As SFR went to press, the US Senate was on track to vote—and pass—a bill to reform health care. Back in New Mexico, state Sen. William Sharer, R-San Juan, was stewing—and not about the dismaying collapse of the Democrats' Medicare buy-in proposal, either.

"What's going on in Washington now is exactly what we fought a revolution over," Sharer says. "You're taking away liberty."

Sharer's is the classic libertarian argument against government-run health care—but he recognizes, laughingly, that in New Mexico, he's in the minority. From a long-winded public debate to a steadily worsening local situation, health care reform became the issue of the year, and the "public option"—which four of New Mexico's five congressional delegates support—its ubiquitous catchphrase.

In New Mexico, despite brief national hysteria about "death panels" and widespread local confusion about what health care reform actually means, reform has started to sound like the only way out of a very broken health care system. One in four New Mexicans are currently uninsured, the second highest percentage in the country. Even before the economy imploded, the percentage of uninsured workers in New Mexico hovered almost 10 percentage points above the national average; once the recession hit, local businesses scrambled to offer coverage without bankrupting themselves.

"Without reform, New Mexico will experience the largest increase in insurance premiums of any state in the country," US Sen. Tom Udall, D-NM, tells SFR. "The status quo is not an option for New Mexico."

The status quo is in part a function of the state's budget problems. In February, Gov. Bill Richardson signed a bill to cut $27 million from Medicaid and the State Children's Health Insurance Program in anticipation of federal money; after the special legislative session in October, Richardson approved additional (albeit limited) Medicaid cuts.

Udall says the federal bills—the House bill passed Nov. 7, with the support of Democratic US Reps. Martin Heinrich and Ben Ray Luján; the Senate bill had not passed as of press time—provide federal money to cover the entirety of the expanded Medicaid program, eliminating the effect of state budget problems on health care. Also, Udall says, the bill has provisions to keep insurance companies from denying coverage to people with pre-existing conditions or long-term illnesses.

Some of the less-publicized aspects of the House bill also are of particular import to New Mexico, according to Dick Mason, the legislative committee chairman for Health Action New Mexico, an advocacy group that favors the public option.

"One of the things that was underplayed is the extraordinary benefits in these plans for rural areas," Mason says. He's talking about loan forgiveness for doctors who practice in rural areas, support for rural community health centers and the reauthorization of the Indian Health Care Improvement Act.

"I think if people realize these insurance reform initiatives, they'll be welcomed and applauded," Udall says.

Udall, along with the rest of the New Mexico delegation, takes contributions from the health care industry, and the sweeping reforms he advocates will not only take years to implement, but will also have their own kinks.

But to Mason, almost any reform is good reform. "New Mexico's going to benefit considerably—probably disproportionately positively—on health care reform," he says. "We are paying a very large price for our uninsured." Thousands of dollars out of every health insurance policy, he says, go to funding uncompensated care.

Currently, Mason is assembling a working group to hammer out the local aspects of health care reform. He says he's not worried about challenges from the likes of Sharer, who plans to reintroduce his 2009 joint resolution that calls for a ban on government-mandated health insurance.

"That isn't going to go anywhere in New Mexico," Mason says. "I'm not concerned about that."

Not that he's completely blasé.

"I've been working on federal health care reform since 1991," Mason says. "This is like my Super Bowl. In 1993, 1994, we thought it was going to happen; this issue was first raised by Theodore Roosevelt over 100 years ago." He pauses.

"I'm very excited," he adds. "And worried"—and then he laughs. He's reluctant to jinx it, but if the Senate does pass the bill on Christmas Eve, this year just might bring real reform.