Copyright © 2019 Albuquerque Journal
As a caregiver for her elderly mom, Michelle Lujan Grisham says she has spent plenty of time waiting in hospitals, moving between poorly connected buildings and watching providers trip over old equipment.
Now she’s making health care a priority as she heads into her first summer as governor of New Mexico.
Lujan Grisham, a former Cabinet secretary for the state Department of Health, says she wants to address the state’s shortage of doctors, offer Medicaid to customers willing to pay for it and help fund a new tower at the University of New Mexico Hospital.
Her agenda also includes recruiting doctors to rural areas, improving reimbursement rates for Medicaid providers and expanding services for people with developmental disabilities.
Some of Lujan Grisham’s proposals are just beginning to take shape, and some will require legislative approval.
They come as New Mexico faces deep-rooted health care challenges that no governor has found easy to solve. The shortage of doctors isn’t new, and more than 40% of the population is covered by Medicaid.
Nonetheless, Lujan Grisham’s attention to health care has been on display throughout her first few months in office.
Just last week, as she spoke in a hotel conference room to 300 business and community leaders in Albuquerque, Lujan Grisham devoted much of her time to speaking about plans to make New Mexico a better place for doctors and patients.
She highlighted her own family as an example, sharing anecdotes about taking her mother, Sonja, to UNM Hospital and seeking out-of-state treatment for a nephew struggling with addiction.
“If anyone has ever provided a service to me,” Lujan Grisham told the audience, “you know I am no easy customer.”
She spoke about waiting lists and wait times, crowded conditions and outdated equipment. But she also described New Mexico’s health care providers as kind, caring people who deserve more resources and a better working environment.
Her ideas certainly have the attention of the medical community.
Barbara McAneny, an Albuquerque doctor and president of the American Medical Association, said she is encouraged by the governor’s interest in health care. A healthy population, she said, is the foundation of a strong economy and community.
McAneny doesn’t agree with all of Lujan Grisham’s proposals – she opposes a Medicaid buy-in program, for example – but she said she likes the governor’s focus on early childhood education and health care.
“I think the best investment that a government can make in a state is in the people,” she said in an interview.
New Mexico has struggled for years with a doctor shortage, especially in rural areas.
The state ranked 48th out of 50 for access to health care in a recent report by Merritt Hawkins, a national physician recruiter. The analysis considered 33 factors, including physicians per 100,000 population and percentage of those with insurance.
David Scrase, a longtime UNM physician who took over this year as secretary of the Human Services Department, said the Lujan Grisham administration is working on a variety of fronts to make the state more attractive to doctors and recruit providers to rural communities.
“We need to do everything we can,” he said, “to grow our primary care and behavioral health networks in rural areas. We’re going to keep pushing it.”
The Lujan Grisham administration has some money to work with. The general-fund budget for the year beginning July 1 authorizes about $7 billion in spending – a record high, driven largely by an oil boom in the southeastern part of the state.
About $987 million in the general fund is dedicated to Medicaid, about $52 million more than this year, for an increase of nearly 6%. The state money, in turn, is used as a match for federal funds.
Some of the extra funding, officials say, will help boost reimbursement rates for providers, reducing the financial pressure on them. The exact amount is unclear because the proposals must work their way through a regulatory process.
But Scrase said he expects a “substantial increase in payment” for certain services, such as in-person visits between doctors and patients. He also expects increases for health care provided in a person’s home to allow the patient to avoid going to a nursing facility.
Medicaid is jointly funded by the federal and state governments and provides health care to low-income people and families. The federal government pays New Mexico roughly $3 to $4 for every dollar the state spends.
It’s a critical part of the health care delivery system in New Mexico, which led the nation in the percentage of babies born into Medicaid families, according to a 2017 survey by the Kaiser Family Foundation.
Providers are typically paid less for serving Medicaid participants than they are for patients covered by private insurance, making New Mexico a less financially attractive place to practice medicine.
McAneny said she estimates that in her own medical practice, Medicaid pays roughly 60% of the actual cost of doing business – a shortfall that’s made up by other customers. Increasing reimbursement rates, then, would be “exceedingly helpful,” she said.
The administration is also working on plans – backed by $300,000 in state funding that will be used as a match for federal money – to expand training slots for medical students or graduates in rural communities or other areas of high need.
People who train in rural areas, Scrase said, are much more likely to stay there, so the training slots are a good way to encourage people to work outside big cities.
Still to come, he said, are programs that would help doctors repay their student loans if they work in rural areas, an idea in its early stages.
Lujan Grisham, a Democrat who took office Jan. 1, also supports expansion of UNM Hospital – an idea that stalled under the previous governor, Republican Susana Martinez.
A capital outlay package signed by Lujan Grisham this year includes $30 million in state funding for a new medical tower at UNM Hospital, the only Level 1 trauma center in the state.
In a presentation earlier this year, UNM officials who have been working on the expansion showed regents pictures of small operating rooms and a hallway crowded with equipment because of a lack of storage space.
The state funding is just a small slice of what would be needed to construct the tower. The university has discussed several different proposals for expansion over the years, with price tags usually running in the hundreds of millions of dollars.
Skeptics say the construction of more bed space isn’t necessarily the best way to improve health care – that spending on actual services is more productive.
The governor has also touted the merits of a Medicaid buy-in proposal that would allow people to pay a monthly premium to receive insurance through Medicaid.
Lujan Grisham said it would target people who make too much to qualify for Medicaid but can’t afford private insurance.
It’s a critical way to expand access to health care, supporters say.
Opponents, in turn, say the program would worsen the financial challenges of providers who already make less serving Medicaid patients.
An analysis by legislative staff suggested that a targeted Medicaid buy-in program would cost the state in the neighborhood of $27 million to $81 million a year, depending on how many people enrolled.
The idea cleared one House committee this session but failed to make it through another. Lujan Grisham said she intends to continue the conversation.
Lujan Grisham has touched on a variety of other ideas, too, aimed at improving health care. She has directed her administration to craft a plan for providing new services to people who wait a decade or more for help under a program for individuals with developmental disabilities.
The Human Services Department is also planning to hire a few more staff members to work with behavioral health providers – to help them navigate the billing process and to encourage them to expand services.
The extra effort is needed, supporters say, after the state in 2013 cut off Medicaid and other funding to 15 providers, citing allegations of overbilling, mismanagement and possible fraud, as outlined in an audit. The Office of the Attorney General later cleared all 15 providers of fraud allegations.
Lujan Grisham said she is also interested in revising the state’s medical malpractice laws, which some say discourage doctors from staying in New Mexico.
“We’re going to create an environment where this is an easy, productive, wonderful state to practice medicine in,” Lujan Grisham said in a speech last week.
Some of the new governor’s proposals have picked up Republican support, though GOP lawmakers have strongly opposed the Medicaid buy-in legislation.
Rep. Gregg Schmedes, a surgeon and Tijeras Republican, said he appreciates Lujan Grisham’s support for improving services for people with developmental disabilities, the push to improve Medicaid provider reimbursement rates and creating incentives for doctors to practice in rural New Mexico.
“One of the defining characteristics of health care in the state is how we pay attention to those folks who may not have a voice,” including those with a severe disability, he said.
But Schmedes said he’d also like to see more attention paid to reducing health care costs by promoting competition and transparency. Much of the legislation that passed this year will raise costs, he said.
“The only way to reduce costs,” Schmedes said, “is to increase free-market principles and let consumers drive prices.”
Lujan Grisham, meanwhile, has made clear that health care is more than just an early focus of her administration. It’s a field she has worked in, both as a consultant and as a Cabinet secretary, and is an area of ongoing interest.
She told one audience last week that she isn’t interested in “candy coating” New Mexico’s medical challenges.
Lujan Grisham grew up with a developmentally disabled sister who deserved better care than was then available in institutions, she said, and her parents brought her home to live with the family.
Her mom has been in and out of the hospital since October.
And she has watched a nephew battle addiction.
Health care policy, Lujan Grisham said, “is really personal to me.”