature allocated even more funding to continue the Health Security Plan design process. We’ve been working with our lead legislative sponsors—Sen. Jerry Ortiz y Pino and Rep. Dayan Hochman-Vigil—on what the priorities should be for this year.

In coordination with the Superintendent of Insurance, six topics have been selected. These topics address vital parts of the current system and solutions that are integral to the Health Security Plan. We’ll be excited to see what the consultants produce!

The first two selected topics build on last year’s research:

1. Global Budget Working Group—This topic builds on the global budgets research from last year. (View our summary here.) Global budgets provide guaranteed revenue for hospitals, which will particularly help our struggling rural hospitals and the communities that depend on them. This task force will bring together key stakeholders to establish priorities and research options for a hospital global budgeting program.

2. All-Payer Rate System—This topic builds on the recommendations from last year’s expert consultant on health care professional payment systems (to find out more, read the full report or view the slide deck). An all-payer payment system sets uniform reimbursement rates that apply to all health care professionals within a specialty and may apply to both private insurance companies and public programs like Medicaid. Such a system greatly reduces billing complexity and increases transparency.

The remaining four topics address other key aspects of our health care system:

3. Prescription Drug Affordability—This topic will focus on how to develop a prescription drug program that lowers prices for patients.

4. Medicaid—This topic will focus on understanding the cost of the Medicaid managed care program, which covers 900,000 New Mexico residents. To address issues around Medicaid (and its impact on the state budget), it is imperative to have an accurate picture of its true costs. As last year’s expert consultant on federal waivers mentioned in their report, Connecticut decided years ago to drop its Medicaid managed care program and have the state administer it instead because of rising costs.

5. Inter-Operational IT System—This topic will focus on how to create an inter-operational IT system that applies to all New Mexico payers (private insurance and public programs) and providers of health care services. This system would also include patient medical information (with privacy and security concerns addressed), so that no matter where you go to receive health care in New Mexico, providers have your medical history.

6. State Health Expenditure Data—This topic will focus on collecting full New Mexico health care expenditure data so we know what we are actually spending on health care in our state. This data will serve as a baseline for future years and should be collected annually going forward. All efforts to increase the effectiveness, stability, and sustainability of our health care system will benefit from having this data available.

Year 1: Research Results

With funding from the 2021 state legislature, the Office of Superintendent of Insurance contracted with several consultants last year to begin to explore possible solutions to two critical and challenging pieces of our health care system. Their research and recommendations focused on global budgets for hospitals and standardized payment systems for health care professionals.

The consultants also looked at federal laws that will affect the structure of our own health plan in New Mexico, along with federal waiver requirements to ensure that federal funding continues and recipients do not lose benefits.

The reports from these consultants contain a lot of excellent information, but we know it’s not easy to find the time to read over 100 pages of report text! Thus far, we’ve put together summaries of two of the three topics initially covered. Take a look!

• Year 1: Global Budgets for Hospitals

• Year 1: Federal Legal Landscape & Waivers

The full reports can be found here.

A Multi-Year Process

Designing our own health plan that guarantees coverage for most New Mexicans will take time. It is important to get it right. We see this process as putting together solutions (such as global budgets) in phases. We can design the Plan piece by piece—as long as the ultimate goal and structure are always kept in mind—so we are not waiting to act until every part of the design is complete. There is no reason why we should delay in strengthening struggling hospitals, addressing escalating drug prices, and simplifying a system that discourages providers from wanting to practice medicine in our state.

As the design process continues this year, we will keep you posted about what is happening and how you can participate.

If a group of people in your community or an organization you belong to would like to find out more about this new and exciting phase, contact us at hsnmc.contact@gmail.com to set up a meeting or presentation.

Solving the Puzzle: Putting the Pieces Together through the Design Process

Imagine if you paid for an airplane ticket and then got separate and inscrutable bills from the airline, the pilot, the copilot, and the flight attendants. That’s how the healthcare market works. In no other industry do prices for a product vary by a factor of ten depending on where it is purchased.

 — Elizabeth Rosenthal, MD, in An American Sickness: How Healthcare Became Big Business and How You Can Take It Back, 2017

So much of the focus on health care is centered on access issues. While it is very important to provide opportunities for New Mexicans to receive health coverage—either through public or private programs—there is another issue that must be addressed: the wasteful, costly and administratively complex pricing of health care services.

We need to think of our health care system as a jigsaw puzzle. Each piece is connected to other pieces. The puzzle cannot be solved without figuring out how the pieces are connected to each other.

Thus, just gaining access to health insurance will not address hospital costs, pharmaceutical drug prices, the frustrating (and costly) administrative burden on health care professionals, or increasing patient out-of-pocket responsibilities, which may prevent people from getting the care they need.

Our state needs to come up with a coordinated solution to address both access and cost. The jigsaw puzzle needs to be solved.

For over two decades, the Health Security for New Mexicans Campaign, currently a coalition of 170 diverse organizations and thousands of individuals, has been working on a homegrown systemic New Mexico solution. We have reached out to all areas of the state, seeking feedback on a simple idea: let’s set up our own health plan that automatically covers most New Mexicans, offers comprehensive services and freedom of choice of provider, and is overseen by a geographically representative citizens’ board (like a co-op). Private insurance may play a supplemental role, as it does in many European countries (and as is the case with traditional Medicare).

The Health Security proposal requires a major paradigm shift, one that combines and coordinates the key elements—the different puzzle pieces—of our health care system.

According to three independent New Mexico studies (the most recent in 2020), the Health Security approach will slow the rate of increase of health care costs, ensure coverage for all state residents, and simplify what has become a complex and administratively burdensome system that frustrates health professionals and patients alike.

In 2021, the New Mexico Legislature provided funding to develop the details of the proposed Health Security Plan. This funding enabled the Office of Superintendent of Insurance to hire consultants to engage in key research areas during the initial year of the design process.

While the 2019 Health Security Act provides important guidelines for creating the Health Security Plan, there are many details that still need to be fleshed out, including enrollment, hospital and health professional payment systems, appeals systems, IT/medical records, accountability systems, and more. Decisions will have to be made about these details before the plan can begin offering coverage. Once designed, a fiscal analysis can then be conducted on the plan as designed— not as projected.

If New Mexico is to develop a systemic solution to our health care crisis, it is important to understand how these different key elements impact each other. Unlike a jigsaw puzzle, however, these critical components of our health system require gathering information about state and international experiences, learning from them and then deciding what would work for our state, keeping in mind how each piece fits together and impacts access and cost.

During the 2022 legislative session, the superintendent of insurance presented very promising results on the three critical research topics selected.

Topic 1. Investigation of federal waivers and agreements that provided key information regarding prospective plan enrollment numbers.

Initial results: The report describes various approaches to receiving federal waivers or agreements, focusing on Medicaid and Medicare, the two largest programs in New Mexico, while ensuring the protection of recipient entitlements.

Topic 2. Exploration of provider payment system methodologies that focused on whether it is possible to standardize our complex multi-layered payment system, as many European countries have done.

Initial results: The report describes various options to develop such a coordinated system so providers and health facilities do not have to deal with multiple different charges for the same service.

Topic 3. Research on the feasibility of creating a global budget program for hospitals, a payment system in which hospitals receive a predictable, sustainable revenue stream instead of depending on an unpredictable, complicated charges system. (Maryland’s global budget program has been very successful.)

Initial results: Two reports, written by separate consultants, concluded that New Mexico could greatly benefit from such a system, whose creation can be funded by the Centers for Medicare and Medicaid Services.

In sum, the reports describe possible paths to take that will address both access and cost issues.

But more research is required.

Recently, the legislature increased the funding for this coordinated approach. The appropriation will enable the superintendent to follow up with the suggestions made in the initial reports and to investigate two additional critical topics: how to address rising drug prices and how to create a workable inter-operational IT system so that no matter which plan you have, the provider you go to will have your complete medical history.

While the design project clearly is a multi-year effort, the research on some of these pieces in the health care puzzle can lead to more immediate solutions.

For example, a hospital (and clinic) task force could be created this year to figure out how a global budget system could work in New Mexico, with the goal of applying for startup funds from the Centers for Medicare and Medicaid Services. It would be possible to create a second task force to explore the creation of a program to negotiate drug prices that could benefit all New Mexicans.

Thus, the Health Security Plan design process will enable New Mexico to phase in key pieces of the puzzle like hospital and drug costs, keeping in mind how these programs would impact the other jigsaw pieces of the health care system and how they would align with the systemic reform the Health Security approach will ultimately bring.

New Mexico has been given an extraordinary opportunity to carefully design a workable solution to our health care crisis, one that is appropriate for our large, mostly rural state with its small population.

Health Security Funding Secured!

Health Security Funding Approved by Governor!

The legislature met in a special session last week, and the governor signed SB 1—a revised version of the regular sessions "junior" budget bill—on Friday.

$790,000 is now available to continue the Health Security Plan design process!

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

What's Next

With funding to continue the design process finally secured, we're back to focusing on 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.

• Reviewing and reporting on the consultants' findings from the initial phase of research on the Health Security Plan. All the reports are now available on the Office of Superintendent of Insurance's website, along with a recorded roundtable discussion with the consultants.

• Continuing our series of informational Zoom sessions.

• Making sure New Mexicans are informed about the design process and have input into the creation of our homegrown plan.

We're excited to get started on year two of Health Security Plan design!

A Path Forward for Restored Funding

“Junior” Funding on Special Session Agenda

On March 9, 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 just one part of this bill, which contained funding for many other good programs.

Now the governor has called a special legislative session, to begin next Tuesday, April 5. During this session, which will likely only last a day or two, the legislature will take up a slightly revised "junior" funding bill. We are working with our allies in both houses to make sure that the funding for the Health Security Plan design process remains in the bill! The legislature is not, at this time, planning to override the governor's veto of the original bill.

Sen. Ortiz y Pino and other legislators feel confident that when the legislature meets next week, the $790,000 will be restored to the budget, enabling the design process to resume!

Roundtable Recording Available

From “Payment Models: Options for New Mexico,” slide 6.

On March 14, a Zoom roundtable was held with the consultants hired by the Superintendent of Insurance to perform preliminary research regarding the design of the Health Security Plan. If you missed the roundtable, you can watch it here.

These very knowledgeable presenters shared their initial findings, which lead to new avenues to explore. Their reports were very encouraging, and it was great to hear them brainstorm about how we could make things like global budgets for hospitals and widespread enrollment work within the framework of the Health Security Plan and amid various federal constraints.

Their questions and conclusions will help to inform what needs to be researched and discussed during this second year of the design process.

The four research reports, along with two slide decks from the March 14 roundtable, are posted on the Office of Superintendent of Insurance website.

Research Findings Roundtable on March 14

Last year, the Office of Superintendent of Insurance contracted with several organizations to research key questions about the Health Security Act, including federal laws and waivers, provider payment methods, and global budgeting.

These researchers will be presenting their findings next Monday, March 14, during a virtual roundtable organized by Health Security sponsor Sen. Ortiz y Pino and the Office of Superintendent of Insurance.

Please join!

Event: Health Security Act Roundtable to Present Research Findings

Date: March 14, 2022, 3:00-5:00 PM

Join Zoom Meeting:
https://us02web.zoom.us/j/86960074240?pwd=eE5uMTNjUldaRkM5SUtCVHNIdEhoQT09

Meeting ID: 869 6007 4240
Passcode: 593480

One tap mobile:
+16699006833,,86960074240#,,,,*593480# US (San Jose)
+12532158782,,86960074240#,,,,*593480# US (Tacoma)

Dial by your location:
+1 669 900 6833 US (San Jose)
+1 346 248 7799 US (Houston)
Find your local number: https://us02web.zoom.us/u/kOWfDoFvy

The research reports so far can be found here.

Governor Vetoes “Junior” Budget Bill Containing Health Security Funding

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

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.