Tony Romero has deep roots in the area around Las Vegas, New Mexico, where he lives with his family. His great-great-grandfather is buried several miles outside the city on a property where, as a kid, Romero spent summer days and weekends helping his grandparents tend their livestock.
After discovering that his child suffered from a rare illness requiring specialized treatment not covered under his employer-provided health insurance plan, Romero tells SFR he had to sell his grandmother’s house to cover costs.
"It was heartbreaking," he says. "I mean, that land has been in our family for generations."
Romero’s experience is common in America. According to data collected by the Kaiser Foundation, in 2017, one in four insured adults skipped or delayed care due to costs or were unable to pay out-of-pocket medical bills.
Here in New Mexico, Romero's story is an example of what HB 295, the Health Security Act, aims to fix.
Sponsored by Rep. Debbie Armstrong (D-Albuquerque) in the Roundhouse this session, the act could set New Mexico on course to develop a statewide public insurance plan that would make affordable health care accessible to virtually all New Mexicans for the first time.
Under the plan outlined in the bill, all state residents would receive a similar level of coverage to that currently available to state employees, including full mental health care, substance abuse treatment, and alternative preventative care options such as Oriental medicine. The plan would be funded through a novel combination of public money from Medicaid and Medicare and individual premiums priced on a sliding scale based solely on income.
If approved during the 2019 legislative session, the bill first calls for a comprehensive study of the state’s current health care costs and needs, to be completed by 2021. If this analysis concludes that adoption of the plan can save the state money as well as improve coverage for a majority of New Mexicans, the Legislature would then vote on whether to move forward.
Armstrong estimates that at least two thirds of New Mexicans are insured through public dollars, and though the percentage of uninsured and underinsured New Mexicans has fallen in recent years—largely due to the expansion of Medicaid—nearly 188,000 New Mexicans remain without coverage.
With the Affordable Care Act facing an uncertain future in Washington after being ruled unconstitutional by a federal judge in December, Armstrong worries that people with longstanding illnesses face an uncertain future as well.
That’s why it is time for New Mexico to seize the lead in crafting a health care system that could truly benefit everyone, Armstrong tells SFR.
Her background in health care includes the role of executive director of the New Mexico Medical Insurance Pool, an organization established decades ago to cover residents otherwise considered uninsurable due to pre-existing conditions.
For Julie Chase-Daniel of Santa Fe, finding coverage under the pool was life-changing. Chase-Daniel has a hereditary health condition that excluded her from receiving coverage except under NMMIP before the passage of the federal Affordable Care Act.
Her voice shaking with emotion, Chase-Daniel shares that getting coverage under the pool gave her the peace of mind she needed to make some of the most important decisions of her life, such as becoming a mother and starting a business.
"I was able to have a healthy birth, with the complete trust that if something happened that required serious medical intervention, I would have the care that I needed, and my baby would too, regardless of my pre-existing condition," she tells SFR. "Knowing that you have access to care is so empowering. It affects everything about your life, and not just in the narrow sense of physical health or well-being."
After passage of the Affordable Care Act, Chase-Daniel left the NMMIP for a plan that she could share with her family. Now, she says, with the threat that the national program will go away, she lives in constant fear that she will lose coverage.
Rep. Armstrong became personally aware of the issue when her own daughter was diagnosed with cancer as a young child.
"Nobody plans on their kids getting sick, and no one should go bankrupt in the effort to save their kid's life," she tells SFR in an interview at her office at the Capitol. "The aim [of the Health Security Act] is to achieve universal coverage."
One of the things that makes the Health Security Act unique is that, unlike single-payer plans considered by other states in the past, New Mexico’s proposed plan would create a publicly run cooperative overseen by a geographically representative committee of 15 members and would represent provider, employer and consumer interests equally.
The Health Security for New Mexicans Campaign has pushed for such a bill for decades. The goal, Campaign Chair Max Bartlett tells SFR, is for decision-making to be transparent and open to public input.
Bartlett emphasizes choice of providers as an important feature of the plan.
It "does away with provider networks. From the patient perspective, this means that you will be able to choose which doctor you want to see. Patients will have agency in the decision-making process about the kind of care they need," he says.
Dr. Tyler Taylor, a retired family practitioner from Los Alamos who now coordinates the Physicians for the Health Security Act as part of the Health Security for New Mexicans Campaign, tells SFR the plan would allow doctors to drastically reduce the amount of time spent on insurance-related administrative tasks, and would eliminate some of the ethical dilemmas that arise when patients seek critical care that lies beyond the scope of their coverage. For these reasons, Taylor predicts that the Health Security Act would likely attract medical professionals to New Mexico.
Legislation for the Health Security plan has been introduced in New Mexico in the past but has never made it through the Legislature, though analysis done in 2007 by Mathematica Policy Research Inc. estimated that the plan would reduce expenditures for the state. This session, the question of of expense remains the greatest obstacle to passage of the bill.
"I would really question the idea that this would somehow be a revenue neutral proposition," says Paul Gessing, president of the Rio Grande Foundation, a non-profit research group specializing in issues concerning "limited government and economic opportunity." Gessing cautions that single payer plans implemented or proposed in other states, such as Vermont, Colorado and Maine, were "so expensive that they were either rejected or repealed after the costs became apparent."
But Bartlett tells SFR there has never been a better time to pursue universal coverage.
"We have more bipartisan support than we've ever had before," he says, citing over 30 New Mexico cities and counties that have signed resolutions in support of the Health Security Act, including Albuquerque, Las Cruces and Roswell. With a 6-to-1 favorable vote by the City Council last Wednesday, Santa Fe joined that list.
Of course, having a Democratic majority in the Legislature doesn't hurt either, and Democratic Gov. Michelle Lujan Grisham has signaled support for the bill.
The Health and Human Services Committee expects to vote on the bill in a hearing on Friday. The bill then heads to the House State Government, Elections, and Indian Affairs Committee and the House Appropriations and Finance Committee for votes in hearings that are yet to be scheduled.