Alexis, a small business owner in Albuquerque, remembers what it was like to try to buy individual health insurance before the Affordable Care Act. “Due to a pre-existing condition, I was denied health insurance on the private market and had to get insured through the state’s high risk pool. It nearly broke us financially.”

The ACA (sometimes called “Obamacare”) created strong protections for people like Alexis, such as ending the practice of denying coverage or charging people with pre-existing conditions higher premiums. Those protections have had an enormous positive impact on people in New Mexico. Shortly after the ACA went into effect, Alexis suffered a medical emergency. “A middle-of-the-night surgery and related complications put me in the hospital for close to three weeks, needing IV antibiotics for another three weeks on top of that. It was expensive, but it didn’t bankrupt us because the caps on out-of-pocket expenses put in place by Obamacare.”

The provisions requiring coverage for pre-existing conditions like Alexis’ are a popular part of the ACA. But covering individuals with high health needs is costly, which is why the ACA also included a requirement that all people purchase health coverage. The so-called “individual mandate” helps keep costs in check by encouraging younger and healthier people to sign up for health coverage. To make sure coverage is affordable for people with low and moderate incomes, the ACA provides financial assistance.


However, in the recent federal tax bill, Congress eliminated the individual mandate, threatening to destabilize the coverage that people like Alexis rely on. Without the requirement to have health coverage, experts warn that premiums will skyrocket, as sick people stay in the market and healthy people leave. In fact, the Center for American Progress projects that up to 89,000 people in New Mexico will become uninsured by 2025 due to the change.

Let’s face it: The individual mandate was unpopular, but there needs to be some way to help young and healthy people get covered to protect against illness and injury while ensuring that people with pre-existing conditions can get the care they need. With the dysfunction in Congress, states need to step up to make sure people’s health care is not disrupted. It’s time for New Mexico to get creative about how to solve this problem.

Health Action New Mexico has a bold idea that could expand coverage while getting premiums under control: Automatically enroll people who are uninsured and eligible for financial assistance into a basic health coverage plan that costs as little as $0 a month, with the option to opt out.


Many people do not know that they are eligible for no-cost or low-cost health coverage. A study by the Kaiser Family Foundation found that nationally, 42 percent of the remaining uninsured were eligible for a zero-cost plan in 2018, and 54 percent could get a plan for less than $60 per month. Yet plan selections in New Mexico dropped by 7.5 percent from 2017 to 2018.

Automatic enrollment is an innovative way to unlock the door to better health without a mandate. When more people sign up for health coverage, it becomes more affordable, leading to a better health care system for everyone.

New Mexico can improve people’s lives while stabilizing New Mexico’s health insurance market. The New Mexico Legislature has a proposal to do just that by creating a Health Coverage Stability Task Force through Senate Memorial 7 & House Memorial 20. The task force will study the opportunities and challenges of setting up an automatic enrollment system and make other recommendations to increase enrollment and reduce premiums. We urge our leaders to support the effort to get the best ideas in the room to chart a path forward for high-quality affordable health coverage for all people in New Mexico.

Colin Baillio is the director of Policy and Communications for Health Action New Mexico. Gerry Fairbrother, Ph.D., is on the policy committee of Health Action New Mexico. Health Action New Mexico is a nonprofit, statewide, consumer advocacy organization that works to ensure that all New Mexico communities have access to quality, affordable, medical and dental care.