Federal tax breaks will continue to offset the cost of employer-sponsored insurance, subsidies will help individuals and small businesses buy insurance through electronic exchanges, more people will qualify for Medicaid and more New Mexicans will age into Medicare coverage, Milligan said.

While 49 percent of New Mexicans’ coverage comes from public funds today, he said, about 55 percent will receive public payment in 2020.

Milligan is a deputy secretary in the Maryland Department of Health and Mental Hygiene, a former Medicaid director in New Mexico, former head of the University of Maryland’s Hilltop Institute and a former Lewin Group consultant. He serves on the Presbyterian Healthcare Services board of directors.

The government is responding to market failures that became acute over the past 10 years, he said.

America’s health bills are paid by a combination of employer-sponsored insurance for workers, Medicaid for impoverished children and Medicare for older and disabled people who left the workplace.

“Failure number one was the presumption that everybody who worked had access to insurance through their employer, that the employer could afford the employer contribution, that the employer would offer coverage for the employees, that the employee could pay the employee premium, that there weren’t any part-time workers and that all of this was affordable,” Milligan said.

A second structural problem is that small employers and the self-employed can’t get the less expensive insurance that is available to large employers.

The result has been an increase in uninsured Americans who can’t afford coverage or whose employer can’t afford to offer it, he said.

While almost 70 percent of people younger than 65 years received employer-supported insurance in 2000, only 59.5 percent did in 2011.

Employment-based insurance dropped from 54 percent of New Mexico’s under-65 population in 2000 to 48 percent in 2011, the lowest in the nation.