Jose Jimenez says he and his family have basically given up on following changes to the nation's health insurance system. Asked why, he says: "Because of Trump."
Jimenez, 24, continues: "At the moment, health insurance, it really doesn't interest me. I know it's a necessity we all need as Americans."
Nevertheless, Jimenez has signed up for individual health insurance through the New Mexico health exchange program every year since it has been available. It's helped him, he says, and he still plans to sign up for coverage by the Dec. 15 deadline—over a month earlier than the deadline fell last year.
"It was important to sign up back then, but I don't know now what to think," he says with a shrug after a recent shopping trip in Santa Fe.
While the reality show of Washington politics can be exhausting to follow, the state's Office of the Superintendent of Insurance contends that New Mexicans have plenty of options for coverage through the state's exchange market in the coming year. And because of politicking at the federal level, people in lower income brackets might inadvertently qualify for more subsidies than past years.
The challenge for the state will be how to enroll eligible people for coverage when the Trump administration has mostly muddied the process.
Even with a month and a half less time to sign up than previous years, people eligible for the exchange and who don't have other forms of insurance will still face a penalty if they don't sign up for coverage (this is known as the "individual mandate" of the Affordable Care Act, or Obamacare). The feds have also cut money for outreach and marketing to get people enrolled, leaving that to the states.
Between 2010 and 2014, the federal government gave $123.3 million in planning grants to New Mexico to set up and run the state exchange, then that cash dried up. Individuals enroll using the healthcare.gov platform, while small business owners can use the state exchange's website, shop.nmhix.com, to buy plans for employees.
As of last February, 54,865 people were enrolled in private plans through the New Mexico marketplace, while another 800,000 were expected to enroll in Medicaid, according to a July 2016 report from the Con Alma Health Foundation.
Some state governments, including New Mexico's, feared that the president's decision last month to end subsidies for insurers would depress enrollment by making monthly premiums more expensive. In September, well before Trump announced the change, regulators in New Mexico approved record high increases to monthly premiums in anticipation of the subsidy cut.
Premiums for the four insurers who participate in the state's individual insurance marketplace, including Christus St. Vincent, New Mexico Health Connections, Molina Marketplace and Blue Cross Blue Shield, are between 17 and 49 percent higher this year than last.
However, in a twist, lower-income people—those who make under 400 percent of the federal poverty level—who qualify for federal assistance to pay monthly premiums (called advanced premium tax credits) might get more assistance than usual this year. That's because the federal tax credit is tied to rising premiums, so if one goes up, the other does too.
"We're finding that thousands of New Mexicans are eligible not only for financial assistance, but there are many area plans that are available for less than $75 a month, even some zero-monthly bronze plans that will take care of premiums," says Heather Widler, spokeswoman of the Office of Superintendent of Insurance.
The office recently released a new tool to connect people with health insurance plans, available at OSICompareHealthPlans.org. Visitors can make doctor and medicine preference choices, and search results yield some coverage plans that are unavailable at healthcare.gov. Widler says the tool will help people find better deals for plans, though they do still have to officially enroll at healthcare.gov, or through the insurer directly.
The process of selecting insurance is the same as past years, requiring that people shop for plans fit both their medical needs and personal budgets. That's how it's supposed to work in theory, but anybody who has signed up through the exchange knows it can be more perilous than grocery shopping.
And middle-income people, those who earn too much to receive an advanced premium tax credit, will almost certainly be hammered by higher premiums this year.
For help picking a plan, New Mexicans can visit bewellNM.com and find insurance brokers, open-enrollment centers with in-person assistance and enrollment counselors, all free of cost. The organization is also hosting an open enrollment meeting 9 am-3 pm Saturday Dec. 9 at the 465 St. Michael's Drive building of Christus St. Vincent.