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Webinar: What you need to know about your preventive and mental health benefits

Health Action NM and the Office of the Superintendent of Insurance are teaming up to give you the information you need to access your mental health and free preventive benefits. Your health insurance must cover these benefits. Please join us for a live webinar on March 22, 2018 at 9:30 AM.

Here is a link to the webinar: https://nmosi.webex.com/nmosi/onstage/g.php?MTID=efc403cd738a90b0a85f39e7235e27db7

For audio: +1-415-655-0002;806 299 174

 

PRESENTATION I: 

Get the most out of your health insurance: Your right to services for mental health, alcohol or drug use problems.

This brief presentation will review the history of mental health parity and use a plain language video to demonstrate how health plans are required to give equal importance to the health of both the body and the mind.

The presentation will highlight red flags that a consumer may encounter that signals unequal access to mental health services or services to address alcohol and drug problems. For example, if a health plan restricts access to services by requiring use of lower cost therapies before accessing other types of services, or not having enough providers in their network. The presentation will use case scenarios to illustrate how the problems with equal access may look to a consumer, and how these can be resolved.

The presentation will conclude with clear advice about how to file a complaint with health insurance companies and how to contact OSI for further support in resolving problems.

 

PRESENTATION II:

Get the most out of your health insurance: Your right to no-cost prevention services.

This brief presentation will use plain language to review the basics of “cost-sharing”, or co-pays and deductibles, and emphasize that preventive care services are available to consumers at no cost, or “cost-sharing free”. The presentation will describe what is typically included in a well-person exam and what are common preventive care services, as well as provide a complete list of preventive care services that consumers can expect to receive at no cost. 

The presentation will highlight red flags that a consumer may encounter when accessing preventive services and provide advice about how to be a smart consumer when it comes to using preventive services. Important tips for Bronze plan users will be included.  The presentation will use case scenarios to illustrate common problems in accessing preventive services, and how these can be resolved. 

The presentation will conclude with clear advice about how to file a complaint with health insurance companies and how to contact OSI for further support in resolving problems.

Health Action

Medicaid Buy-In: The Basics

Sponsors: Representative Deborah Armstrong, Senator Jerry Ortiz y Pino, and Representative Nathan Small

New Mexico should allow people use their own dollars and tax credits to purchase health coverage through the state Medicaid program.

  • Medicaid is a public health coverage program that provides New Mexico’s children, families, people with disabilities, and older adults with comprehensive health care benefits.
  • Medicaid is a trusted, proven program that has served New Mexico for more than 50 years.
  • More than 40% of New Mexicans are already covered by Medicaid.

New Mexicans want high quality health coverage.

  • Medicaid covers the ten essential health benefits plus dental and vision care.
  • 93% of office-based physicians accept new Medicaid patients in New Mexico, according to a 2015 study from the Center for Disease Control & Prevention.

New Mexicans want affordable health coverage.

  • Medicaid for adults costs $297 per person a month according to the Kaiser Family Foundation, compared to the average $520 premium per month for employer insurance.
  • Tax credits and employer contributions could make health coverage even more affordable for working families. 

New Mexico could be a national leader in expanding affordable health care.

  • With a bold vision and smart planning, New Mexico could be the first state to take the innovative approach of a Medicaid buy-in.
  • Congressman Ben Ray Luján has introduced federal legislation using the Medicaid buy-in model.

SM 3 & HM 9 request the Legislative Health and Human Services Committee to study how a Medicaid buy-in could work in New Mexico. The bills passed with bipartisan support during the legislative session. The Legislative Health and Human Services Committee will study the concept throughout the summer! Check our website regularly for updates. 

Let’s work together to make sure every person in New Mexico can get the care they need to be healthy.

Health Action

Our Priorites for the 2018 Legislative Session

Given that this will be a short session and the governor’s final year in office, the 2018 New Mexico legislative session probably won’t be all about passing sweeping legislation. Instead, it will lay the groundwork for the 2019 session and beyond. Health Action NM plans to advocate for ideas that will improve health and increase access to care.

Medicaid buy-in study

Sponsors: Representative Deborah Armstrong, Senator Jerry Ortiz y Pino, and Representative Nathan Small

The Big Idea: Medicaid provides comprehensive health benefits at a lower cost than private insurance. We should allow everyone to participate in Medicaid by letting people and small businesses use their own dollars and tax credits to buy Medicaid coverage.

The Bill: SM 3 & HM 9 request the Legislative Health and Human Services Committee to explore how a “Medicaid buy-in” could expand health coverage and make health care more affordable for the people of New Mexico.

The Bottom Line: Everyone should be able to get the health care they need without breaking the bank. Let’s bring our values to life by giving the people of New Mexico a new option so that they can make the choice that works best for their family.

Health coverage stability task force

Sponsors: Representative Liz Thomson, Representative Debbie Armstrong, and Senator Bill Tallman

The Big Idea: Policy changes at the federal level may destabilize New Mexico’s health care system and disrupt access to care. The repeal of the individual mandate, re-introduction of “junk insurance,” and end of federal cost sharing subsidies could put people’s health and wallets in jeopardy. The task force will explore an exciting new idea: automatic enrollment for people who are uninsured and eligible for no-cost or low-cost health care.

The Bill: SM 7 directs the Office of the Superintendent of Insurance to set up a task force to study disruptions to New Mexico’s individual health insurance market and report recommendations to the Legislative Health and Human Services Committee.

The Bottom Line: New Mexico needs to take a proactive approach to protect people’s health care.

State agency drug purchasing council

Sponsors: Senator Jeff Steinborn and Representative Joanne Ferrary

The Big Idea: Prescription medication costs are skyrocketing, straining pocketbooks and the state budget. A recent Legislative Finance Committee analysis found that prescription medication spending in New Mexico jumped from $442 million in 2014 to $738 million in 2017, due in large part to price increases. A number of state agencies purchase medications but there is no communication with one another about purchasing decisions. By coming together, state agencies can negotiate better deals for taxpayers and begin to address the unfair pricing practices of pharmaceutical companies.

The Bill: SB 8 and HB 59 bring together state agencies that purchase prescription medications to find cost savings through smarter, better-coordinated purchasing decisions.

The Bottom Line: Prescription medication costs are rising at an unsustainable rate and New Mexico do everything in its power to get the best possible deal.

Health care cost commission

Sponsor: Representative Debbie Armstrong

The Big Idea: Health care costs are always on the rise, outpacing wage increases and making it difficult for New Mexicans to afford health coverage. And yet, the state does not have any formal body to look at what’s driving health spending or make recommendations on how to make health care more affordable. Many states have set up cost commissions to take the problem of health care costs head on, leading to savings and innovation.

The Bill: HM 29 would task the Office of the Superintendent of Insurance to establish a working group to identify priorities for a health cost commission and draft legislation for the 2019 session.

The Bottom Line: New Mexicans want access to high quality affordable health care and it’s time for the state to take affordability head on.

Fully Funding Medicaid

The Big Idea: Medicaid is a public health coverage program that gives kids, people with disabilities, older adults, and working New Mexicans access to high quality health care. Medicaid saw a wave of cuts over the past few years. With 42% of people in New Mexico relying on Medicaid for their health care needs, it is essential that we fully invest in their health so that our families and neighbors can live healthy lives.

The Bill: SB 192 assesses a fee on certain health care providers in order to draw down federal matching dollars and improve Medicaid doctor and facility payments. Several other potential proposals may be included in the state budget.

The Bottom Line: New Mexico should stand by our commitment to invest in our people’s health.

Health Action

Medicaid buy-in study passes the legislature!

On Wednesday, February 7th, the New Mexico Senate joined the House in approving a study that will explore allowing residents of New Mexico to purchase Medicaid coverage through a buy-in option. The enabling memorial was sponsored by Representative Debbie Armstrong (co-sponsored by Representative Nathan Small) and Senator Jerry Ortiz y Pino. Despite progress under the Affordable Care Act, 180,000 New Mexicans remain uninsured and many face high deductibles and co-payments.

“A Medicaid buy-in could give people a more affordable health care option,” said Barbara Webber, Executive Director of Health Action New Mexico. “New Mexico is in a unique position to offer a state coverage plan that provides better coverage at a lower cost.”

House Memorial 9 and Senate Memorial 3 passed their respective chambers with overwhelming support. HM 9 passed on a vote of 42-24 on Monday February 5th, while SM 3 passed on a vote of 33-8 on Wednesday, February 7th. According to the memorial, “New Mexicans who are uninsured or underinsured must often forego needed medical services, have less access to preventive care and behavioral health services and may be forced to wait until medical conditions worsen into expensive and sometimes untreatable emergencies.”

The study will consider similar initiatives in other states, potential costs and savings of a Medicaid buy-in program, federal waivers that may improve the viability of a Medicaid buy-in program, and the impact on patients, consumers, and other health care stakeholders. The effort is supported by community and advocacy groups such as Health Action New Mexico, Strong Families New Mexico, the New Mexico Center on Law and Poverty, and the New Mexico Together For Healthcare Campaign.

Health Action NM is a non-profit, statewide, consumer advocacy organization that works to ensure that all NM communities have access to quality, affordable, medical and dental care

Health Action

NOVEMBER 28th ONLY: Double your donation to Health Action NM

Today (November 28) the Bill & Melinda Gates Foundation will match your donation to Health Action NM.

We are more committed than ever to defending the health care protections in place now and expanding health care to every person in New Mexico. In fact, we want you to be the first to know that our staff has been working on a brand new initiative to do just that.

If you donate today, we will invite you to get the first look at a brand new Health Action NM initiative that will bring down premiums and deductibles while moving New Mexico a step closer to universal coverage. Donate today on Facebook to get a matching donation from the Bill & Melinda Gates Foundation. If you don't have Facebook, you can start a monthly tax deductible donation through MobileCause.

"2017 has been a trying year. But together, we have defended progress and made strides towards a better future. We are thankful for all those who make our work possible by contributing their tax deductible donation to Health Action NM."

Barbara Webber
Executive Director
Health Action NM

Health Action

New report shows tens of thousands of New Mexicans are eligible for premium-free health insurance in 2018

 

ALBUQUERQUE — A new report by Health Action New Mexico shows that premiums may be much less expensive in 2018 for New Mexicans who receive financial assistance under the Affordable Care Act. The report uses data from healthcare.gov to show the lowest cost options in each plan category that are available for the 2018 plan year. One example shows that a family of four earning $70,000 per year in Roswell, NM could cover the whole family with a Bronze plan for $0 per month, a Silver plan for $484 per month, or a Gold plan for $220 per month. Bronze plans offer the least financial protection while Gold plans generally offer the most. For lower income consumers, Silver plans offer enhanced financial protection through cost sharing reductions.

“For those who qualify for financial assistance, many marketplace plans will be much less expensive than ever before” said Colin Baillio, Policy Director of Health Action New Mexico. In 2017, 73% of marketplace enrollees qualified for premium assistance, while 38,000 uninsured New Mexicans are eligible for assistance. “If early trends are any indication, we may see a big boost in enrollment as people take a look at the great deals that are available.”

The shift in prices is mostly attributed to insurers and state regulators reacting to the Trump administration’s decision to end cost sharing reduction payments. Insurers are still required to discount co-payments, coinsurance, and deductibles for lower income enrollees but the federal government will no longer reimburse them for it. Ending these payments has caused premiums to go up. 

However, premium assistance is still available, and because it rises alongside increases in the benchmark silver plan, plans that have risen at a slower rate have become much more affordable. On the other hand, those who don’t qualify for financial assistance will likely find themselves in a situation where premiums are substantially higher than they were last year due to the Trump administration’s actions. Still, other plans may be a better deal than others, such as the lowest cost Gold plan which costs less than the lowest cost Silver plan.

“People should use New Mexico's brand new plan comparison tool OSICompareHealthPlans.org to see if they qualify for a no-cost or low-cost plan,” said Baillio. “If you don’t get coverage from your job or a public program, we encourage you to take a look at what is available. We’ve heard from quite a few people who were surprised by the great deal they got. It’s important to shop around and see which plan works best for your family. Once you find a plan that you like, visit healthcare.gov to sign up.” 

The Kaiser Family Foundation found that nationally "70% of subsidy eligible-uninsured are able to purchase a Bronze plan for nothing or less than the cost of the individual mandate penalty." The penalty for lacking insurance is $695 per adult or 2.5% of income, whichever is higher.

Open enrollment is underway and ends on December 15, 2017. Free local assistance is available at BeWellNM enrollment centers.

Health Action

"The Truth About Trumpcare" Rally in ABQ on 5/13

The Truth About Trumpcare

Last week, the US House of Representatives passed a bill that would end Medicaid as we know it and cut it by $839 billion, weaken pre-existing condition protections, and cut taxes for the wealthiest Americans. Supporters of the bill rushed to the airwaves and lied about Trumpcare's true impacts. That's why US Senator Martin Heinrich and Congresswoman Michelle Lujan Grisham are teaming up with local leaders and advocates to tell the truth about this devastating bill.

Date: Saturday, May 13, 2017
Time: 10 AM - 12 PM
Location: Tiguex Park (1898 Mountain Rd NW, Albuquerque, New Mexico 87104)

This event was organized by Indivisible Nob Hill.

 

Speakers:
Senator Martin Heinrich
Congresswoman Michelle Lujan Grisham
Pat Davis - ABQ City Council
Samia Assad - Center for Peace and Justice
Shakir Farid Abdullah
Can't make it to the event? You can still take action

1. Call Governor Martinez TODAY (505-476-2200) and ask her to vocally defend Medicaid and oppose the repeal of Medicaid Expansion. It will only take a couple of minutes. Like other Republican policymakers that have been outspoken in their support of Medicaid, our Governor can take a public stance with her colleagues to urge them not to repeal the Medicaid expansion.
 
2. Call your elected representatives and tell them what you think about Trumpcare. You can find your House representative’s number 
here - let them know what you think about their vote on Trumpcare. And click here find your Senator's numbers - tell them to vote NO on Trumpcare .

3. Share your story about how Medicaid and the ACA have helped you or a loved one. Your story can make a difference. It is the most powerful tool we have in our fight to protect and expand access to quality health care. Send us your story and share your story with Senator Martin Heinrich.

Health Action

Dental therapy will be heard in Senate Public Affairs Committee on Friday, March 10!

Thanks to the dedication and persistence of all dental therapy supporters, HB 264 (Access to Dental Care Act) passed the House of Representatives by overwhelming margins!

House Health and Human Services Committee Vote: 5-0
House State Government, Indian and Veteran Affairs Vote: 9-0
NM House of Representatives Floor Vote: 60-5


Momentum is on our side and we must now get the bill through the Senate.


HB 264 is scheduled to be heard in the Senate Public Affairs Committee (SPAC) on Friday, March 10, 2017.
There is a chance that the bill will be heard on Saturday - we will keep you posted if this is the case. Please contact members of SPAC and urge them to support the bill.

Gerald Ortiz y Pino (D) 
986-4482 

Bill B. O'Neill (D)
986-4260

Craig W. Brandt (R)
986-4260

Candace Gould (R)
986-4266

Elizabeth "Liz" Stefanics (D)
986-4377

Jeff Steinborn (D)
986-4862

Mimi Stewart (D)
986-4267

Stuart Ingle (R)
986-4702

Word of Mouth

A bill that would bar mid-year prescription coverage restrictions reveals everything wrong with US health care

by Colin Baillio

 

Adam Consiglio is fighting for consumers whose prescription medication coverage lapses mid-year.  

Adam Consiglio is a businessman in Taos, NM. He’s worked in the mortgage industry for decades and even lobbied on the industry’s behalf at the State Capitol. But now, he’s coming to the roundhouse every day to fight for a different constituency: patients.

Last year, Consiglio was informed that his prescription medication was being dropped from his health plan in the middle of the year. “I spent hours researching all of the different forms of this particular medication, consulted my doctor, and finally found one that wouldn’t give me unwanted side effects,” Consiglio explains. A few months later, he was informed that his doctor was being dropped from his plan, too. “I specifically purchased that plan so that I could get that medication and see my doctor. And now, in the middle of the year, I’m suddenly cut off? It was not right…I expected to get what I paid for.”

When he called two other health insurance companies to find a 2017 plan that covered his medication, neither could give him an answer. “Their formulary [a list of drugs that a plan will cover] wasn’t set! How am I supposed to make an informed decision if they can’t even tell me what’s offered?” Consiglio had enough. He called his state representative to explain what had happened and ask what could be done about it. “Look, I can afford it, so I just paid for it out-of-pocket. But I started thinking about all the people who aren’t as fortunate .”

The answer seems clear: when a consumer signs up for a health plan, they should know what they are getting. Insurance companies shouldn’t be able to restrict access to prescription medications or health care providers in the middle of the year. The contract between the consumer and the insurer should be upheld for the duration of the plan. If new drugs are introduced at a lower price, the insurance carrier can share the savings with the consumer by offering lower out-of-pocket costs to switch the new drug. As with all things in the U.S. healthcare system, the interested stakeholders said answer was not so simple.

An inadequate compromise

This issue was debated in New Mexico as recently as 2013, when a bill was introduced to end mid-year formulary restrictions for certain health plans. The industry backlash was fierce. Insurance companies and pharmacy benefit managers (middlemen that negotiate prices with pharmaceutical manufacturers on behalf of insurance companies) argued that it would drive up premiums and give drug manufacturers an advantage in negotiations.

compromise was reached, requiring insurance companies to inform consumers of any changes to prescription medication coverage within 60 days of the change and limiting changes to every 120 days. These are the types of restrictions that can be made in the middle of a plan year:

  • Reclassifying the drug to a higher tier of the formulary;
  • Reclassifying a drug from a preferred classification to a non-preferred classification unless it is to a lower tier of the formulary;
  • Increasing the cost-sharing, co payment, deductible or co-insurance charges for a drug;
  • Removing a drug from the formulary;
  • Establishing a prior authorization requirement;
  • Imposing or modifying a drug’s quantity limit; or
  • Imposing a step therapy restriction.

But the law doesn’t appear to be adequately enforced. Barbara Webber, Executive Director of Health Action New Mexico, was moved off three of her four medications without warning last year (Disclosure: Barbara is also the author’s boss). “I struggled to navigate my way through the system and I have been working in health care and health policy for decades,” Webber said during her testimony to the New Mexico House Health and Human Services Committee. “I spent upwards of forty hours filing appeals, explaining my doctor’s orders to insurance representatives and pharmacies, tracking medication authorizations and reauthorizations. I was forced to go without needed medications for weeks or months until the issue was resolved. Not everyone has the knowledge and time to commit to this kind of hassle. And frankly, they shouldn’t have to.”

Even if Barbara was informed within the 60-day time period required by law, she still would have been left to navigate the system on her own, forced to switch her medication or pay more out-of-pocket despite her original agreement with the health insurance company when she purchased the plan.

The big picture

Insurance companies aren’t restricting access to medications just because they want to save money for themselves (thought that is a factor). They are responding the skyrocketing prices of prescription medications that go up throughout the year. The rise in prescription drug costs is out of control. A report found that pharmaceutical costs have increased an average of 8.3% per year since 1994, far beyond the rate of inflation. In recent years, we have seen more dramatic price increases and the introduction of expensive specialty medications.

Even generic medications (which are generally less-expensive forms of brand name medications) are seeing explosive increases. A recent study found that “almost 400 generics saw price increases of more than 1,000%” between 2008–2015. And the U.S., by design, pays far more than any other country for nearly every medication. For example, take a look at the cost of a prescription medication called Capaxone in 2013.

 

Source: International Federation of Health Plans

At the same time, when restrictive measures are placed on life-saving medications, people respond by splitting their pills in half to make the prescription last longer, cutting down on other expenses like food, or not taking medications as directed. This leads to a variety of negative outcomes, including higher death rates, worse health status, more hospitalizations, and increased costs to the system. The measures allowable under current health insurance law do very little to protect consumers from these risks.

Louisiana (yes, Louisiana) is ahead of the curve on this issue

In 2011, Louisiana, one of the most conservative states in the nation, successfully tackled this problem. Louisiana’s law requires insurance companies to provide a guaranteed formulary once the plan is available for purchase and disallows efforts to restrict access to medications. Insurers can always add medications to the formulary and the only restrictive change that can be made is moving a medication to a higher cost sharing level if a generic medication becomes available.

Did the law lead to an explosion of premiums? Quite the opposite. A 2016 study found that “Louisiana experienced the largest slowdown [in single premium growth rates in the employer market], as average premium growth fell from 7.8 percent a year between 2006 and 2010 to 2.4 percent from 2010 to 2015.” At the same time, deductibles in Louisiana rose 3.1% between 2010 and 2015, the fourth-lowest rate in the nation.

 

Source: Commonwealth Fund, 2016 (click link for interactive map)

Why did premiums and deductibles rise at a much lower rate than the national average when the 2011 law insurance companies said would lead to higher costs? Part of the explanation could be that, thanks to the 2011 law, patients have better adherence to doctor’s instructions because their access to medications isn’t unexpectedly prohibited by increased costs, leading to reduced health risks and lower use of other health care services. This theory needs to be studied more closely, but the data show that the law did not lead to the kind of premium and deductible growth that critics feared.

Take action

Mr. Consiglio plans to keep fighting to protect consumers from these harmful practices. “In the mortgage, even minor changes to the terms of the loan during the application process need to be disclosed to, and acknowledged by, the consumer, We are dealing with our health care here which I believe is more important.” You can take action to advance this bill during the legislatives session.

A reflection of the broader problem

While disruptions in prescription medication coverage are significant issues faced by consumers, they are symptomatic of a larger problem in the U.S. Our health care system is organized around a poorly coordinated network of doctors, hospitals and clinics, drug manufacturers, health insurance companies, pharmacy benefit managers, and various other players. Many of these stakeholders exist in other countries, but are organized to minimize the burden on the most important person in the system: the patient.

Laws that make it easier for patients to get the care they need without disruption are badly needed if we hope to make our healthcare system achieve the goal of a healthier population. We should do everything in our power to ensure that the various interests in U.S. health care are serving the patient, first and foremost. That means supporting legislation like HB 112 and SB 291 as well as laws that would rein in pharmaceutical companies on prescription drug prices.

— — —

Colin Baillio is the Director of Policy and Communications at Health Action New Mexico, a non-profit, statewide, health consumer advocacy organization that works to ensure that all New Mexico communities have access to quality, affordable, medical and dental care. Health Action New Mexico has extensively researched and officially endorsed HB 112 and SB 291.

Health Action

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