ABQ Journal Article "Money at Root of N.M. Caution Over Medicaid"

Money at Root of N.M. Caution Over Medicaid
By Winthrop Quigley / Journal Staff Writer on Tue, Aug 7, 2012





In the 12 years I’ve covered health policy for the Journal, the one unchanging and undiminished concern of insurance companies, public officials, hospital administrators and many doctors, nurses and business leaders has been New Mexico’s large number of people who lack health insurance.
The federal Affordable Care Act offers New Mexico the chance to eliminate the problem at a relatively low cost to the state. You would think that after fretting about the uninsured for so many years our state’s political leaders would be jumping at the chance finally to bring health care coverage to an estimated 400,000 to 500,000 people who lack insurance.
They are not jumping.
It’s not as if they’ve suddenly decided that having as much as a quarter of our state’s population going uninsured is a good thing. They know what we’ve always known: Uninsured people are in worse health than insured people; unhealthy people are less productive; uninsured people seek care eventually, and when they do it costs more to treat them; uninsured people can’t pay their medical bills in full so the cost of their care is shifted to everyone who pays taxes or insurance premiums.
They know that uninsured people die younger.
They know that many of the state’s uninsured are working adults who earn so little they can’t afford their share of employer-provided insurance. Some work intermittently, at seasonal or temporary jobs, or at one or several part-time jobs. Many work in small businesses that don’t offer health insurance.
They also know that perhaps 200,000 of the people counted as uninsured could get and afford coverage. They just choose not to do it.
New Mexico is being offered a sweet deal to solve the problem.
The uninsured who can afford coverage will either buy insurance or pay the feds a tax or penalty, call it what you will. The federal government will give subsidies to qualifying small businesses and individuals to help.
Uncle Sam is willing to give New Mexico more than $6 billion from 2014 through 2020 to cover our lowest-income adult population through an expanded Medicaid program. All we have to do is tell Washington we’ll take their money, then put up 10 percent of the cost starting in 2017, about $500 million over the first three years of expansion.
The federal government swears it will continue in perpetuity to pay 90 percent of our cost of expanding Medicaid to more adults.
The health policy people and many of the state budget experts I talk with call this a no-brainer decision. Why not pay $500 million to get more than $6 billion in federal money? There certainly is a case to be made that an injection of $6 billion-plus into our economy from any source would stimulate economic activity. Sure, we would rather get $6 billion from new business startups and expansions, but that isn’t being offered. Medicaid expansion is.
New Mexico’s hesitation seems to be budgetary in nature. Our state has been blessed over the years with a lot of really smart tax and budget officials, elected and nonelected. When some of these people say they are not sure about this, we are well-advised to pay attention.
The feds have always been generous to New Mexico when it comes to Medicaid. Today, the state picks up only about 30 percent of the cost of covering beneficiaries, most of whom are low-income children, disabled adults and the elderly. Even at that, Medicaid is expected to account for about 16 percent of state general fund spending this fiscal year, up from 12 percent last year. Expanding Medicaid to all low-income adults would cost the state nothing for the first three years, then perhaps $167 million a year more for three years starting in 2017, which is as far as state officials are prepared to forecast.
Will the state have that extra money? Where will it come from? What if the state has promised low-income adults Medicaid coverage only to find in 2021 or thereafter that the federal government no longer wants to pay 90 percent of the cost of covering them? Can we pick up the higher cost then?
This isn’t an academic issue. Budget shortfalls forced the state to cut $40 million from Medicaid spending in 2004. New Mexico has always worked to avoid cutting eligibility and benefits. Usually we save money by making it a nuisance for beneficiaries to sign up and by cutting payments to providers. At some point, we may have to copy other states, like Nebraska, which removed 16,000 children from Medicaid in 2004.
If $40 million was a problem in 2004, can we expect $167 million in 2017 to be easy?
The budget people I know aren’t cruel, and they are far from stupid. They believe it is cruel and stupid to make promises they can’t keep. They want to be sure how deep the pool is before they make the state of New Mexico jump.
UpFront is a daily front-page news and opinion column. Comment directly to Winthrop Quigley at 823-3896 orwquigley@abqjournal.com. Go to www.abqjournal.com/letters/new to submit a letter to the editor.
— This article appeared on page A1 of the Albuquerque Journal