Recommendations to State Officials: Health Coverage and COVID-19

Dear State Leaders and Lawmakers,

Thank you for your continued efforts to limit the spread of the COVID-19 in New Mexico. Decisive  action early in the crisis by Governor Lujan Grisham’s administration saved countless lives in ourcommunities. We have also witnessed state agencies demonstrating a commitment to collaborating and removing barriers for New Mexicans to access the care, social services, and economic relief they need in this trying time. As we look toward the June special session and beyond, we see further opportunity to safeguard New Mexicans from the short- and long-term ramifications of the pandemic. COVID-19 has exposed serious holes in America’s social safety net. Health care access is a critical part of the response to this global pandemic and will continue to be paramount over the coming months and years as the country recovers. Nearly 190,000 New Mexicans did not have health insurance prior to the pandemic, according to the Urban Institute. This often means postponing or completely skipping needed care, both routine and urgent. Barriers to healthcare access make it difficult to connect uninsured New Mexicans with testing and treatment services. Efforts to eliminate these barriers are necessary to slow the spread of disease by making COVID-19 testing and treatment more accessible for those who need it, especially for populations with limited income.

We are also deeply concerned by the revenue crisis facing our state, especially as social services and public safety net programs play a more important role than ever before. Our overreliance on oil and gas leaves New Mexico severely vulnerable to volatility and the health issues associated During the June special session, we urge legislators not to allow short-sighted cuts to our budget that will hurt our families in the long run.

State legislators, agencies, and executives must address the urgent needs of New Mexicans and the state economy, while maintaining a strong social safety net and sustainable revenue sources for the future. To do so, we recommend specific legislation, statute modifications, and operational adjustments to be implemented as soon as possible. We also emphasize the need for all parties to do their part to safeguard attacks on pivotal social services and revenue streams.

Protecting Health Care and Social Services Amid Revenue Crisis

 Do not reduce or eliminate essential health and social services, including fully-funded Medicaid.
In the midst of the historic public health crisis, New Mexicans rely on these services more than
ever to stay healthy and provide for their families.

 Oral health services are essential to overall health. Do not reduce or eliminate dental benefits
during the revenue crisis as has been done historically in other downturns.

 Tap into available reserve funds for their intended purpose of safeguarding New Mexicans from
damaging cuts during a budget shortfall

 Pass a bill 1 to transfer the federal health insurance carrier fee to the state, creating a crucial
revenue source for COVID-19 response measures and long-term affordability efforts. This
revenue can temporarily be put into General Revenue for 18 months before transferring to the
coverage affordability fund. Insurers have experienced a windfall 2 during the pandemic as claims
have plunged. All players must assist at this moment in time.

 Continue to support the expansion of health coverage under the innovative expansion of coverage
being studied by HSD.

 Help New Mexicans directly by expanding existing tax credits and rebates, expanding the
General Assistance Program, and creating a supplemental unemployment program for those left
out of the federal program.

 Promote transparency and accessibility in the special session by releasing proposals in advance
and making user-friendly streaming options available with language access options.

 Strengthen measures to address food insecurity, especially among New Mexican children. One in
three children in NM experience food insecurity 3 as we move through the pandemic.

 Continue to explore lowering the cost of prescription medications including convening the task
force to study other potential caps in the Prescription Drug Cost Sharing Bill 4 passed in 2020.

 Avoid serious cuts to the NM Environmental Department and the NM Department of Energy,
Minerals and Resources that would delay the important public health task of state methane rule
making.

 Continue the environmental work of safely plugging abandoned oil wells, 6 especially if these
increase amid oil industry bankruptcies in NM, and seek federal funding to expand this work as
well as reforming industry bonds to assure these costs are more fully covered.

 Native Americans in NM have been disproportionately affected by Covid-19 in part due to lack
of federal and state partnership for necessary infrastructure and resources. Schedule more
frequent and regular tribal consultations to robustly address the historical neglect, silence and
lack of Native American voices in state policy and resource allocation.

Increasing Access to Coverage and Reducing Barriers to Medicaid Enrollment

 Continue statewide presumptive and continuous eligibility during the pandemic.

 Continue to suspend the recertification process and data checks for the duration of the outbreak.

 Streamline Medicaid and SNAP enrollment for individuals and families who file for
unemployment insurance.

 Include maximum information to unemployment beneficiaries regarding health insurance options
if they have lost coverage both electronically with sign-on tools and in person both in the
application and recertification process.

 Continue to automatically re-enroll people whose Medicaid was suspended or terminated while in
the corrections system.

 Continue to eliminate asset tests wherever possible.

 Continue to conduct an earned media campaign to raise awareness in immigrant communities
about the suspension of federal public charge rules for COVID-19.

Covering the Uninsured Who Don’t Qualify for Medicaid or Other Options

 Join other states in extending Medicaid Emergency Assistance to cover non legal status
immigrants in NM for Covid-19 treatment 7 in addition to testing during the pandemic.

 Identify emergency funding to pay down premiums for individuals with coverage through MIP
making less than 200% FPL.

 Identify emergency resources for community clinics that primarily serve the uninsured.
Minimizing Cost Barriers in Private Insurance

 Enforce requirement that insurance companies to waive out-of-pocket costs related to COVID-19
testing and treatment. Clarify under what conditions, if any, antibody testing will be paid for
without co-pays.

 Require insurance companies to issue letters, emails, phone calls, text messages, and other forms
of contact to individuals and families who purchase coverage on the Marketplace informing them
that they can reduce their premiums by adjusting their annual income on healthcare.gov if they
expect to earn less than anticipated when they initially signed up for coverage. Include
information on Special Enrollment Periods related to income or job changes.

 Encourage self-insured businesses and their third party administrators to waive out-of-pocket
costs related to COVID-19 testing and treatment for employees.

 Raise awareness about efforts to eliminate cost barriers, including surprise billing protections and
waived out-of-pocket costs.

Your efforts to respond to this challenge are greatly appreciated. Please contact us at any time should
questions arise regarding any of these recommendations.

Barbara K Webber
Executive Director

Gabriella Rivera
Communications/Policy Analyst

1 https://www.nmlegis.gov/Legislation/Legislation?Chamber=H&LegType=B&...
2 https://www.healthleadersmedia.com/welcome-ad?toURL=/strategy/health-ins...
demand-elective-treatments
3 https://www.thedenverchannel.com/news/coronavirus/more-american-children...
pandemic
4 https://www.nmlegis.gov/Legislation/Legislation?Chamber=H&LegType=B&...
5 http://www.stateoftheair.org/key-findings/
6 https://www.politico.com/news/2020/05/11/orphaned-oil-wells-to-squeeze-s...

7 https://www.shvs.org/wp-content/uploads/2020/05/Pathways-to-Coverage-for...

Treatment-for-Adults_Updated-Final_5_5_2020.pdf

Health Action

 What is Telemedicine, and how can I access it?

 

Definition

Especially during the COVID-19 pandemic, it is important to stay home and refrain from visiting the hospital unless your medical issue requires urgent hands-on care.  However, you don’t have to forego your routine services or put off important visits during this time.  Even as services begin to reopen, 

Telemedicine is a way to access quality health care services over the phone or through video chat, including diagnosis, consultation, prescriptions, and referral to a physician. Telemedicine services are often covered by insurance and provide a safe, secure way to get care from a distance. 

Telemedicine is also an important resource if you think you are experiencing COVID-19 symptoms to lessen the risk of exposing yourself and others to the disease.

 

Why you should consider it

In addition to the reasons above, telemedicine allows you to receive specialist consultation from the comfort of your home and on your own time; you can record a video for your doctor if you’re experiencing symptoms outside of normal office hours, or you can chat with a doctor live if they’re available. Telemedicine is also more affordable than a traditional consultation and can be a great resource for those without insurance.

New Mexico also covers one of the widest ranges of telemedicine services in the country; so even if you’ve been unable to receive a consultation in another state, New Mexico may cover it!

 

What are my options?

Because of legislation passed in 2019, New Mexico law requires most insurance carriers to cover basic telemedicine at no extra cost. Below is a quick guide to telehealth under major insurance carriers in New Mexico. Find your insurance carrier below to see their current telemedicine policies, but call your carrier for the most accurate information. Even if you have insurance, self-pay may be more cost-effective, so be sure to explore all your options!

 

 

Federally-Qualified Health Centers

FQHCs are offering expanded telehealth services, and are treated the same as in-person visits for billing purposes.

 

Self-Pay

There are many telemedicine services that allow self-pay, and they are often more affordable for uninsured individuals than in-person visits. Make sure you are accessing reputable providers. Teladoc contracts with many service providers and provides quality telemedicine services. Another good starting point is GoodRX, which has a database of reputable telehealth providers and allows you to compare prices and reviews from different providers

Health Action

To view a video of this content, click here

What do I do if I lose my health insurance?

Coronavirus is a public health emergency that has upended the economy, causing tens of thousands of New Mexicans to lose their jobs and the health insurance provided by their employer. No one should go without health coverage during this pandemic. Fortunately, there are quality coverage options available to all people in New Mexico. Most people who lose their insurance qualify for Medicaid or Marketplace coverage. If you don’t qualify for those options, you automatically qualify for comprehensive coverage on the New Mexico Medical Insurance Pool. It is important to sign up as soon as possible to avoid disruptions in coverage and meet the deadline for getting covered. Here is Health Action NM’s guide to staying covered and avoiding scams during this difficult time.

What do I qualify for?

Everyone qualifies for coverage during the pandemic. The first thing you should do is use Healthcare.gov’s online screening tool to see what type of coverage you might qualify for. Based on that screening, we recommend contacting the New Mexico Human Services Department, BeWellnm, or the NM Medical Insurance Pool to get help filling out your application. But if you want to sign up on your own, this blog post has some helpful tips.

 

Medicaid

Medicaid is a comprehensive health coverage program that is available to low-income U.S. citizens. If you receive coverage through Medicaid, all costs related to COVID-19 will be covered free of charge. If you were billed for testing or treatment related to COVID-19, you can file a complaint here. Medicaid eligibility is based on your household’s current monthly income, not how much you made in the past or expect to make this year. You qualify for Medicaid if you make less than the monthly income listed on the table below called “TABLE 1: Medicaid Eligibility.” When selecting your family size, include yourself, your spouse, and everyone you claim as a dependent, even if they don’t need coverage. If you have questions about whether or not to include someone when determining your family size, check here.  

To see if you qualify for Medicaid, select how many people are in your family at the far left of the table, then see if your monthly income is below the amount listed. If it is, you likely qualify for Medicaid. Even if you don’t qualify for Medicaid, your children might.

If you think you qualify for Medicaid, here is how you can sign up. We recommend starting off by calling the Human Services Department at 1-855-637-6574 to confirm that you meet the basic program requirements. 

Sign up over the phone: If you want help with your application call or prefer to complete your application over the phone, call 1-855-637-6574. 

Sign up online:Online Application

Fill out the application on paper:Paper Application

Need help? Call customer service at 1-800-283-4465 or visit this webpage.

During the application process, you will be asked to provide information about your household income. The table below shows the type of income information that you will need to share to get covered.

Source: Brookings Institute

Marketplace Coverage through BeWellNM

 Marketplace Coverage is available to individuals and families that do not qualify for Medicaid and are not offered insurance by an employer. COVID-19 testing and treatment is covered free of charge, thanks to an order signed by the New Mexico Superintendent of Insurance under Governor Lujan Grisham’s COVID-19 emergency order. Many Marketplace applicants qualify for premium reductions based on income and household size. These reductions are called Premium Tax Credits, and are based on your expected incomefor the year you are applying for coverage. For instance, if you were enrolling for coverage for 2021, you would calculate what you think your income will be for 2021, and the Marketplace will use that amount and your household size to calculate the discounts you qualify for. For questions about how to estimate your income and who to include in your household, click here.

 

If you lose your job-based health insurance, have a significant reduction in your income, or experience other qualifying events, you may be eligible for a special enrollment period to sign up for coverage. If you experience one of these events, you have a 60-day window to apply for coverage.

 

Remember, if your income goes up during the year, you should adjust it on Healthcare.gov so that you don’t have to pay it back at the end of the year. You can also adjust your income down if you expect to earn less, which will reduce your premiums. If you gain a new form of coverage, such as Medicaid or job-based coverage, make sure to terminate your coverage through BeWellNM to avoid unexpected fees.

 

If you think you qualify for Marketplace Coverage through BeWellNM, here is how you can sign up. We recommend starting off by calling BeWellNM (New Mexico’s Health Insurance Exchange) at 1-833-862-3935 to confirm that you meet the basic program requirements. 

Sign up over the phone: If you want help with your application call or prefer to complete your application over the phone, call 1-833-862-3935.

Sign up online:Online Application

Fill out the application on paper:Paper Application

Helpful resources:

Get more helpful information:bewellnm.com

Use the NM Plan Comparison Tool:New Mexico Plan Comparison Tool 2020

Preview your options:Window Shop for a Plan

During the application process, you will be asked to provide information about your household income. The table below shows the type of income information that you will need to share to get covered.

 

 

The New Mexico Medical Insurance Pool

All people who reside in New Mexico qualify for the New Mexico Medical Insurance Pool (or “the pool”). COVID-19 testing and treatment is covered free of charge. You can sign up for the pool any time of the year. You can get premium discounts based on your income. 

Normally, the pool uses your tax return from the previous year as well as any Social Security payments you receive to determine eligibility. However, if you lose your job or have other major changes in your economic situation, you can give them an estimate of your current income and the pool will work with you to reduce your premiums.

If you think you qualify for the New Mexico Medical Insurance Pool, here is how you can sign up. We recommend starting off by calling the pool at 1-505-424-7105 or 1-844-728-7896 to confirm that you meet the basic program requirements. 

If you want help with your application call or prefer to complete your application over the phone, call 1-505-424-7105 or 1-844-728-7896.

Fill out a digital or paper application:Digital or Print Application

 

Keep your employer coverage

COBRA allows you to continue the health coverage you had through your employer after you lose a job, as long as the termination did not involve gross misconduct. This option is available to workers whose employer covers 20 or more employees. COBRA is usually quite expensive and other coverage options, like Medicaid, Marketplace Coverage through BeWellNM, and the NM Medical Insurance Pool, are typically more affordable. Click here to see if you qualify for COBRA. For application assistance, call 1-866-444-3272. If you need more information, you can visit the following websites:

#Q1">NM COBRA FAQ

New Mexico COBRA Insurance - Health Care Continuation

U.S. Department of Labor: Continuation of Health Coverage (COBRA)

 How can I get help with my application?

If you want to talk to an enrollment counselor who is not affiliated with any health insurance company, visit https://bewellnm.com/Find-Counselor. They can usually help you sign up for any type of insurance, including Medicaid, Marketplace Coverage through BeWellNM, the NM Medical Insurance Pool, or Medicare.

If you want to talk to a broker about signing up for private insurance or insurance through the NM Medical Insurance Pool, visit https://bewellnm.com/Find-Broker to find a broker in your area.

Medicaid

Human Service Department’s Customer Assistance Center: 1-800-283-4465

Marketplace Coverage through BeWellNM

BeWellNM’s Call Center: 1-833-862-3935

NM Medical Insurance Pool

Office Number: 1-505-424-7105

Call Center: 1-844-728-7896

 

How do I avoid scams?

Unfortunately, some are using this pandemic as an opportunity to sell junk health insurance by misleading people about their options. Here are some websites you can trust to give you accurate information about comprehensive health coverage:

Hsd.state.nm.us or yes.state.nm.us

bewellnm.com

Healthcare.gov

NMMIP.org

 

Health Action

COVID-19 has exposed major holes in our health care system and social safety net. Bold action is needed to ensure that New Mexicans have the resources they need. The Families First Coronavirus Response Act (FFCRA) was a critical first step in this effort.

However, additional steps will be necessary. The State of New Mexico, local clinics, and the New Mexicans who are weathering this crisis need more resources to ensure an adequate response. To that end, Health Action New Mexico has developed a series of health-related recommendations to help individuals and families access care and feel more financially secure, bolster the state’s capacity to respond, and assist clinics who help vulnerable populations. While this is by no means a comprehensive list of the steps necessary to address this crisis, we hope it provides useful insight on critical health coverage and access issues facing New Mexico and the United States.

Create a Universal Coronavirus Crisis Health Insurance Program.
While FFRCA guarantees free testing for uninsured Americans, treatment costs may deter individuals from seeking necessary services. According to the Robert Wood Johnson Foundation, while “costs clearly pose a barrier for the uninsured, the likelihood of significant cost-sharing, combined with a wariness about out-of-network billing, may deter even those with insurance from seeking care.” That is why it is imperative for the federal government to establish a COVID-19 Coronavirus Health Insurance Program built upon the framework of Medicare.

Because our health insurance system is so fractured, it is difficult to have a coordinated response to a global pandemic. Medicare’s provider network, billing system, and consumer protections are well-suited to take on this challenge. In addition, health insurers did not anticipate the resources necessary to cover COVID-19 and will likely require a bailout if they are overwhelmed by those costs. Creating a federally financed and administered program to offset those costs and logistical challenges is prudent. As the authors of a recent article on this approach describe, there are four major upsides to this type of program:

1. “In one step, Congress could stop financial barriers from interfering with coronavirus care — a threat that will otherwise grow as more people lose employment and their health insurance. There is little value in providing free diagnosis if patients who test positive are reluctant to go to the hospital as their condition deteriorates. Every delay in treatment is an opportunity for the virus to spread deeper into communities.
2. “A second advantage is better data. A new program using a single billing system could aggregate information quickly about where and how much illness is occurring. Places like Taiwan and South Korea are each using a single data set to identify and track changes in demographic and clinical factors associated with infection and hospitalization. A single billing system can also improve the ability to track the total number of tests performed, which is helpful for gauging disease prevalence. This information can then be used to drive local recommendations for social distancing and clinical care.
3. “A third advantage is a more sustainable national response. Insurance companies did not include the potential massive expense of care for novel coronavirus in their actuarial calculations and are at risk for massive losses in the coming year that could not have been predicted. Rather than wait for the insurance industry to need bailouts or much higher premiums in ensuing years, the federal government can assume the expense directly. Doing so will also relieve the unexpected burden of coronavirus on self-insured employers, reducing the pressure for layoffs.
4. “A fourth and final advantage is a mechanism for everyone to benefit from medications and vaccines for the novel coronavirus. A new program can negotiate for a global purchase of critical medical advances for the entire population at a fair price for the companies that have invested to develop them.”

It is vital that this program be universal, so that no one goes without necessary testing and treatment. This effort should be carried out in conjunction with other measures to help as many people as possible sign up for comprehensive health insurance. We recommend the swift adoption of a Universal Coronavirus Crisis Health Insurance Program.

Further enhance the Medicaid Federal Matching Assistance Percentage (FMAP).
State budgets are going to be under immense pressure, as officials decide how to meet the increased demand for effective public services while the economy is in freefall. The FFRCA provides some relief by increasing the Medicaid FMAP by 6.2%. States should not be forced to cut Medicaid at a time when our health care system is under so much strain. We recommend that, at a minimum, the Medicaid FMAP be increased by an additional 5.8%, for a total 12% increase when combined with the provisions of FFRCA. The provision should also include a mechanism to automatically increase the FMAP if economic conditions worsen.

Restore the 100% FMAP for Medicaid expansion.
In addition to providing relief for state budgets, our hope is that restoring the 100% FMAP for Medicaid expansion will encourage other states, including our neighbors in Texas, to reconsider expanding their program during this difficult time. Because the communities along the border of New Mexico and Texas are so interconnected, poor access to medical services on the other side of the state line puts New Mexico at heightened risk. We recommend that Congress restore the 100% FMAP for Medicaid expansion for the duration of the crisis and maintain the matching rate until state budgets have fully recovered.

Provide additional health care resources to Native Americans, Indian Health Service (IHS), and tribal public health programs.
First and foremost, Native American tribes and nations should be consulted to determine their priorities and needs. IHS is chronically underfunded and will likely require additional capacity to administer tests and take precautions necessary to keep health care workers safe. Tribes also need additional resources for public health programs. To reduce barriers to health coverage, premiums should be waived for Native Americans who qualify for Marketplace coverage. We recommend adopting measures to address the health needs prioritized by tribal leaders.

Provide an infusion of resources to private non-profit clinics, Federally Qualified Health Centers (FQHCs), and FQHC look alikes.
As clinics that disproportionately serve the uninsured prepare for a major surge in services, clinic finances are of great concern. These clinics in particular operate on very thin margins and rely on donations, private foundation grants, and patient co-pays to keep their doors open. Many of these funding sources may be strained in the coming months, even as the clinics have an influx of patients. Federal grants should be made available to private non-profit clinics, with additional resources made available to those who serve a higher proportion of uninsured patients. FQHC funding should also be increased. We recommend that Congress provide an infusion of resources to private non-profit community clinics, FQHCs, and FQHC look alikes.

Ensure rural providers have the resources they need.
Because the Coronavirus has reached urban centers first, there are concerns that states will be financially pressured to divert resources towards hospitals in those areas. We recommend the establishment of a Rural Provider Emergency Fund that providers can tap into if hospital or clinic financing takes a downturn during the pandemic.

Create a Special Enrollment Period (SEP) on the federal Health Insurance Marketplace and waive Marketplace premiums for certain populations.
States like New Mexico that currently rely on the federal Health Insurance Marketplace platform (Healthcare.gov) cannot establish SEPs. Instead the federal government sets SEPs. Despite requests from a variety of leaders and stakeholders, the Trump administration has not yet established a COVID-19 SEP. We recommend a general SEP lasting through April and a rolling SEP for qualifying uninsured individuals who contract COVID-19. One way to provide targeted economic relief for families and encourage uninsured New Mexicans to sign up for coverage is to eliminate premiums for Marketplace coverage in the coming months. We recommend that Congress adjust Marketplace advance premium tax credits so that they cover premiums for individuals under 400% FPL in their entirety for the next three months.

Give states the authority to work directly with the World Health Organization (WHO) and other countries to secure COVID-19 testing kits.
The federal government’s response to developing and distributing COVID-19 testing kits has been a failure. The Trump administration chose not to secure tests from WHO when they were first available. Given that there is still a massive shortage of testing kits, states need to be able to get effective kits however they can. We recommend that Congress pass measures allowing states to work directly with WHO and other countries to secure COVID-19 testing kits.

Bolster production of personal protective equipment for all who need it and combat price gouging for basic medical and sanitary supplies.
Medical professionals and medically vulnerable populations need personal protective equipment. Shortages of respirators have been alarming and there are reports of individuals purchasing the respirators en masse. The federal government should take steps to boost production of equipment and make sure that they are immediately available to those who need it. In addition, basic medical and sanitary supplies should be readily available to consumers, but reports of price gouging have been on the rise in recent weeks. We recommend subsidizing the production of personal protective equipment, creating processes for ensuring those who need it most have access, and combat price gouging for basic medical and sanitary supplies, including medications.

Immediately reverse the public charge rule.
While US Customs and Immigration Services announced a temporary suspension of public charge rules, Health Action New Mexico has heard from several partner organizations that families continue to fear that public charge rules will be used against them in the future. We need to make sure that no one fears using public services that they qualify for during this global pandemic. We recommend amending federal statutes to reverse recent changes to public charge rules.

Forgive medical debt for those diagnosed with COVID-19.
When people are diagnosed with COVID-19, the last thing they should worry about is medical bills, especially as the overall economy is on a downward trajectory. According to a study published in the National Center for Biotechnology Information, “problems paying medical costs are associated with higher credit card debt, more calls from bill collectors, increased bankruptcy rates, and diminished access to care.” We recommend forgiving medical debt for all people diagnosed with COVID-19.

— — —

We need bold, decisive action as soon as possible to ensure that all people can access the services they need . If you agree with our recommendations, please share this with your Members of Congress. Find your Representative and Senator here.

Health Action

Health Action

 

Health Action

The Affordable Care Act (ACA) ushered in a new era of health care in America. Insurance companies can no longer deny coverage due to pre-existing conditions; lifetime and annual caps on coverage are banned; all plans must cover free preventive services; financial assistance is available low-income and middle class families; and Medicaid is expanded to people in need. New Mexico saw the largest drop in the percent of people who are uninsured, falling from 28% in 2013 to 13% in 2016. We should celebrate this incredible accomplishment and build upon our progress to ensure every person in our state and country are covered by quality health coverage.

Attacks on health care

A barrage of federal policy changes threatens to dismantle the gains we made. After several failed attempts to repeal and replace the ACA, GOP Members of Congress are now publicly discussing another attempt to dismantle the law next year. Previous versions would have capped and slashed Medicaid by over $1 trillion, dismantled the ACA’s pre-existing condition protections, raised premiums on people who need care the most, and eliminated the essential health benefits.

Congress repealed the individual responsibility provision of the ACA, which the Congressional Budget Office estimates will lead to 13 million people becoming uninsured over the next 10 years, including 90,000 New Mexicans.

The Trump administration has also taken extraordinary efforts to undo the law administratively. Over the past year and a half, the Trump administration:

1. Unilaterally ended payments that reduce out-of-pocket costs for low-and-moderate income consumers
2. Allowed states to impose burdensome requirements on Medicaid beneficiaries in order to slash enrollment
3. Expanded junk insurance that can discriminate against people with pre-existing conditions
4. Shortened the period to enroll in health coverage by half
5. Slashed critical outreach and enrollment funding

And most recently, the administration refused to defend pre-existing condition protections in court, arguing that critical protections should be struck down in case called Texas v United States. Experts say it “would have ramifications in almost every aspect of the health insurance market and the health care delivery system,” leading to widespread chaos. 27% of New Mexicans have a pre-existing condition and would be at risk of being locked out of health coverage if the court sides with the Trump administration.

States can take the lead

In the absence of leadership at the federal level, states must take action to protect the critical gains made under the ACA. This presents an opportunity to build upon what works and fix what isn’t working. Health Action NM supports a wide array of policy options that would do just that.

1. Adopt a Medicaid buy-in option to create a more affordable health care option for New Mexico
2. Build the ACA’s consumer protections into state law to protect against a negative ruling in Texas v United States
3. Creating common sense rules to ensure discriminatory substandard insurance does not flood New Mexico
4. Address the flaws of the “individual mandate” and move towards a model that actively assists people who are uninsured to sign up for $0 premium health coverage

• Maryland has proposed an innovative model that would serve NM well

What we need from national leaders

According to a 2018 survey, 92% of working-age adults think that all Americans should have the right to affordable health care. Ultimately, Americans need certainty that Congress and the federal administration will work to make the health law work and will commit to building upon the successes of the health law and identify areas of agreement. We urge leaders to come together to work for the common good and meet people’s expectation of a health system that is accessible and affordable for all people.

Voters should be informed of the positions their elected representatives hold on health care and ask people running for office about critical issues, such as:

1. Do you support the full array of the Affordable Care Act’s consumer protections, including pre-existing condition protections and essential health benefits?
2. What are your ideas for protecting and building upon the coverage gains made under the Affordable Care Act?
3. How do we get make sure every single person can get the care they need, when they need it, at a cost they can afford?

 

Health Action New Mexico is a 501c3 non-profit and does not endorse candidates for public office.

Health Action

The following letter was submitted to the US Department of Health and Human Services on April 23, 2018.

 

To Whom It May Concern,

 

Health Action NM is a non-profit consumer advocacy organization that has served New Mexico since 1995. The organization has conducted extensive community outreach over the past several years to educate New Mexicans about new health coverage options under the Affordable Care Act (ACA). Our staff has held over 500 community events across 13 counties since 2013, reaching 17,000 individuals and families and connecting over 5,000 with enrollment assistance and health system navigation services.

The education and assistance provided by Health Action New Mexico gave our staff a deep understanding of the rural, underserved, and hardworking communities across our state and the struggles that they face as they attempt to get the coverage and care they need to stay healthy. There is a need for high quality, affordable health coverage in every community of our great state.

Prior to the enactment of the Affordable Care Act (ACA), people with pre-existing conditions could be denied coverage or charged exorbitant premiums in the individual health insurance market, leaving many of the sickest patients without any meaningful way to protect against the high cost of health care. President Donald J. Trump made numerous commitments to protecting people with pre-existing conditions, protections which enjoy support from a large majority of Americans.

The proposed regulations submitted by the Department of Health and Human Services regarding short-term limited duration plans violate the principle that people living with illness should not be subject to discrimination due to their health status. Moreover, according to the National Association of Insurance Commissioners, these regulations would have the effect of separating healthy people into a market that puts them at greater risk of facing financial hardship if they do become sick or injured, while increasing premiums in the ACA-compliant individual health insurance market that covers people with higher medical needs. The overall impact will be to shift costs towards individuals who are sicker.

According to a recent report by the non-partisan Kaiser Family Foundation, “Mid-year results from 2017 suggest the individual market is stabilizing and insurers in this market are regaining profitability. Insurer financial results show no sign of a market collapse. Second quarter premium and claims data from 2017 support the notion that 2017 premium increases were necessary as a one-time market correction to adjust for a sicker-than-expected risk pool. Although individual market enrollees appear on average to be sicker than the market pre-ACA, data on hospitalizations in this market suggest that the risk pool is stable on average and not getting progressively sicker as of early 2017.” We are on the verge of a stable individual marketplace that works for Americans. Segmenting healthier people out of the market will undermine the insurance that people who desperately need care rely upon.

Health Action NM recognizes the need to bring down health insurance premiums for Americans. However, we do not believe the correct strategy for achieving this goal is to shift costs to people with greater health needs and re-invent a system of discrimination against people with pre-existing conditions. Instead, the federal government should continue to encourage states to apply for reinsurance through a 1332 waiver, increase funding for outreach and enrollment, and request that Congress pursue cost-effective policy changes that will have positive effects on the individual marketplace.

We urge the department to rescind the proposed regulation.

 

Sincerely,

Colin Baillio

Director of Policy and Communications

Health Action NM

Health Action

Health Action NM and the Office of the Superintendent of Insurance are teaming up to give you the information you need to access your mental health and free preventive benefits. Your health insurance must cover these benefits. Please join us for a live webinar on March 22, 2018 at 9:30 AM.

Here is a link to the webinar: https://nmosi.webex.com/nmosi/onstage/g.php?MTID=efc403cd738a90b0a85f39e7235e27db7

For audio: +1-415-655-0002;806 299 174

PRESENTATION I:  Get the most out of your health insurance: Your right to services for mental health, alcohol or drug use problems.

This brief presentation will review the history of mental health parity and use a plain language video to demonstrate how health plans are required to give equal importance to the health of both the body and the mind. The presentation will highlight red flags that a consumer may encounter that signals unequal access to mental health services or services to address alcohol and drug problems. For example, if a health plan restricts access to services by requiring use of lower cost therapies before accessing other types of services, or not having enough providers in their network. The presentation will use case scenarios to illustrate how the problems with equal access may look to a consumer, and how these can be resolved. The presentation will conclude with clear advice about how to file a complaint with health insurance companies and how to contact OSI for further support in resolving problems.

 

PRESENTATION II: Get the most out of your health insurance: Your right to no-cost prevention services.

This brief presentation will use plain language to review the basics of “cost-sharing”, or co-pays and deductibles, and emphasize that preventive care services are available to consumers at no cost, or “cost-sharing free”. The presentation will describe what is typically included in a well-person exam and what are common preventive care services, as well as provide a complete list of preventive care services that consumers can expect to receive at no cost.  The presentation will highlight red flags that a consumer may encounter when accessing preventive services and provide advice about how to be a smart consumer when it comes to using preventive services. Important tips for Bronze plan users will be included.  The presentation will use case scenarios to illustrate common problems in accessing preventive services, and how these can be resolved.  The presentation will conclude with clear advice about how to file a complaint with health insurance companies and how to contact OSI for further support in resolving problems.

Health Action

Sponsors: Representative Deborah Armstrong, Senator Jerry Ortiz y Pino, and Representative Nathan Small

New Mexico should allow people use their own dollars and tax credits to purchase health coverage through the state Medicaid program.

• Medicaid is a public health coverage program that provides New Mexico’s children, families, people with disabilities, and older adults with comprehensive health care benefits.

• Medicaid is a trusted, proven program that has served New Mexico for more than 50 years.
• More than 40% of New Mexicans are already covered by Medicaid.

New Mexicans want high quality health coverage.

• Medicaid covers the ten essential health benefits plus dental and vision care.
• 93% of office-based physicians accept new Medicaid patients in New Mexico, according to a 2015 study from the Center for Disease Control & Prevention.

New Mexicans want affordable health coverage.

• Medicaid for adults costs $297 per person a month according to the Kaiser Family Foundation, compared to the average $520 premium per month for employer insurance.
• Tax credits and employer contributions could make health coverage even more affordable for working families. 

New Mexico could be a national leader in expanding affordable health care.

• With a bold vision and smart planning, New Mexico could be the first state to take the innovative approach of a Medicaid buy-in.
• Congressman Ben Ray Luján has introduced federal legislation using the Medicaid buy-in model.

SM 3 & HM 9 request the Legislative Health and Human Services Committee to study how a Medicaid buy-in could work in New Mexico. The bills passed with bipartisan support during the legislative session. The Legislative Health and Human Services Committee will study the concept throughout the summer! Check our website regularly for updates. 

Let’s work together to make sure every person in New Mexico can get the care they need to be healthy.

Health Action