NM OHCR informational piece on HB 168 relating to NMHIX

Good afternoon Advisory Task Force Members et al:

 

Offered for your information below is a summary, prepared by the ABQ Chamber, of the first committee hearing on legislation (HB 168) proposing the creation of a NM Health Insurance Exchange:

HEALTHCARE EXCHANGE – MOVES AHEAD ON NARROW VOTE
The House Health, Government and Indian Affairs committee gave a do-pass recommendation to committee substitute for HB 168 on a straight party line 6-5 vote.  The bill, sponsored by Representative Mimi Stewart (D-Bernalillo) seeks to create a Healthcare Exchange that will offer health insurance plans to small businesses and individuals pursuant to the federal Affordable Care Act, aka Obamacare.  Chamber lobbyist Jacqueline DuBose Christensen appeared in opposition to the bill.
Representative Stewart reported that for more than three weeks, she has been negotiating with the Governor to attempt to reach a compromise.  She said, “We almost got a compromise but not completely.  This is probably as close as we can get at this point.”  Representative Stewart complimented the Governor’s people as being great to work with.
Heart of the matter
First, there is a dispute as to whether legislation is needed at all.  The administration asserts that the 1994 law creating the Health Insurance Alliance is sufficient for developing the new Health Care Exchange.  An Attorney General’s opinion says that the 1994 law conflicts with the new federal law and needs to be fixed.  Some legislators clearly want to have a role in shaping the board that will govern the exchange, including some of the board members being appointed by the Legislature.  The committee substitute for HB 168 allows the board to exclude plans certified by the federal government from the New Mexico Health Care Exchange.
Major sticking point
If the exchange board can exclude plans, then the state gets into the business of picking winners and losers.  This is the basis for opposition by the Chamber, many health insurance carriers and Republicans on the committee.  We want the marketplace to decide which plans succeed or fail.  As Representative Terry McMillan (R-Dona Ana), the Legislature’s only doctor, put it, “The poison pill is in those three lines [the lines allowing the board to select who’s in or out].  McMillan summarized the situation as follows:
“This legislation is not required to create an exchange.  It’s on its way and being formed…We have this legislation because some legislators want to have a say on the formation of an exchange.  We negotiated a lot of the issues but the fulcrum of the debate remains the same.  This is the rub.  The exchange board will determine which qualified plans can participate.  Until this language allows for more of a free market place, I can’t support it.  I think all qualified plans should be allowed on the exchange and let consumers and employers decide in a free market.”
Providers excluded from negotiations
Providers of health insurance plans were excluded from negotiations on the bill.  They assert that not only will they be assessed fees to pay for the exchange but they also have a great deal of expertise to offer and, therefore, deserve a place at the table and we agree.  Representative Stewart observed that the negotiations focused on the Governor.  “We can’t sit here and negotiate with everyone, if we do, we’ll never get agreement.”  In addition to the Chamber, health insurance plan providers also opposed the bill including America’s Health Insurance Plans (a coalition of health insurance providers), AFLAC, Blue Cross/Blue Shield, United Health Care, the Secretary of Health and Human Services and the National Federation of Independent Businesses. 
Supporters of the bill include the League of Women Voters, the New Mexico Center on Law and Poverty, the Lutheran Ministries, the American Cancer Society Network and New Mexico Voices for Children.
Take a little more time…dogs and cats dancing in the streets
Republican Minority Whip Nate Gentry (R-Bernalillo) urged Representative Stewart to hold the bill over and see if additional compromise could be reached.  He said, “You know, this is the session where dogs and cats are dancing together in the streets.  This is about compromise.  I suggest Representative Stewart that you give this one more try and bring in the parties to see if you can work it out.”
A motion to table was defeated on a 5-6 party line vote before the final vote was taken on the do-pass recommendation, which passed 6-5.  According to one individual testifying in opposition to the committee substitute, an additional bill creating an exchange may be introduced before the bill introduction deadline on Thursday.
Why a state health care exchange at all?
Under Obamacare, states are given the option of establishing a health care exchange or, if they do not, the federal government will establish one for that state.  Some states have opted out.  New Mexico Governor Susanna Martinez opted to create an exchange believing that it will give a better chance for local providers to participate and that the needs of New Mexico consumers and businesses will be better addressed.
How it works

An exchange will provide an on-line, one-stop “virtual” marketplace where small businesses and individuals can shop for health insurance plans.  The state plans to employ “navigators” that will assist consumers in evaluating and selecting plans best suited to their needs.  It is estimated that some 400,000 New Mexicans are currently uninsured.  It is hoped that some 200,000 will use the exchange to become insured either through their place of employment or as individuals.  Federal tax credits are available to help offset some of the costs.  Individuals who make more than 138 per cent of poverty level, about $15,000 for individuals and $32,000 for a family of four are eligible to use the exchange.  Lower income individuals will be covered on Medicaid.