It is cruel to rip healthcare coverage away from anyone, especially children, people with disabilities, and individuals surviving near the poverty line. Yet that is exactly what Gov. Susana Martinez’s Human Services Department (HSD) will do in its recent proposal to cut Medicaid.
In its renewal of our state’s Medicaid waiver, known as Centennial Care 2.0, HSD wants to charge unmanageable patient fees in the form of premiums and copays; lock patients out of coverage when they can’t afford to pay; end retroactive coverage that keeps families out of medical debt; and eliminate important health benefits for the development of our children and young adults.
Thousands of New Mexicans will lose coverage if the proposal moves forward. Take the premiums for example. There is a wide body of research showing that these fees, even in nominal amounts, lead to massive losses in Medicaid coverage because thousands of low-income patients get disenrolled when they cannot pay. In 2003, Oregon implemented premiums on a sliding scale from $6-20 per month and locked patients out of coverage for failure to pay. Within the first year, 50,000 Medicaid patients lost coverage, many of them remaining uninsured. More recently, an evaluation of Indiana’s waiver showed that in its first year of implementation nearly six percent of Medicaid patients with incomes above the federal poverty guideline were locked out of coverage because they couldn’t keep up with their monthly premiums.
HSD is moving forward with these cruel proposals despite overwhelming opposition. In September, HSD presented its proposal to me and my colleagues on the Legislative Health and Human Services Committee. We recommended HSD reconsider its proposal. Dating back to last year, HSD’s own stakeholder group opposed copays and premiums. In ongoing public hearings, community members, hospitals, provider associations and advocates have all opposed the patient fees and other cuts. Their opposition is based on extensive research that shows the inevitable negative impacts. Despite no public support, HSD is intent on moving forward with its damaging proposal.
The proposal is especially reckless because it is supposed to save costs yet will only inflict fiscal damage. For example, in states that enacted premium fees, the administrative costs of collecting the fees wiped out any savings. Back in the early 2000s, Virginia implemented a $15 monthly premium for children between 150 percent and 200 percent of the federal poverty level. The state spent $1.39 to collect every $1 in premium fees. Most of the savings will instead come from forcing thousands of people to disenroll from Medicaid – a penny-wise and pound-foolish decision that will result in more uninsured people and higher costs of care in the long run.
Why would Gov. Martinez propose such ill-conceived and unsupported policies? Sadly, she is taking a page out of the Trump playbook. In Congress, a budget is advancing that cuts $1 trillion out of Medicaid over the next decade. The Trump administration has been targeting health care for millions of Americans to pay for tax cuts for the wealthiest households and corporations.
Similarly, Gov. Martinez’s proposal targets low-income New Mexicans who are doing the best they can on limited resources. Most of the impacts of the cuts will hit children, the working disabled and low-wage workers. The governor is placing higher financial burdens on low-income New Mexicans so she can protect tax breaks for large corporations, the wealthy and those who are well-connected to her administration. She would rather target our poorest households than face the fact that she has done nothing to implement sound policies that create jobs and generate the revenue necessary to support critical services like health care, education and public safety. That is shameful.
It is clear these proposed Medicaid cuts are not based on sound policy. HSD should focus on the evidence, listen to the public outcry, and reverse the proposal before it does irreparable harm to New Mexicans.