OPINION: Leaders need to address health care time bomb

New Mexico is facing a health care time bomb, and leaders need to act quickly.

The Land of Enchantment relies heavily on the federal government to provide health insurance for its residents, and we are facing severe impacts with recent federal policy changes. About 38% of the state is enrolled in Medicaid, which is significantly above the national average of around 21%, according to the Kaiser Family Foundation. And the program is facing significant cuts — $1 trillion nationwide over 10 years — with the signing of the so-called “Big Beautiful Bill.” The state has already been dealing with a health care worker shortage for years, with 32 of the state’s 33 counties designated as Health Care Professional Shortage Areas, according to KFF. Many people around the state have struggled to find a primary care physician or waited too long to see a specialist.

The effects of the federal cuts are going to make the problem worse. It’s expected that at least some of the rural hospitals could close in the coming years. And when hospitals stay open and absorb the cuts, things like translation services, rural family assistance and specialized training for workers are likely to be the first to go. When people lose their health insurance, they will end up in emergency rooms for either basic care for colds and cuts, or for chronic illnesses that have manifested because they haven’t been managed by primary care or medications. That will put a bigger strain on indigent health claims, often covered by taxpayer dollars. Long-term care will become an even bigger issue because of our state’s aging population.

Why does New Mexico rely so heavily on Medicaid compared to other states? High poverty rates have led to a large portion of the population, including children, pregnant women and people with disabilities, relying on Medicaid. Under the Affordable Care Act, the state made nearly all nonelderly adults with incomes up to 138% of the federal poverty level eligible for coverage. Many organizations, like New Mexico Voices for Children, championed the economic and fiscal impacts of that expansion, essentially rolling out a welcome mat for furthering the state’s reliance on federal assistance.

Estimated Medicaid spending in New Mexico in the 2025 fiscal year is expected to be around $8.5 billion, according to the New Mexico Health Care Authority. The federal government has traditionally paid about 70-90% of those Medicaid costs, depending on the population served. That shows how significant the looming federal cuts are to the state.

The Albuquerque Journal’s Community Council recently discussed the topic, and the conversation highlighted a lack of clear alternatives. Expanding private sector coverage is crucial, but the industry has shown little interest in our state’s market. Make no mistake, economic development in New Mexico isn’t a luxury any longer; building an economic base so workers get insurance through their employer is a necessity.

The state is at a crossroads, and it’s time for leadership to stand up. Management is no longer the job — it’s time to lead. Health care is one area where the state has dropped the ball, despite mounting evidence like workforce shortages and long wait lists for care, too many lawmakers have dismissed the crisis and try to pretend like the problem is made up by insurance companies or out-of-state corporations. Efforts to address the problem with health care compacts to expand telehealth opportunities or reform medical malpractice laws went nowhere in the most recent legislative session. Though it is a positive sign to see momentum building.

This marks another opportunity for term-limited Gov. Michelle Lujan Grisham to either fade into the political background or wrap up her tenure with bold, reform-minded leadership. We’ve seen that she’s willing to think big with her recent decision to flip the child welfare system on its head by requiring all infants born exposed to fentanyl, methamphetamine or with fetal alcohol disorder be immediately placed into state custody and go before a family court judge who can require parents to seek services. Now she needs to expand that style of governance and do what she can to help the rest of us.

The policy details of much-needed health care reform are complicated and nuanced. One of the ideas to be debated is a proposed Medicaid Forward plan, which would further expand Medicaid eligibility in New Mexico.

Stakeholders from all aspects of health care, insurance, Medicaid and lawmakers from both sides of the political aisle will need to roll up their sleeves and take a seat at the table. That includes New Mexico Senate President Pro Tem Mimi Stewart and Minority Leader Bill Sharer, and House Speaker Javier Martínez and Minority Leader Gail Armstrong. We’re going to work to do our part to provide a platform to flush out the details and come up with common-sense solutions. The president’s signing of the major spending bill has backed New Mexico into a corner. We can’t wait for next year’s legislative session or the next governor’s administration to come up with a solution.

We need leaders who will put their necks on the line, not their heads in the sand. Lives are at stake.