Hinton, who is also chairman of the American Hospital Association, said the law, officially called the Affordable Care Act, is designed to fix a fundamental flaw in the nation’s health system – the failure to provide adequate access in a reasonable way to everyone who needs it.
ACA’s solution is an expanded system of insurance, which the act attempts to create by extending Medicaid to more poor people, subsidizing the cost of coverage for the middle class and requiring most people to have coverage, he said.
“The essence of the Affordable Care Act is the expansion of coverage,” Hinton said.
About 40,000 more people have signed up for the state’s Medicaid program since Jan. 1, when new federal money allowed New Mexico to enroll anyone earning up to 138 percent of the federal poverty level, he said. Previously, nearly all Medicaid recipients were low-income children, older people and the disabled.
Hinton described the care given to a boy insured by Presbyterian’s Medicaid managed care product.
“Our society has chosen to spend more than $1 million on Joshua,” Hinton said. “We’ve received approximately $100,000 from Medicaid to take care of Joshua’s health issues. I’m proud of that.”
The system works because on the rare occasions when those kinds of costs are incurred, revenue healthier people pay into the system can be tapped. The $900,000 Medicaid didn’t pay for Joshua’s care was covered by shifting the costs to people who have private coverage, Hinton said.
New Mexico’s problem is that its health care providers can tap too few non-governmental payers, which pay better than Medicaid and Medicare. Only 48 percent of New Mexicans have coverage from a private source, such as an employer. In Utah, 71 percent of coverage is private.
“Utah’s premiums are really low because a lot of people pay into the system,” Hinton said. According to the Kaiser Family Foundation, the average annual family premium per enrolled employee with employer-based health insurance in Utah is $14,558. In New Mexico the premium averages $15,880 because fewer people pay into the system, a problem the act is designed to solve by requiring everyone to have health insurance.
Hinton said insurance companies’ uncertainty is pushing premiums higher in the near term. “We really don’t know how this is going to work,” he said. “There is no easy fix to this.”
Since health care among states is as different as New Mexico and Utah, Obamacare attempts the impossible by imposing a national policy, Hinton said.
“Health care resists national policy, but we have a national policy, and it’s the Affordable Care Act,” he said. Thirty years from now “they are still going to be talking about the ACA and health care policy. That’s just the way it is.”