ABQ Journal Article "GOP Wasting Time on ACA Repeal"

http://www.abqjournal.com/main/2012/08/19/opinion/gop-wasting-time-on-aca-repeal.html




GOP Wasting Time on ACA Repeal
By Sen. Jeff Bingaman / Democrat, New Mexico on Sun, Aug 19, 2012



In June the Supreme Court upheld the vast majority of the Affordable Care Act. Still, Republicans in the House of Representatives continue to press for the law’s repeal.

This is a waste of time. Instead, we need to get to work on fixing our broken health care system. The time has come to stop fighting over ACA and instead focus on implementing it.

Across the country, the law is already working. Under ACA, millions of Americans benefited from free preventive health services last year, and women now have access to the full range of recommended preventive health services they need at no cost. ACA also requires that at least 80 percent of health care premiums be spent providing high-quality health care, not boosting the bottom line of insurance companies. Implementation of the fraud, waste and abuse protections in the law recovered $4.1  billion in taxpayer dollars in 2011 alone.

I am a strong supporter of ACA because New Mexico will benefit tremendously.

New Mexico has one of the highest rates of uninsured people in the country – nearly one in five residents lack health insurance. Uninsured New Mexicans still get lifesaving health services when they need it, but only because insured New Mexicans subsidize these costs through higher premiums. ACA expands health care coverage to more uninsured residents, saving all families money. According to one study, New Mexican households will have an additional $1,756 in their pockets in 2019 due to this law. 

Here in New Mexico, we’re seeing other important benefits as well. Twenty-six thousand young New Mexicans have gained coverage because the ACA requires their parents’ health insurance plans to cover them until they turn 26. 

Another 122,000 children in our state are no longer being denied coverage because of their pre-existing conditions. In 2014, no one with a pre-existing condition will be denied coverage; that’s at least 420,000 New Mexicans. And seniors and people with disabilities in New Mexico saved more than $17 million on prescription drug costs since the law was enacted. 

And there is more to come. We won’t feel the full effects of the law until 2014, when some 30  million more Americans will get health care coverage either because they will qualify for Medicaid or can purchase health insurance through the new health insurance exchanges. These are marketplaces that will be set up in every state so Americans can comparison shop to find the most affordable health care plan. 

According to the Bureau of Labor Statistics, by improving our nation’s health care safety net we will be creating millions of new jobs. New Mexico Voices for Children projects that 30,000 to 38,000 health sector positions will be created in our state. Our health care sector will be bolstered with an influx of $8 billion to $10  billion, according to one study. 

These dollars will help pay New Mexico doctors, nurses and other providers, and cover the cost of laboratory tests, medications and visits to health clinics. 

On the other hand, according to the nonpartisan Congressional Budget Office, repealing the law would add $109 billion to our deficit over the next decade, and dig us an even deeper hole in the following 10 years. Repeal would include rolling back controls on the unsustainable rise in Medicare costs and reducing intake of revenues further straining our economy.

What will we have to do in order to fully benefit from the ACA?

First, our state needs to continue developing its health insurance exchange. Nearly half of working New Mexicans do not have access to health insurance through their employers. Through the exchange, individuals and small businesses will both be able to shop for insurance and determine whether they qualify for federal subsidies or tax credits to help pay premium costs.

Second, we should fully participate in the Medicaid expansion. As many as 170,000 low-income New Mexicans would become eligible for Medicaid; the federal government will cover 100 percent of the cost of expansion for the first three years and more than 90 percent of the cost after that. 

Implementing health care reform will not only help make us a healthier nation, but it will also strengthen our economy and put money in our pockets. Let’s stop bickering over ACA and instead prepare to fully reap its benefits.

BIz journals New Article "Medicaid expansion wouldn't hit NM general fund"

http://www.bizjournals.com/albuquerque/news/2012/08/16/report-medicaid-expansion-wouldnt.html

Report: Medicaid expansion wouldn't hit NM general fund
New Mexico Business Weekly by Dennis Domrzalski, Reporter
Date: Thursday, August 16, 2012, 10:59am MDT

New Mexico Voices for Children says the state could expand Medicaid with no net expense to the general fund.

New Mexico could expand its Medicaid program to cover low-income adults with no net expense to the state’s general fund, says a new report by New Mexico Voices for Children.

The state’s Human Services Department has estimated that expanding Medicaid to cover adults who earn up to 138 percent of the federal poverty level would require as much as $496 million in new general fund revenue. However, that total would be covered by state taxes on the new federal Medicaid money that would come into the state. That federal money would be subject to the state’s 4 percent insurance premium tax and to the gross receipts tax when Medicaid benefits are paid by insurers to health care providers, said the study by the children’s health care advocacy organization.

It’s estimated that up to 150,000 New Mexicans would be eligible for Medicaid under the proposed expansion.

The June 28 U.S. Supreme Court decision that upheld the federal Affordable Care Act gave states the option to not participate in Medicaid expansion. Gov. Susana Martinez has not decided whether New Mexico would participate in the expanded program.

Under the ACA, the federal government would pick up 100 percent of the cost of new Medicaid enrollees for the first three years of the expansion. After the seventh year, the federal share would drop to 90 percent.

More than 530,000 New Mexicans currently receive Medicaid services.

News article Las Crusus Sun "Leaders hash out future of Medicaid for Navajos"

http://www.lcsun-news.com/new_mexico-news/ci_21324012/leaders-hash-out-future-medicaid-navajos

Leaders hash out future of Medicaid for Navajos
By Jenny Kane jkane@daily-times.com
Posted:   08/16/2012 01:00:00 AM MDT



SHIPROCK &mdash: Stanford Washburn, 53, was ready to tell the story of his deteriorating heart to the Legislative Health and Human Services Committee on Wednesday.
He was going to tell the committee about how his condition, cardiomyopathy, leaves him vulnerable to a heart attack at any time.
He was going to tell them about how he has no transportation from his home, a storage shed, to the hospital and how he walks six miles to town for every appointment.
He was going to tell them about how he once had to hitchhike to the hospital in Farmington to get a pacemaker, and then how he had to hitchhike back after the procedure.
He was going to tell them, but then he had a heart attack just before the meeting.
"We think he's going to be okay," said Sovereign Hager, Washburn's attorney from the DNA People's Legal Services in Shiprock.
Washburn's story led assembled leaders into a day-long discussion Wednesday about how the state might better provide comprehensive health care to American Indians.
The conversation focused on the potential to expand the state's Medicaid program, a possibility since the Supreme Court upheld the Affordable Care Act in June.
Gov. Susana Martinez, who was in Farmington on Wednesday, and the Legislature both are under pressure from organizations statewide to expand or not expand Medicaid to about 200,000 low-income New Mexicans. Neither has led on to what decision might be in the works.
"There's a fine line in the sand that says, "We're not going to go there,'" said Rep. Miguel Garcia (D-Albuquerque).
Studies already are in the works to determine how Medicaid expansion beginning in 2014 would affect the state and the Navajo Nation.
Studies shared Wednesday were positive, though not always believable, committee members said.
A study by New Mexico Voices for Children found that the state would generate more than $1 billion in new tax revenue by 2020. It also would generate between 32,000 and 38,000 jobs by the same time, the study said.
"We're selling this as an economic boost, but there's a lot of issues here," said Rep. Dennis Kintigh (R-Roswell).
Kintigh also questioned how the Navajo Nation intended on figuring out Medicaid expansion for the tribe when it is stretched across three states, New Mexico, Arizona and Utah.
All could pass different policies.
"The Navajo Nation already is assessing the expansion of health care," said Gayle Din Chacon, surgeon general for the Navajo Nation.
Currently, about 30,000 Navajo in New Mexico are enrolled in the state's Medicaid program. About 50,000 are enrolled in Arizona's program, and 1,000 in Utah's.
Many more, however, are eligible and are not taking advantage of the services offered.
"A lot of these people don't know these services are available to them," said Quela Robinson, an attorney for the New Mexico Center on Law and Poverty.
The committee considered increasing outreach to low-income New Mexicans, particularly those living in rural areas. Many of them do not have access to mainstream media and technology.
"If the state chooses to do this, I want to make sure that everyone that qualifies gets it," said Sen. Sander Rue (R-Albuquerque).
The state has much research to do on the outcome of expanding its Medicaid program, as does the Navajo Nation, but it was clear Wednesday parties statewide are interested in collaborating to better the system.
"If we don't do a lot of planning, there's going to be a lot of collateral damage," said David Foster, chairman of the Health Care Committee for the Association of Commerce and Industry of New Mexico

NMICoA HC Medicaid Coaltion informal discussion comments

NMICoA Health Committee

Medicaid Coalition Discussion with

Centers for Medicaid and Medicare

August 14, 2012

The Health Committee of the New Mexico Indian Council on Aging (NMICoA) has followed NM Human Services Department (HSD)’s Centennial Care waiver proposal to the Centers for Medicare and Medicaid (CMS) since it’s unveiling earlier this year. The Health Committee has these following concerns and issues with HSD’s attempts to have its 1115 waiver accepted by CMS.

• HSD has not been transparent in properly informing and involving Tribes and Pueblos to input grassroots solutions and networking to inform HSD about possible problems incurred with developing strategic health planning from a unilateral perspective. The government to government process is still not evident in meetings attended by members. Discordant information was presented at the NM Primary Care Association meeting and UNM Cancer Center meeting sponsored by the Navajo Nation.
• HSD does not understand the sovereign status of Tribes and Pueblos of NM and the Federal responsibility
• HSD needs to review Federal-Tribal policy and understand Tribes and Pueblos should be funded directly for their members who are enrolled in Medicaid
• This allows a 100% Federal Medical Assistance Percentage (FMAP) funding for natives to obtain medical services at Indian Health Services (IHS), 638 facilities but more importantly, Non-Tribal network providers who provide services not available at IHS/638 facilities.
• Carve out of Medicaid funding to Tribes/Pueblos should be considered such that local facilities and service providers can benefit patients with in –house; case management, care coordination, transportation, personal care, respite care in a more intergraded fashion.
• The health committee believes that the opt-out category should still be intact and the choice to enroll in Managed Care should remain with the individual Medicaid enrollee.
• In the past, with the institution of the Salud program, Native Americans were mandatorily enrolled in Managed care. This experience resulted in a loss of revenue to IHS and 638 facilities and confused the Native population. Currently approximately 80 % of Native Americans enrolled in Salud still opt-out of managed care in the face of enrollment efforts by the state and MCO’s
• The State of NM needs to present information to be consulted on to Governors/Tribal Leaders, at least ten days (10) prior to consultation sessions and submission of plans, amendments, proposals, waivers in order to give tribes proper time to analyze State documents to give informed input and comments in consultation sessions.
• Managed care organizations need to involve Tribes/Pueblos early in the proposal process to allow Native programs and providers the opportunity to be included in strategic planning
• The Health Committee also stands by its support of Tribal leadership and does not accept the State mandate for enrolling Natives into managed care.
• Tribes and Pueblos should be allowed to develop their own system of care management which includes all on and off reservation providers which provide primary and secondary services. The State should allow Tribal/Pueblo programs and providers to be in these case managed systems with HSD collaboration to provide technical assistance such as getting billing, coding and reimbursement services, integrative systems need to be developed to track clinical, behavioral health and long term care services needs and documentation of non-duplication by service providers, and patients are not inappropriately utilizing Medicaid services.
• After the last Tribal Consultation session between the State and NM Tribes, Tribes asked that HSD exclude them from mandatory inclusion in to Managed Care for one year. This will allow the State of NM to develop, implement and streamline Centennial Plan for the rest of the population. This will also give Tribes additional time to analyze their’ own options for health care delivery. If after one years’ time, the Tribes decide, based on Health outcomes data, to be incorporated into Centennial Care they may choose to.
• The US Supreme Court’s decision to up hold the PPACA except for the Medicaid Expansion is a concern for Tribes in NM. If Governor Martinez decides not expand Medicaid for NM’s low income individuals it will have a great effect on the Tribal Health Programs. NM Native Americans make up between 22%-26% of the Medicaid population with many individuals eligible but not yet enrolled. That number will grow with expansion and help many individuals obtain needed healthcare. This is another instance where the State of NM will make a decision without Consultation with Tribes. Given the Government to Government relationship what will happen if Tribes want to Expand Medicaid and the State of NM chooses not to?

In conclusion the Health Committee still believes the opt-out category should remain intact and if patients choose to enroll in managed care, it should be a personal choice. The State needs to understand Tribal Protocol from the Tribal/Pueblo perspective and honor these protocols when meeting on reservation lands. The Tribes/Pueblos need to revisit the consultation process in order to achieve meaningful outcomes.

Respectfully Submitted by

Erik Lujan
Volunteer Advocate

Impact of Republican "Ryan Budget" will have on Medicaid and Medicare by congressional districts

This information was forwarded to me by the National Committee to Preserve Social Security and Medicare (NCPSSM) www.ncpssm.org

The link below was produced by the Democrats in the Energy and Commerce Committee in the House. It breaks down the impact of the Ryan budget for every congressional district (CD) in the country.


http://democrats.energycommerce.house.gov/index.php?q=page/district-by-district-impact-of-republican-medicare-plan-and-medicaid-cuts

Very helpful information regarding how valuable Medicaid is to NM communities

Alternate plan from Roxane Bly

Hi there!  This is a very rough draft of an alternative to the mandatory managed care that is proposed in the Centennial Care plan.  I'd be interested in any feedback you all might offer.  I don't feel strongly about pushing forward with this idea, but I do feel it's critical that we offer some type of alternative rather than simply stating our opposition. 

My thinking is that we could consider piloting (in one maybe two counties) a partially capitated managed care model that would continue the Fee For Service structure for primary care while capitating payments for specialty care. 


I'm attaching a summary evaluation report of the Sooner Care model (Oklahoma's Medicaid program) which I think is also really helpful when formulating compelling arguments in opposition to the mandatory managed care proposal outlined in Centennial Care. 


Anyway, hope this might of use to some of you and am interested in any feedback you might offer.

Please comment on the Draft document on this site or email Roxane

Roxane.bly@gmail.com or the Blog nahainformation@gmail.com

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