We must put thought into developing health exchange

Just as my parents must have looked with dismay at the 1960s counter-cultural revolution while trying to pursue the “Ozzie and Harriet” version of life they knew, I imagine many people today are watching warily as we as a society — and health care as an industry — face a host of profound changes.

The changes before us now may not seem as dramatic as those of the 1960s but it often is hard to gauge the magnitude of change when you’re in the middle of it. It is also usually hard to know if the change will result in improvement.

The only thing we can be sure of is that refusing to change results in more of the same. Two recent moves by our elected officials are to be applauded for helping to move New Mexico in the direction it needs to be going — forward.

Gov. Susana Martinez’s thoughtful decision to expand Medicaid in New Mexico will open up coverage for approximately 170,000 more New Mexicans by redefining eligibility requirements. And this week a bill passed by the New Mexico Senate creates the framework for a New Mexico health insurance exchange. Senate Bill 221 is sponsored by Sens. Benny Shendo Jr., D-Jemez Pueblo, and Gerald Ortiz y Pino, D-Albuquerque, and now moves to the House, which must act on it before the Legislature adjourns this weekend if it is to be sent to the governor to consider.

It is encouraging to us as New Mexico’s only not-for-profit health care organization, largest provider of health care and second largest private employer that our elected officials are making thoughtful decisions that will help to improve the health of the people who live here.

SB221 is a compromise bill that Shendo and Ortiz y Pino collaborated on with Rep. Thomas Taylor, R-Farmington. It was one of a handful of health insurance exchange proposals introduced during the current legislative session. The bill creates an exchange that would not act as an insurer. Rather, all plans that want to participate in the exchange would have the right to do so and individuals would be able to turn to the exchange to compare health insurance options and purchase insurance.

A vibrant, market-based health insurance exchange will be attractive to businesses considering whether to stay or relocate here. In a state with an unemployment rate of more than 6 percent, economic development and diversification are necessary. Presbyterian supports reform initiatives such as this that are designed to provide insurance to people and increase access to care. The health insurance exchange will be a state-operated entity designed to meet the unique needs of New Mexico.

Lowering New Mexico’s uninsured rate — about 21 percent of the state’s residents currently have no health insurance, compared with 16 percent nationally — should help lower health care costs. A large uninsured population doesn’t just affect the health of the individuals who lack coverage; it affects all of us. Uninsured New Mexicans mean more uncompensated care, which results in doctors and hospitals having to raise rates, which leads to higher insurance premiums, which takes us back to the start of this unhealthy cycle: more people who cannot afford insurance.

In 1994, the Legislature passed House Bill 702, which was a bold decision to move Medicaid from a fee-for-service system to SALUD! managed care. The innovative vision of Centennial Care, the next evolution of Medicaid managed care, aims to streamline administrative processes and engage and educate members so they can be proactive in taking care of themselves.

The Legislature today has a similarly bold opportunity to shape our health care future through the passage of SB221.

The expansion of Medicaid and the health insurance exchange will pose significant challenges for the health care industry as providers must expand access while lowering total costs.

Many may be warily watching Centennial Care and a market-based exchange. Will these changes have the impact intended? No one can say for sure. However, these challenges are worth facing and they will serve to change a system that desperately needs change.