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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) 

Bill B. O'Neill (D)

Craig W. Brandt (R)

Candace Gould (R)

Elizabeth "Liz" Stefanics (D)

Jeff Steinborn (D)

Mimi Stewart (D)

Stuart Ingle (R)

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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With so much health care news and events coming in, it's important to be in-the-loop. Sign up for Health Action mobile updates so that you can stay informed and involved. We won't text you every day - just when there's something you need to know.

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January 15th - National Day of Action to Protect Health Care

Across the nation, communities are coming together to speak out against plans to repeal the Affordable Care Act, dismantle Medicaid, and privatize Medicare. These programs are a lifeline for so many New Mexicans. Stand with us to call on congressional leaders to end the reckless attempts to take away people's health care. We will be co-hosting events in Albuquerque and Santa Fe. 

ABQ Rally to Protect Our Care

Sunday, January 15, 2017 from 1PM - 3PM
UNM Hospital
2211 Lomas Blvd NE, Albuquerque, New Mexico 87106

Invited speaker: Congresswoman Michelle Lujan Grisham

Save the Affordable Care Act! - SF Event

Sunday, January 15, 2017 from 2PM - 4PM
Unitarian Universalist in Santa Fe
107 W Barcelona Rd, Santa Fe, New Mexico 87505

Confirmed speaker: Congressman Ben Ray Lujan

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Health advocates applaud Obama Administration for updated rules on stream pollution

Health Action New Mexico is applauding the Obama administration’s action today to finalize the Stream Protection Rule.  Since 2009, the Department of Interior has been working to revise inadequate regulations developed in the 1980’s that govern impacts to waterways from coal mining.

“The Stream Protection Rule is a common sense step to protect our nation’s streams and waterways from coal pollution that can harm the health and livelihood of local communities, farmers, and recreation,” said Barbara Webber, Executive Director of Health Action New Mexico. “This update is a long overdue step to ensure that regulation is keeping up with the best available science and new coal mining technology.”

In particular, this rule strengthens the requirements for testing water quality to ensure coal mines aren’t polluting streams and waterways both while they are operating and after mining has occurred.  These requirements improve on the status quo and help to make sure that active and shut-down coal mines won’t pollute our streams like what occurred in the Gold King Mine Spill that was disastrous for Northwest New Mexico in 2015.

The rule would also require coal mines to have a plan for how to protect fish and wildlife from coal mining, reducing the impacts on habitat and improving the reclamation of mines once development has ended.

Overall, the rule takes commonsense steps to protect the public and wildlife from damaging coal mine pollution, all for very little cost.  Independent analysis has shown that the rule would cost between $.01 and $.60 per ton of coal and will not have a significant impact on jobs.

Health Action New Mexico applauds the Department of Interior for finishing this long overdue update that will protect public health and our nation’s streams and waterways.

Health Action

Please donate to Health Action NM on #GivingTuesday

November 29th is Giving Tuesday – a national day of giving at the start of the annual holiday season.  It celebrates and encourages charitable activities that support non-profit organizations like Health Action New Mexico.

Today we invite you to pause and consider supporting Health Action New Mexico on the kickoff of Giving Tuesday as we work to protect essential health programs.

Please donate to Health Action New Mexico to support our work.

A local non-profit like Health Action New Mexico relies on small donors to be successful in advancing our mission. Over the past year, with the help of small donors, we have worked with the Office of Border Health to improve health and health care access in small border communities and colonias; helped sign up thousands of working families for health coverage; reached an agreement with dental care professionals, including dentists, to license dental therapists in New Mexico; and worked on a number of consumer health policy priorities. This year, we’re shifting our focus to reigning in prescription drug prices, advancing a dental care access bill, and maintaining the integrity of Medicare, Medicaid, and the New Mexico Health Insurance Exchange.

Our outreach and enrollment funding has been cut by 80 percent, even as the recent national election has made this work more important than ever. With your help, we can continue to work in communities throughout New Mexico not only to connect them with the health care they need, but to ensure their voices are heard as changes at the national level are considered.

With your help we know we can continue our mission of health care for all people in New Mexico. Please share this link via email or on social media with the hashtag  to spread the word. You can also support our GoFundMe campaign here

Health Action

Protecting Our Progress on Health Care

Donate today to support our campaign to protect Medicare, Medicaid, and the Affordable Care Act.

Health Action New Mexico has worked for over twenty years to improve equal access to health care in New Mexico. We have worked tirelessly on the ground and with decision makers to ensure that health reform and new health coverage options are being implemented successfully. During the first three years of enrolling people in Medicaid and new NM state marketplace, our bilingual field team of local organizers has connected over 5,500 previously uninsured families in 11 counties with the highest uninsured rates. Unlike four years ago when NM had the highest rate of uninsured, today more people are covered than ever before. 

The recent national election threatens to strip away the progress New Mexico has made on health care. Members of Congress have vowed to repeal health coverage for 22 million peoplescrap essential consumer protections (like ending pre-existing conditions and hiking rates on older adults, women, and the medically vulnerable), dismantle Medicaid so that fewer people are covered and states are on the hook for costs, and privatize Medicare for older adults ending the free preventive services and bringing back the donut hole for prescriptions drugs. This would fundamentally alter the commitment our nation has made to help those in need. 

We need to hold decision makers accountable if they choose to take action on these extreme ideas. Unless we stand up together at the community-level to oppose these harmful plans and offer a positive vision for our future, many will have worse or no access to health care and other basic rights, especially the most vulnerable among us. 

Here is our plan:

1. Mobilize a broad coalition to quickly respond to actions that threaten the rights of New Mexicans, especially on health, social justice, and civil rights issues.
2. Organize events across the state to ensure community input on social justice issues including their right to quality, affordable health care.
3. Stay on top of the latest and most accurate information and analysis about proposed changes and regularly update the public and decision makers.
4. Mobilize statewide canvassing, phone banking, rallying and other forms of civic engagement to educate and activate the public.
5. Continue our work on maximizing enrollment in low income communities throughout the state with our bilingual team of community organizers, lowering prescription drug costs, and expanding access to dental care through the use of dental therapists.

You can make a difference today by making a donation to our organizing efforts. All proceeds will go directly towards our work in the field. This work is often overlooked, but it is one of the few things standing between people and their health care. It means so much to us that you care about this cause as much as we do, and we promise that we will work tirelessly to protect our progress and acheive health care for all.

Health Action

Vermont Signs in to Law Dental Therapist Bill

A Victory in Vermont is a Victory for All
Vermont establishes the practice of dental therapists, increases access to dental care for all Vermonters.


It took nine hundred community members and forty state organizations. It took the stories of the people and the facts that backed up their experience. It took the hard work of activists like Voices for Vermont Children. But it happened! 

We are so pleased to announce that this week, Vermont Governor Peter Shumlin signed a law that establishes the practice of dental therapists in Vermont. Vermont’s decision to authorize dental therapists is monumental step forward in this mission to make dental care more accessible. 

As we rally New Mexico residents and we urge our lawmakers to consider dental therapy as a cost-effective, scalable approach to making the dental care system work better for patients, we are thrilled to be able to point to this recent victory in Vermont. 

This innovative, team-based approach enables dental practices to increase the number of people they can serve, is cost-efficient and patient-focused. 

In the past year alone, close to a dozen states and tribes, including New Mexico, have pursued establishing these health care professionals as a way to solve deep oral health disparities and severe unmet dental needs. Dental therapists currently practice in Minnesota and on tribal land in Alaska and Washington. They are authorized to practice in Maine and will soon be practicing in Oregon under a statewide pilot program.  

And this is just the beginning! The momentum is building, and the need in New Mexico is real. Over half of all New Mexicans have advanced dental disease. One-in-three 3rd graders sit in class with untreated dental disease. And 1.3 million people live in counties that are recognized as having insufficient access to dental care. It’s time to work together to find a way to end this epidemic. It’s time to make dental therapists part of the dental care team.

We know that the victory in Vermont is a step in the right direction for our nation, and this victory provides an opportunity to continue to push for increased access to high-quality dental care in New Mexico. Just last year, the NM Dental Hygienists Association Health Action NM and the reached an agreement with the NM Dental Association to advance common ground legislation to make dental therapists part of the New Mexico dental care team. The legislation will be filed during the 2017 legislative session. We hope state leaders will rise to the occasion and make New Mexico the next state to bring high quality dental care to more of our people.

Join Health Action New Mexico as we applaud Vermont’s progress and join us as we make access to dental care a priority in New Mexico.

Word of Mouth

In this season of giving thanks, Health Action NM thanks you


As we gather this Thanksgiving season to celebrate family, friends and those we care about and are thankful for in our lives, we at Health Action New Mexico want you to know how important you are to us and our work.

Direct Action Donation

Together with your support, partnership, consumer
activism and advocacy, this year we have:

  • Defended Medicaid – including informing the public and officials about the importance of keeping the Medicaid budget intact and joining in advocacy to secure Medicaid for the incarcerated population as they leave the prison and jail system.
  • Advocated for oral health access and affordability for the fourth year sponsoring legislation to license dental therapists. In the 2015 l this legislation passed the House for the first time.
  • Participated in a dental therapist task force that brought Health Action NM, the NM Dental Association, NM Dental Hygienists Association, legislators together to work on a solution to NM's oral health crisis.  After an arduous negotiating process, an historic agreement was made with all parties to advance dental therapist legislation in NM. More later.
  • Worked on enrollment in expanded Medicaid and exchange beWellNM. To date our statewide field team working with over 150 local partners has connected to enrollment nearly 5,000 uninsured rural, Hispanic and low income families including the border area. 
  • Organized celebration of the 50th anniversary of Medicare and Medicaid and honored 20 health care champions across NM at our 20th Anniversary.
  • Always, always, ensured that consumers and the consumer voice are at the table when decision makers are gathered regarding health care and its access and affordability. 
  • And much, much more.

Stella, Health Action's office pup, wishes you a Happy Thanksgiving and holiday season. 

On December 1st, Health Action NM will celebrate .  We hope you will join us on this national day of giving.

Your voiceactionvision and support are essential to the work of change and health justice. 

So thank you. We send our very best wishes to you and your loved ones for the Thanksgiving holidays. 

The Whole Health Action NM Team

Health Action