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Editorial: N.M. Should Embrace Medicaid Expansion

It is time for New Mexico to bite the Medicaid expansion bullet.

Contrary to what advocates argue, this isn’t a no-brainer game-changing panacea. It’s just that after weighing the pros and cons, the scales come down on the side of doing it.

As a result of the U.S. Supreme Court affirmation of the Affordable Care Act of 2010, states have the option of expanding Medicaid. The federal government has promised to pick up the lion’s share of the cost.

The ACA — aka Obamacare — would extend Medicaid coverage to adults with incomes up to 138 percent of the federal poverty level. If that happens, about 170,000 New Mexicans could be added to the state’s Medicaid rolls.

Medicaid, which currently pays health care costs primarily for low-income children, the elderly and disabled people, is jointly financed by the federal and state governments. It currently covers about one-fourth of New Mexico’s population, or about 550,000 people, most of them children. At this time the feds pay about three-fourths of the state’s roughly $4 billion program annually.

Proponents say that in addition to increasing the number of people who have health care coverage, the expansion will inject billions of dollars into the state economy, develop a more robust health care infrastructure especially in rural areas and create thousands of jobs in the health care industry and in other businesses as a result of the increased economic activity.

With the feds picking up virtually 100 percent of the cost for the first three years of expansion starting in 2014 — although the state Human Services Department says it could be 97 percent — and 90 percent thereafter through 2020, what’s not to like?

A lot. A good argument can be made that it’s bad policy for the country. All this infusion of cash comes from the federal government, which doesn’t have any. So this is borrowed money.

And for New Mexico, at some point we need to be good at something other than poverty as a way of generating economic activity.

Plus, the state will have to cough up a larger share — an estimated additional $320 million to $500 million for 2014 through 2020.

Ultimately it’s up to Gov. Susana Martinez to decide whether the state takes the federal government up on its offer. But either way, New Mexicans’ federal taxes will go into a pot to pay for Medicaid expansion in the states that participate.

A sticking point is that adding upward of 170,000 eligible New Mexicans to the program is going to slam the state’s already burdened health care system that is desperately short, especially in rural areas, of medical personnel — up to 600 primary care physicians and 1,000 nurses.

That will require a sea change in how services are delivered. Instead of automatically seeing a primary care doctor, patients might see a nurse practitioner or a physician’s assistant, or have their meds prescribed by a pharmacist. More thought might go into what medical services are really necessary. Large providers have already started gearing up for the influx of new patients.

Some prognosticators say having more people with access to routine and preventative care should help dampen costs overall by decreasing the use of emergency rooms for nonemergencies. And some say having nearly everyone covered for medical services will keep costs down in the long run for those who have insurance, as providers will no longer have to make up for people who don’t pay their bills by raising the premiums of the insured. Time will tell whether any of that is true. While advocates say this will keep people out of hospitals, UNMH is already citing the expansion as one reason it needs more acute care hospital beds.

While polls show America is divided on the Affordable Care Act as a whole, it is clear that opting out will do nothing for New Mexicans. Although it will increase the amount of money spent on health care in the state budget, New Mexico can’t afford to walk away from the federal government’s offer — and the expansion is aimed at people in need.

Martinez has shown real compassion on public safety net issues before, and this is a chance — not a sure bet — to offer more New Mexicans a healthier future.

She should sign New Mexico up.

This editorial first appeared in the Albuquerque Journal. It was written by members of the editorial board and is unsigned as it represents the opinion of the newspaper rather than the writers.

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