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Editorial: NM should be evenhanded when making Medicaid cuts

Faced with a staggering shortfall in funding for Medicaid, state officials had to come up with some kind of plan. But the first one they rolled out was fatally flawed.

Under the state’s original plan for Medicaid payments this fiscal year, inpatient and outpatient care at University of New Mexico Hospital would have been reimbursed at a lower rate than at any other hospital in the state.

Considering UNMH is the largest hospital in New Mexico, how was that going to follow federal guidelines that require Medicaid patients – fully 41 percent of New Mexicans – have the same access to medical care as others?

One unintended consequence would have been to force Medicaid patients to go to less-crowded hospitals, whose reimbursements also are being cut but at a lower level, if in fact those hospitals could even provide the needed care. UNMH is the only Level 1 trauma center in the state.

So the New Mexico Human Services Department decision last week to make cuts equitable – every hospital will be cut at the same rate – was the right decision for UNMH and Medicaid patients. Inpatient services will be cut by 5 percent, outpatient by 3 percent. (The original plan was to cut UNMH by 8 percent and 5 percent, respectively.)

There is no question Medicaid places a huge burden on the state’s budget – declining oil and gas revenues have the state facing a $417 million Medicaid shortfall over the next year. But as the Journal has argued before, if the purpose of Medicaid expansion is to make health care accessible to more New Mexicans, then pushing physicians and hospitals to the point of financial instability defeats it. What good is medical coverage if there’s nobody to supply care?

Not only do cuts need to be equitable, but benefits that outstrip private insurance policies need to go away and patient responsibility needs to be part of the equation.

HSD should finally consider placing a modest burden on Medicaid patients who choose expensive care because taxpayers are footing the bill (such as the emergency room rather than a primary care office visit). Unless and until that happens, they have no incentive to change behavior and make better health care decisions.

And New Mexico will have no way to afford health care coverage for them.

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.