By MERILEE DANNEMANN
Triple Spaced Again
© 2024 New Mexico News Services
To review the obvious: Most of us could not afford the financial cost of serious illness or injury.
We never know who’s going to be the unlucky one to become ill or injured. Health insurance was developed to share the risk. When private health insurance was not enough, government joined in with Medicare and Medicaid. One principle underlying these policies is that when more of us have access to healthcare, we are all better off.
I find that principle persuasive. When more people have healthcare, fewer people spread infectious diseases. Fewer people take days off work, disrupting business and public services. Fewer children stay home from school, so they have a better chance of getting an education and elevating the economy for us all.
The United States has had a long-running argument between those who agree with that principle and those who think access to healthcare should be earned, giving preference to those who can afford to pay for the insurance or who contribute enough (however you measure that) to society.
We may be approaching a clash between a New Mexico policy initiative designed to expand access to healthcare and a Trump administration policy intended to restrict it. We can’t tell now how this will play out.
The initiative is called Medicaid Forward. It has been under study for a couple of years, to expand Medicaid eligibility so that many more New Mexicans can get health coverage.
By New Mexico standards, this initiative is bold. Depending on which of several designs is adopted, it will increase enrollment in Medicaid between 93,000 and 326,000 new enrollees.
The in-depth analysis was prepared by Mercer Health and Benefits. You can read the full report on the New Mexico Health Care Authority website.
The expansion will include people who are now in the Medicaid gap, who earn a little too much money to qualify for Medicaid by today’s rules but can’t afford other coverage. It may include people who work for small businesses where employer-provided coverage is particularly expensive. It may also include some public employees, moving them from more expensive coverage and saving state and local governments some money.
The plan will attempt to adjust Medicaid reimbursements to providers so that they don’t lose by treating patients under Medicaid. This is a critical component. If it works, it potentially could reduce the incentive for doctors to leave New Mexico in favor of states where reimbursement is higher.
But here’s the kick: The federal government pays roughly 70% of the cost of Medicaid. Do I even have to tell you what’s coming next?
The Medicaid Forward plan appears to presume that federal participation will remain stable. But we can’t count on that.
Project 2025, the Republican blueprint for transforming the federal government in the upcoming Trump administration, proposes adding work requirements for Medicaid and imposing lifetime caps on benefits (page 468 of the Project 2025 plan document). The American Public Health Association notes that this would “disproportionately affect … those with chronic conditions or disabilities.”
Medicaid itself could also be affected by the Trump-proposed Department of Government Efficiency (DOGE). One of the proposed co-heads of this department, Vivek Ramaswamy, has been saying publicly that he will fire thousands of federal employees. But the Project 2025 work requirement would require a new bureaucracy to administer the program and determine who is eligible.
So there’s almost surely conflict ahead. I fear the plan for Medicaid Forward might turn out to be a wasted effort. And we may continue to be stuck with an overly complicated, confusing, expensive and inefficient system that fails to cover everybody, which might get a little bit worse.
Contact Merilee Dannemann through www.triplespacedagain.com.
