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Standards for Dental Therapists are ready to be implemented!

by Ellie Perkins - Dental Therapy Intern at Health Action New Mexico

Big news on the dental therapy front! The Commission on Dental Accreditation (CODA), the organization responsible for accreditation of dental education facilities nationwide, adopted accreditation standards for dental therapy education programs on February 6th 2015. Now, Health Action NM, in partnership with numerous other national and local organizations, is asking CODA to begin implementing the newly adopted standards for existing and new educational programs. 

So what is keeping CODA from implementing dental therapy education accreditation? According to the American Dental Association, further information on two criteria are needed before accreditation can take place: (1) has the allied dental education area been in operation for a sufficient period of time to establish benchmarks and adequately measure performance, and (2) is there evidence of need and support from the public and professional communities to sustain educational programs in the discipline. It is the position of Health Action NM that these criteria have clearly been met in the three dental therapy training programs already operating in Alaska and Minnesota and will be met as more states establish dental therapy education programs to address the lack of access to dental care for underserved communities in their state.  The time is now to start implementing accreditation standards.  Click here to read our letter to CODA.

 

  

 
Word of Mouth

What Health Action NM's Staff Are Reading This Week: July 20-24

 

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To improve health and save money we need to start thinking about policies that address the social determinants of health. The glaring irony of the American health care system is that we spend so much more than any other county on health care and have no substantially improved outcomes to show for it.  That realization can boggle the mind, but it starts to make sense when you look at our approach to other public programs linked to health.  The United States spends about half as much of our GDP on social services, such as nutritional assistance programs and supportive housing programs, than our European and Scandinavian counterparts. Studies consistently find that well-structured, basic social services can be incredible investments that pay themselves off in a variety of ways, one of which is reduced health costs.  It’s time to get serious about investing in programs that simultaneously improve health and save money.

 - Barbara Webber, Executive Director

It's unwise to impose Medicaid premiums and co-pays.  Several states have asked the Department of Health and Human Services for permission to charge Medicaid beneficiaries premiums and co-pays to keep their coverage active.  The report finds that even small payments are enough to deter people who are struggling to make it day-to-day from retaining coverage and seeking necessary medical care.  When people are forced to reject one basic need to meet another, we can be certain of a negative outcome.  Moreover, the proposed payment increases would be so small that they would barely affect the state’s budgets while adding a huge administrative burden on the state. We must maintain the integrity of public programs that improve people’s health.

Joe Martinez, Outreach Coordinator

Medicaid expansion enrollees cost more than anticipated – but not for long.  Initially, it was estimated that Medicaid beneficiaries would cost 1% less than those on traditional Medicaid but new data reveals that costs were 19% higher than those of traditional Medicaid.  How could that be?  It turns out that there was a lot of pent up demand for medical services that people couldn’t access without health coverage.  The report indicates that costs are expected to fall substantially by 2016, once beneficiaries have met their basic health needs.  It should be noted that all years of higher-than-expected spending will occur when the federal government pays for the full costs of expansion.  The actuarial analysis found that there would be no effect on state budgets.  The report also found that the cost of program as a whole is well under recent projections. Medicaid is living up to its promise of giving low-income people greater access to health care services and more control over their health.

- Colin Baillio, Communications and Outreach

Anthem and Cigna strike $54.2 billion deal.  This is the largest buyout in the history of the health insurance industry.  It raises worries among consumer health advocates because consolidation often leads to higher premiums – and for all the wrong reasons.  As Sarah Kliff points out, mergers increase insurance carrier’s ability to negotiate lower prices with providers while also leading to higher premiums.  The benefits of greater negotiating power ought to be passed on to consumers in the form of lower premiums and out-of-pocket costs, as they are in Medicare and Medicaid and single-payer health coverage systems.  The government must now decide if the Anthem-Cigna merger violates antitrust laws.  Consolidation in the health care system should be approved only if there is a guaranteed benefit for consumers.

- DeAnza Sapien, JD, State Advocacy Coordinator 

Health Action

Monthly Newsletter: July 2015

 Click here to sign up for our monthly newsletter.

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Health Action NM has had a busy month!  A range of issues have come about, requiring advocacy at all levels - community, regulatory, and legislative.  We have been attending community rallies & hearings to urge the governor not to make it harder for people in New Mexico to afford food, preparing for the health insurance premium rate review process to keep premium hikes in check, and working on proposals to fund the state’s 5% portion of the Medicaid expansion in 2017.

And all the while, we have been planning two big celebrations: The 50th Anniversary of Medicaid & Medicare (July 30th at Explora) and Health Action NM’s 20th Anniversary (September 26th at the Sheraton Uptown Albuquerque).

Community Advocacy: Opposing Work Requirements for SNAP

Hunger is a health issue.  As our own Joe Martinez said at a hearing last week, “Hungry children are not healthy children.  Hunger rapidly impacts the health of the person.”  Yet even as our economy struggles to create jobs, the governor has proposed work requirements for the Supplemental Nutritional Assistance Program, impacting up to 80,000 people who are already working so hard to make ends meet.  Now is not the time to even consider making it more difficult to access food.  Health Action NM has formally submitted comments in opposition to the regulations.

Regulatory Advocacy: Keeping Premiums Affordable

Health Action NM worked to establish the health insurance premium rate review process in New Mexico in 2012.  The process gives the Office of the Superintendent of Insurance the authority determine whether rate hikes truly reflect the costs of medical care and coverage.  Our staff is working with other partners to review the numbers from each insurance carrier to determine whether or not recent rate increases are justified.  Health Action NM will work with the Superintendent to ensure that consumers are represented in this process.

Legislative Advocacy: Funding the Medicaid Expansion

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The costs of the Medicaid expansion have been fully covered by the federal government since the expansion began in January of 2014.  In 2017, the state will have to pay for 5% of the costs, scaling up to 10% of the costs by 2020.  Historically, New Mexico has paid nearly 30% of the cost of traditional Medicaid, so only paying 10% is a great deal for the state.  Medicaid has had huge benefits for New Mexico.  That’s why it is imperative that we maintain the integrity of the program as we fulfill the promise our state committed to when it expanded Medicaid.

Given the impact expansion has had on state revenues as a result of the up to $8.6 billion in increased economic activity, the $60 million in savings already recognized in the state budget, savings from reductions in uncompensated care, additional revenues from increased enrollment in private health plans, and revenue from expansion-driven jobs growth, the expansion of health coverage has largely paid for itself.

Even so, Health Action NM has been exploring other options for funding the expansion to ensure that the integrity of the program is not weakened.  One proposal that recently caught our attention was put together by a coalition that has formed around increasing the tax on alcohol in New Mexico.  Our state leads the nation in alcohol-related deaths, spending over $1.8 billion a year on the harms of alcohol.  Research suggests that the proposed tax increase would save 52 lives in the first year and save even more each following year, greatly decrease youth alcohol use, and prevent alcohol dependency for tens of thousands of people living in New Mexico.  

The coalition proposes that the legislature appropriate funds from an increased alcohol tax to fund the Medicaid expansion, strengthen existing alcohol prevention and treatment programs, and reimburse cities and counties for the costs of alcohol-related harms.  The coalition meets the second Wednesday of every month.  If you are interested in becoming involved in the coalition, please contact Peter DeBenedittis (alcoholtaxessavelives@gmail.com).

Dental Therapy: The Swinomish Tribe Hires a Dental Therapist

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Brian Cladoosby - Photo by Mark Trahant
 

The Swinomish Indian Tribal Community in the Pacific Northwest has exerted its sovereignty by choosing to train and hire a dental therapist to practice on its tribal grounds.  “Oral health is essential to overall health,” said Brian Cladoosby, Chairman of the Swinomish Indian Tribal Community. “We cannot have healthy communities without access to reliable, high quality and culturally competent dental care.” 

As in New Mexico, tribal advocates in Washington State have played a crucial role in a broad coalition that has fought to license dental therapists for the past five years. After so many years of frustration with a federal law that restricts tribal sovereignty, the Swinomish Tribe has taken actions in to its own hands. This is an exciting development for advocates working to improve access to oral health services and tribes throughout the nation looking to provide culturally competent care for their people.

Upcoming Events

1) 4th Annual Native Youth Leadership Summit: July 28-31 @ Tamaya Resort & Spa
2) State Innovation Model Meeting: July 29th 2-4 @ The United Way Conference Room from 4-6 pm
3) 50th Anniversary Celebration of Medicare and Medicaid: July 30th @ Explora from 4-6 pm
4) NMHIX Board Meeting: July 31st @ The Indian Pueblo Cultural Center at 8:30 am
5) Beer for a Better Burque: August 3rd @ Tractor Brewery in Nob Hill & Wells Park from 3 pm - 12 am
6) Stakeholders Advisory Committee: August 13th @ ABQ Hispano Chamber of Commerce from 10 am – 12 pm
7)
Health Action NM’s 20th Anniversary Celebration: September 26th @ Sheraton Uptown Albuquerque at 5:30pm

Health Action

What Health Action NM's Staff Are Reading This Week: July 13-17

 

The Obama Administration submits workaround for Hobby Lobby ruling.  In 2014, the Supreme Court determined that employers could reject covering contraception for employees on religious grounds.  The case, known as Hobby Lobby v Burwell, has the potential to restrict millions of women’s access to contraception.  Now, the Obama Administration has submitted the final rules to ensure that any person that needs contraceptive coverage has access to it.  The proposed rule respects the court’s ruling while creating a way for employees to get the coverage they need.

Here’s how it works: An eligible company that objects to contraception needs to inform the Department of Health and Human Services (HHS) of its objection.  HHS will then designate the insurance carrier to provide the coverage directly rather than through the employer.  This will give employees a way to access the coverage they need while respecting the religious beliefs of employers as defined by the court.

- Barbara Webber, Executive Director

Texas-based organization pens op-ed in ABQ Journal about how ACA is bad for Latinos in New Mexico – they’re wrong.  Daniel Garza of the Libre Initiative claims that the Affordable Care Act (ACA) has failed to live up to its promises, particularly for Hispanics.  He cites the recent proposed premium hikes and access issues with Medicaid.  Of course, he fails to mention that in 2015 New Mexico had one of the lowest pre-tax credit premiums for Silver benchmark plans in the nation.  And on that note, Mr. Garza says nothing about the availability of premium tax credits that ensure premiums remain affordable.  The average premium tax credit in New Mexico is $200 a month.  If the lowest priced plan is, as Mr. Garza claims, $199 a month then that's great news for consumers in New Mexico.

Also missing is any mention of the rate review process, which Health Action NM worked to establish, that is currently being undertaken by the New Mexico Office of the Superintendent of Insurance (OSI).  This process allows the insurance department to open insurance carrier’s books to prevent unjustified premium hikes. 

In fact, this year’s rates are shaping up to be lower than 2014’s rates. In 2015 rates went down 11.8% and 2016 rates are expected to increase about 11%.  And that’s before OSI reviews the rates and carriers consider how premium stabilization programs affect their bottom lines (which was released after  these rates were proposed).

  
by Kaiser Family Foundation

 

Mr. Garza’s claims on Medicaid ignore the incredible economic and health benefits that the Medicaid expansion has had for New Mexico.  Medicaid is actually a highly efficient program that offers a comprehensive range of benefits at a much lower cost than private insurance.  Medicaid is a good example of how we can better control the cost of health care in the US

If anything, New Mexico needs to do a better job of directing outreach to Hispanics and beef up enrollment assistance to guide them through the options that now exist.  Our staff’s analysis indicates that just over 10,000 Hispanics signed up for marketplace coverage in New Mexico.  Given the portion of the population that Hispanics make up, those numbers should be much higher.  For a real take on how the Medicaid expansion and health insurance exchange has impacted Hispanics and other ethnic minorities, read DeAnza’s story of the week.  Health Action NM will continue to provide accurate information on the ACA for Hispanics and all people living in New Mexico.

- Colin Baillio, Communications and Outreach

New Data Show ACA Enrollment for Communities of Color.  For the first time, we have data showing enrollment numbers by race and ethnicity for individual counties in states that use healthcare.gov.  The evidence shows that the Affordable Care Act’s marketplace coverage options have been a boon for millions of people across our country, particularly for communities of color, who have struggled with pervasive health disparities and higher rates of uninsured people compared to non-Hispanic whites.  In fact, the reduction in the rate of uninsured Latinos and African Americans over just the last two years significantly outpaced whites—the rate dropped 12.4 percent and 9.2 percent respectively compared to 5.3 percent for whites. This is welcome news for the hundreds of national, state, and local organizations that conducted concerted outreach and enrollment efforts in minority communities across the country.  Still, there is much work to do to raise awareness about the benefits available on the marketplace among hard-to-reach populations in New Mexico and cover all who are eligible.

- DeAnza Sapien, State Advocacy Coordinator

Despite weak job growth, Governor Martinez proposes work requirements for the Supplemental Nutrition Assistance Program.  Governor Martinez has proposed regulations that would impose stringent work requirements on SNAP benefits for
- teenagers without children 16 to 18
- adults without children age 50 to 60
- adults 16 to 60 who have children over age six

Given that nearly every sector of the economy is barely adding any jobs and that much of our workforce is aging, now is not the time to even consider regulations that make it more difficult for New Mexico’s people to afford food.  I was able to submit the following comments to the NM Human Services Department (HSD) at a recent hearing:

“We are blessed with many things in New Mexico . . . our people of many cultures, of many languages, people of many talents.  And we are blessed by the many people in state government who work with their heart and their administrative skills to assist those who need essential, basic help such as food assistance.  We are blessed to have many state people all over the state to administer this assistance to help people who are hungry.

So, my appeal is to your heart . . . people in state government.  The new proposed rules for SNAP are an administrative strategy to make it harder . . . , in fact, to make it impossible for people who are already struggling to provide for their families to keep getting food assistance!  Who will be harmed?   Many, many children, and parents, and seniors.

Hungry children are not healthy children.  Hunger rapidly impacts the health of the person.

So, I appeal to you State of New Mexico, don’t do these new rules.  They will hurt those who are hungry.  They will add to the struggle for survival for so many in New Mexico!  Instead, use your state talents to create livable wage jobs.  And hire the unemployed to use their talents to serve others, and not have to be in need of SNAP.

Finally, please do something very healthy for your heart . . . and don’t require these new rules!”

Health Action NM’s staff has submitted comments to HSD urging them not to leave New Mexicans hungry.  We encourage you to do the same by the end of the day by emailing comments to HSD-isdrules@state.nm.us

Health Action

What Health Action NM's Staff Are Reading This Week: July 5-10

 
 
This week, Health Action NM pulled together the facts on Medicaid.  Legislators are considering how best to pay for 5% of the cost of expanding Medicaid starting in 2017.  Before that discussion takes place, it is important to know how crucial Medicaid is for the health of New Mexico's people and economy.  
  1. FACT: Medicaid saves lives. Watch Guida's story.

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  2. FACT: The return on investment for Medicaid Expansion in New Mexico is $4.8 billion - $8.6 billion in economic activity from 2014-2020
  3. FACT: Medicaid has provided the security of health coverage to 216,000+ ppl in New Mexico

  4. FACT: In 2010, Medicaid generated $4.8 billion in economic activity for New Mexico
  5. FACT: Medicaid greatly improves the financial security of its beneficiaries 
  6. FACT: Medicaid is a tremendous investment in kids and more than pays itself off down the line
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  7. FACT: Medicaid reduces mortality and improves access to care 
  8. FACT: Medicaid provides more comprehensive coverage than private insurance at a much lower cost
  9. FACT: The Medicaid Expansion has already ADDED $60 million in new revenue for New Mexico
  10. FACT: Medicaid is the most cost efficient and effective form of health coverage in the US 
     
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  11. FACT: 53% of new jobs are in the health care sector, which was largely driven by the Medicaid expansion 
     
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Health Action

SPECIAL EDITION: What Health Action NM's Staff Are Reading This Week

 

 
 

As early as this Monday, the Supreme Court is expected to issue a ruling on a case that would strip health insurance subsidies from 6.4 million people.  The plaintiffs in the case, which is called King v Burwell, claim that Congress intended to withhold subsidies from states that chose not to establish a state-based health insurance exchange.  Though the history of the Affordable Care Act’s (ACA) passage suggests that this was never the case, there are signs that the Supreme Court may indeed strip subsidies from states with federally facilitated marketplaces.  

Consumers in New Mexico are protected from a bad decision since our state operates a state-based exchange, but it has the potential to negatively affect New Mexico in a number of ways, depending on how Congress handles the fallout of the decision.  President Obama has called on Congress to simply fix the language in the ACA to clarify that the subsidies are available to all states.  However, congressional Republicans are seeking to extract concessions in exchange for a continuation of subsidies.  Instead of re-capping the news of the week, Health Action NM has thoroughly investigated the concessions being called for by congressional Republicans and the implications that they have for consumers.

 Repeal the Individual Mandate

The Individual Mandate, which requires all Americans to acquire health coverage or else pay a penalty, has long been a target for repeal since it is the most unpopular part of the ACA.  However, it is the glue that holds the rest of the law together, including the popular components such as a ban on denying insurance based on pre-existing conditions, guaranteeing that consumers can purchase any coverage that they want, and ending the practice of charging women more than men for insurance.  

Without the individual mandate, the incentive to purchase insurance would be greatly weakened, creating a dysfunctional market in which only the sickest consumers sign up for coverage.  This would cause premiums to soar, causing more consumers to drop out of the market, leading to what economists call a death spiral.  The nonpartisan Center for Budget and Policy Priorities estimates that 22 million fewer uninsured people would be able to access insurance without the Individual Mandat

Repeal the Employer Mandate

The Employer Mandate requires all companies with 50 full-time employees or more to offer affordable health coverage to employees.  According to the US Treasury Department, 96% of businesses in the US are exempt from the Employer Mandate because they have less than 50 employees.  96% of those that are required to offer coverage already do so and less than .2% of firms are expected face fines for not offering coverage.

The reason lawmakers included the Employer Mandate in the ACA was to ensure that companies didn’t drop their employee’s coverage and push them on to individual marketplace.  A repeal of the provision has serious budgetary considerations as well.  It would increase the amount spent on subsidies because more people would get coverage on exchanges that offer coverage.  Still, it would not shake the ACA at its core the way a repeal of the Individual Mandate would. 

 Repeal the Medical Device Tax

 The Medical Device Tax applies a 2.3% tax on medical device manufacturers’ sales. The ACA is designed to reduce the deficit even as it expands coverage.  To do that, lawmakers cut spending in some areas and increased revenues on industries that stood to benefit from the law.  Since medical device manufacturers enjoy some of the greatest profit margins in the health care industry and stood to greatly benefit from increased utilization of their products as a result of the ACA’s coverage expansion, lawmakers included this tax as a way to finance the law.  

   

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Many have claimed that the tax gets passed on to consumers through increased prices, though Consumers Union (a consumer advocacy organization) disagrees, given the high profit margins and rate of growth that medical device manufacturers enjoy and the benefits it will reap from the ACA.  Repealing the Medical Device tax would increase the deficit by $26 billion between 2015-2024, unless Congress could make up for the loss of revenue by increasing taxes or decreasing spending in other areas. 

Repeal the Independent Payment Advisory Board

The Independent Payment Advisory Board (IPAB) is a committee of experts that would be convened if Medicare spending grew at an exorbitant rate.  IPAB has not yet been convened because of the recent slowdown in health spending.  If triggered, IPAB would be tasked with finding ways to restrain spending without impacting Medicare benefits.  Congressional Republicans have long sought to repeal IPAB, claiming that it will lead to rationing of care, restrict Congress’ role in Medicare, and give bureaucrats too much control over patients.

However, the ACA specifically prohibits IPAB from rationing care, increasing premiums or cost sharing, cutting benefits, or limiting eligibility.  Cost controls can only achieve savings through payment and delivery reforms. Congress will still play a central role in Medicare policy when IPAB is active.  If Congress can produce equivalent savings, IPAB’s recommendations won’t go in to effect.  It is likely to be the most effective cost containment program built in to the law and is vital to the sustainability of Medicare.  Future generations need access to this important program for seniors and IPAB will play a critical role in ensuring the its integrity.

Repeal the Cadillac Tax

The Cadillac Tax refers to a 40% excise tax on health plans with unnecessarily excessive benefits. It is designed to discourage employers from offering benefits that drive up costs for everyone else and raise revenues to increase health coverage.  Congressional Republicans claim that the tax limits employers’ ability to compete for employees on benefits and restricts access to the high quality health coverage.  

In the 2008 presidential campaign, John McCain proposed ending the $250 billion a year tax break on employer sponsored health insurance to finance a new health care program.  The Cadillac Tax achieves a similar result, only on a much smaller scale and on the upper echelon of high-end plans offered by employers. 

Reduce Subsidies

Currently, those making under 400% of the Federal Poverty Level (FPL) are eligible for premium tax credits under the ACA.  Some congressional Republicans have proposed that those subsidies be reduced, limited to those under 300% FPL, be based on age rather than income, and be a fixed dollar amount rather than based on the cost of insurance.  This would seriously weaken the effect subsidies have on access to affordable insurance, especially for low and moderate income households.  The way subsidies were initially designed was to ensure longterm affordability for individuals and families across the economic ladder.  Reducing financial assistance just as so many have begun to feel the security of health coverage would be irresponsible and detrimental to consumers.

Health Action

What Health Action NM's Staff Are Reading This Week: June 8-12

 

The Department of Health and Human Services releases new enrollment data for New Mexico.  As of March 31st, 44,085 individuals are enrolled in New Mexico Health Insurance Exchange (NMHIX) plans, 33,244 of whom qualify for premium tax credits and 21,149 of whom qualify for cost sharing subsidies.  The average premium tax credit in NM is $200.   

There are 5 tiers of health plans that consumers can choose from, each of which covers a certain percentage of the cost of care.  Catastrophic plans cover less than 60% of costs, Bronze plans cover 60% of costs, Silver plans cover 70% of costs (but up to 94% with cost sharing reductions), Gold plans cover 80% of costs, Platinum plans cover 90% of costs.  Enrollees can access cost sharing reductions only if they purchase a Silver plan.  Here’s a breakdown of how New Mexico compares to the nation as a whole:  

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There is still a great deal of work to do to get people living in New Mexico who are eligible for benefits enrolled in NMHIX coverage.  Only 33,244 of the 118,000 New Mexicans who are eligible for premium tax credits have taken advantage of this opportunity.  Health Action NM will continue to track the implementation of health reform and work to raise awareness about new options and benefits in hard-to-reach communities.

- Barbara Webber, Executive Director

New Mexico is safe from a negative King v Burwell ruling.  This month, the Supreme Court is expected to release a ruling on a lawsuit alleging that consumers in states with federally-operated health insurance exchanges aren’t eligible for premium subsidies.  New Mexico is in a special situation in terms of the lawsuit since our state has established an exchange but continues to use the federal web portal, known as healthcare.gov.  The Centers for Medicare and Medicaid Services has consistently affirmed that New Mexico is classified as a state-based exchange, meaning that we will be protected from an adverse ruling.  Health Action NM has reached out to legal experts to confirm this.  Consumers in New Mexico can rest assured that subsidies will remain in place regardless of the outcome of King v Burwell.

- Colin Baillio, Communications and Outreach

Americans use less care but pay way more than other industrialized countries.  Many claim that the reason health costs are so high in America is because Americans visit the doctor too much.  But new data show the exact opposite - Americans utilize services less than any other industrialized country with the exception of Switzerland, which has system similar to the US.  The real problem: extraordinarily high prices.  Americans are charged much more for services than those in any other country.  Here are some highlights from the most recent study:

  • Along with Switzerland, the U.S. has the fewest physician consultations per capita among higher-income OECD countries. Consistent with this lower physician use, the U.S. also has fewer physicians per capita and about one in every ten adults (11%) report that they either delayed or did not receive needed medical care due to cost in 2013.
  • U.S. patients on average experience shorter hospital stays than in other OECD comparable countries.
  • The U.S. performs fewer angioplasties and more coronary bypass surgeries than comparable countries, but for both procedures prices are substantially higher than in other countries where data are available. According to the International Federation of Health Plans, the national 95th percentile average for an angioplasty in the US is $61,184.
  • The average price per coronary bypass surgery in the U.S is 2.4 times higher than in other countries where data are available. 
  • The average cost per Caesarean section in the U.S.  is 1.7 times higher than in comparable countries where data are available.  Normal delivery in the U.S. averaged $10,002 in 2013.

Prices for nearly all services are remarkably high compared to similar countries.  Despite high prices, quality outcomes remain lower than other industrialized countries.  This trend is even worse for uninsured consumers, who are regularly charged up to 10 times the rate of those with insurance.  Health Action NM will continue to keep an eye on this trend and what can be done to limit adverse effects on consumers.

  • DeAnza Sapien, JD, Advocacy Coordinator 

Hillary Clinton will make substance abuse and mental health treatment a priority in her presidential campaign.  Clinton has made clear that drug abuse and mental health issues should be given the same attention as any other chronic disease.  Her policy advisors are reaching out to stakeholders to gather input on how to craft effective policies to address the needs of patients with mental health and substance abuse disorders.  Clinton stated that adequate funding to treatment facilities and insurance coverage of addiction treatment are often not priorities in our current health care framework.  Although the ACA classifies substance abuse treatment and mental health services as essential health benefits, the issue of access for these remains, as patients who seek treatment are often unable to. The ACA plays an important role in shifting the perception of mental health and substance abuse issues from neglected aspects of overall wellbeing to a fundamental part of our health care system. New Mexico’s population would greatly benefit from increased support for these services and Health Action will continue to advocate for greater access. 

Andrea Andersen, Health Policy Intern   

Former insurance executive Wendell Potter says the American health care system is not the best in the world.  Americans are big spenders on health care, but our outcomes don’t seem to reflect it. We fall far behind in important categories like life expectancy and infant mortality rates compared to every other developed country in the world, but we continue to buy into the idea that the more money spent, the better health care we receive. Unfortunately, our system is more often dictated by insurance and pharmaceutical companies, than the needs of our people and this has dangerous consequences for our health and our pocketbooks. Our system lacks the policies needed to help protect consumers from the high costs set by drug companies and providers that our insurance carriers inevitably pass down to us. It’s time for consumers to start demanding more accountability and transparency of our health care dollars. 

- Ellie Perkins, Health Policy Intern

Health Action

What Health Action NM's Staff Are Reading This Week: May 25-29

New York’s State Assembly passes a universal health care bill. The legislation proposes that the state eliminate the private health insurance system and instead cover services through a single program operated by the state.  This type of system is often referred to as “Single-Payer.”  Several other countries, including the UKCanada, and Taiwan, have implemented this type of system with great success. The benefits of such a system include universal access to health services, lower costs, and better coordination of care.  The NY bill now heads to the state Senate where it’s expected to face an uphill battle. Be sure to check out the Vox.com cardstack on single-payer health care systems. A single-payer system is on Health Action NM’s radar as states begin to consider the future of health reform. 

- Barbara Webber, Executive Director

New proposed rules for Medicaid managed care organizations (MCOs) aim to increase insurer & provider accountability and access to care.  The Department of Health and Human Services (HHS) proposes 1) that Medicaid MCOs must spend at least 85% of Medicaid dollars on medical services, 2) enhanced requirements to ensure the continuation of care when a beneficiary moves between programs or switches to a private health plan, 3) annual reviews of provider networks to ensure that beneficiaries have accurate information about the number and location of providers in their network, and 4) a system designed to give consumers information on provider quality ratings.  Since New Mexico decided to shift the state’s Medicaid program from a fee-for-service model to the MCO model, these new rules will have far-reaching effects on our Medicaid system.  Health Action NM is pleased to see that steps are being taken to improve a program that covers over 1/4 of New Mexico’s population.

- Colin Baillio, Communications and Outreach

Blue Cross and Blue Shield (BCBS) of New Mexico requests a 51% premium increase for all individual plans. The premium hike would affect about 35,000 consumers who are enrolled in plans both on and off the New Mexico Health Insurance Exchange. The request is subject to the rate review process, meaning it must be approved by the New Mexico Office of the Superintendent of Insurance. This request is by far the largest filed so far.  Presbyterian’s Health Plan and New Mexico Health Connections are requesting single digit increases and other plans have yet to file rate requests.  BCBS is citing higher than anticipated costs as the reason for increase.  Please inform Health Action NM if you are facing a rate increase of this magnitude.  Click here to view all rate increase requests in the state.  Health Action NM will continue to track this development and advocate on behalf of consumers whose rates are raised arbitrarily.

- Andrea Andersen, Health Policy Intern

A survey by AARP and the Urban Institute finds that uninsured rates among individuals aged 50-64 dropped 31% over one year. The drop in the number of older adults who are uninsured is largely a result of the Affordable Care Act (ACA), which prevents insurance companies from denying coverage due to pre-existing conditions, eliminates the practice of charging those with greater health needs higher premiums than those in good health, limits the amount insurance companies can increase premiums based on age, and expands coverage. The study also found that states that expanded Medicaid under the ACA have seen a greater decrease in the number of uninsured between 50 and 64 than states that chose not to expand Medicaid.  These findings are a sign that the ACA is serving older adults who are more likely to utilize health care services.

- Ellie Perkins, Health and Dental Policy Intern

Health Action

What Health Action NM Staff Are Reading This Week: May 18-22

74% of consumers with Affordable Care Act (ACA) health plans are happy with their coverage – but those with high deductible plans were deeply unsatisfied. The Kaiser Family Foundation’s recent report on ACA plan satisfaction holds a great deal of positive news, with some very concerning insights as well.  Overall, people are happy with their plans, have access to primary and specialty care doctors, and have a sense of financial security with their coverage.  However, 32% of those with deductibles (the amount you pay before your insurance kicks in) above $1,500 rated the value of their plan as being poor whereas only 9% of those with deductibles below $1,500 thought that of their plan’s value.  In addition, cost continues to be the main barrier to care and a large majority of second-year shoppers aren’t looking for new plans even though new high value plans may be available. Health Action NM will continue to advocate for higher value plans and inform consumers about the risks associated with high deductible plans.

- Barbara Webber, Executive Director

Health system expert Uwe Reinhardt makes an important point: when we focus our freedom to choose our health insurance carrier we sacrifice our freedom to choose our health care providers.  A recent study showed that Americans want to be able to decide what kind of health insurance is best for them.  Many debates about health care revolve around the freedom choose the health plan that you want.  And while Americans value this choice, many don’t realize that insurance carriers restrict access to many providers even as they permit access to others.  Some may remember the tragic story told by Dawnelle Keys, whose daughter died when she took her to a hospital that didn’t accept her insurance and was denied care.  If we didn’t organize our system in a way that restricted access to providers on the basis of insurance, consumers would have more opportunities to get care when they need it from the provider they choose.  This may be a conversation worth reigniting.

- Colin Baillio, Communications and Outreach

Study shows that in-person assisters play a very important role in ACA enrollment, especially those in minority populations.  A recent report by Enroll America found that consumers who received help from an assister were 60% more likely to enroll in health coverage than those who attempted online enrollment on their own. The role of in-person assisters varies by state but includes Navigators, Certified Application Counselors (CACs) and health insurance agents/brokers that all help bring greater consumer awareness of ACA health insurance coverage. The most successful assistance programs are those that work in collaboration with other state entities and utilize a nationwide assistance-scheduling tool called the Get Covered Connector. This tool works to link consumers with assisters regardless of location and streamline the enrollment assistance appointment process, as well as strengthen data monitoring and alliances with like-minded organizations. Use of in-person assisters in New Mexico is vital to enrolling hard-to-reach communities throughout the state.

Andrea Andersen, Health Policy Intern   

Health reform is influencing physician provider practices in some interesting ways.  A collaborative initiative between aethenaResearch and the Robert Wood Johnson Foundation called ACAView closely monitored the impacts of the ACA on medical practices in 2014. They found that: 1) A feared surge of new patient volume did not occur. Although many anticipated that primary care providers would be burdened by an influx of new patients, the overall change was less than 0.3%. This lack of change may be due to continued use of urgent care clinics or emergency services by the newly insured and this was not monitored ACAView; 2) Physician offices in states that expanded Medicaid have seen sharp decreases in uninsured patients. In states that decided to expand Medicaid there was a 39% decrease in uninsured patients seen between 2013 and 2014, while those in non-expansion states only saw an 11% decline; and 3) More commercially insured patients are switching to Medicaid. Medicaid is often a better option for those in low-incomes jobs who don’t want to pay the higher out-of-pocket costs that come with private insurance.  Health Action NM is pleased that the ACA hasn’t overwhelmed doctor’s offices & hospitals and that Medicaid expansion is serving our population well.

- Andrea Andersen, Health Policy Intern   

Health Action

What Health Action NM Staff Are Reading This Week: May 11-15

The White House takes action on three major consumer issues: surprise medical bills, inaccurate provider directories, and the enforcement of free birth control coverage 1) As we reported last week, about 1/3 of those with private health insurance received surprise medical bills over the last two years.  2) According to New Mexico’s Superintendent of Insurance, inaccurate provider directories are the number one consumer complaint his office receives.  3) And a National Women’s Law Center study found that hundreds of insurance plans fail to fully cover FDA-approved contraceptives, despite the federal requirement to do so. 

The White House is working to address each of these issues administratively.  1) Next year, healthcare.gov will likely come with an out-of-pocket cost calculator that gives consumers a better idea of the overall value of their plan than, say, a premium.  The administration hopes that this will reduce unexpected costs for consumers.  2) Insurers must now update their provider directories each month, and will face a fine if they don’t.  3) New regulations clarify that insurers must cover every type of birth control without any out-of-pocket costs.

Health Action NM has been reporting on these issues to our national partners for the past year.  We are pleased to see that they are being addressed.  While progress is being made on all three of these issues, there is much more work to be done on each of them.  Health Action NM will continue to follow them closely.

Barbara Webber, Executive Director

 

NM Medicaid expansion enrollments reach 214,000 by the end of April and are expected to grow to 241,000 by June of 2016.  The Human Services Department (HSD) announced another positive month of enrollment growth in the state’s Medicaid program.  The Medicaid expansion has been a huge success story in New Mexico.  While original estimates suggested that about 170,000 people were eligible for expanded Medicaid, we’re now expecting closer to 250,000 - the need was much greater than we anticipated.

Since the expansion began in 2014, the federal government has paid for it in full.  In 2017, the state must pick up 5% of the cost of expansion. HSD estimates that the state will need to devote about $43 million to cover these costs during fiscal year 2017.  Now is the time to start talking about how best to pay for NM’s portion of the incredibly successful Medicaid expansion.

- Joe Martinez, Outreach Coordinator

 

Employers take a new approach to reducing health costs: set your own price.  Hospitals have come under scrutiny in the past for charging exorbitant and unreasonable medical bills, driving up costs for everyone.  After one employer was charged $600,000 for a an employee’s three day stay in a local hospital, they hired a consulting firm to look in to what had happened.  The firm assessed the services and found that they cost a small fraction of what the hospital was charging.  They added a modest profit for the hospital to their calculation and sent the payment back. “We wrote a check to the hospital for $28,900 and we never heard from them again,” said the business owner.

Prices in US health care are notoriously high.  And, as this story shows, they are also extremely unreasonable.  How could a hospital get away with charging $600,000 for a procedure that they wound up accepting $28,900 for in the end?  This is why many advocates continue to push for a system where prices are transparent and set based on how much the services cost rather than backdoor deals between hospitals and insurance companies.  There is little consumers can do to stand up against this type of pricing scheme.   Isn’t it time to formally address the problem of arbitrary pricing?

- Colin Baillio, Communications and Outreach

 

Maryland implements pilot programs that may be the next big step in controlling costs for consumers.  The state is experimenting with how it pays hospitals to reduce readmissions.  It provides a lump sum of money to a hospital for any admission and doesn’t pay anything for readmissions within the next 30 days.  The hope is that hospitals will provide the best possible treatment for the patient during the first admission without providing costly and unnecessary care and will reduce the likelihood of a readmission.  Health Action NM will continue to keep an eye on this model and its impact on costs and the quality of care.

- DeAnza Sapien, JD, Health Advocacy Coordinator

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