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Medical Insurance
Membership |
SB |
778/aSCORC |
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APPROPRIATION
Appropriation
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Additional Impact |
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FY03 |
FY04 |
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NFI |
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Duplicates HB832
Relates to SB 505 & HB 498
Conflicts with SB 754
Public School Insurance Authority (PSIA)
Public Regulation Commission (PRC)
Human Service Department (HSD)
Health Policy Commission (HPC)
Attorney General’s Office (AGO)
SUMMARY
Synopsis of SCORC Amendment
The Senate Corporations and Transportation
Committee amendment deletes the specific representation requirements of the
four board members who are appointed by the members of the pool.
Synopsis of Original Bill
Senate Bill 778 amends the definitions of the
Medical Insurance Pool Act, revises board membership eligibility criteria for
the medical insurance pool, and amends eligibility for inclusion in the pool.
has
18 months of prior coverage under a health plan, who is not otherwise eligible
for a health plan, and whose prior coverage did not end due to nonpayment of
premium or fraud, or early termination of COBRA continuation coverage. (These
individuals are currently covered.)
Significant
Issues
In many states’ pool programs, the premiums that
members and employers pay are capped as a percentage of the premium charged for
comparable coverage in the commercial market. In SB 778, the premium cannot be
more than 150% of the average premium for similar coverage in the commercial
market that is a lower percentage than many states. However, this language only
codifies the current eligibility.
The HPC believes the inclusion of additional
individuals assuming a marginal or insignificant impact on the insurers is
inline with the HPC’s policy of assuring that basic
health service are available and accessible to New Mexicans regardless of
financial status.
CONFLICT, DUPLICATION, RELATIONSHIP
Conflict
with SB 754, Medical Insurance Pool Prescription Drugs, which allows for the
creation
of a prescription drug benefit. Persons eligible for this new benefit would
include persons over the age of 65, who upon becoming age 65 would
automatically be eligible for Medicare. Under SB 778, membership to the pool is
not allowed for individuals eligible for coverage under Parts A and B of
Title 18(Medicare). Parts A and B of Title 18 do not have a prescription drug
benefit. There are also individuals who are Medicare beneficiaries who are not
age sixty-five whose eligibility under the bills is unclear.
Relates to SB 505, Health Care Security Act, which provides
health insurance for all New Mexicans, and to HB 498, Health Security Act.
Duplicates
HB 832, Medical Insurance Pool Membership.
TECHNICAL ISSUES
Page 7, lines 20 and 21 notes the appointment of
a representative of the medical community to the pool board. Medical community
could be further defined regarding whether that means a currently practicing or
retired physician, hospital administrator, independent pharmacist or any other
type of medical professional who the superintendent could appoint.
OTHER SUBSTANTIVE ISSUES
The New Mexico Medical Insurance Pool (NMMIP)
was created in 1987. It is a nonprofit program that enables private health
insurers to pool resources with New Mexicans who have been denied health
insurance coverage, providing these citizens with comprehensive health care.
This coverage is the coverage of “last resort”
for individuals or their dependents with very significant medical problems and
who have not been able to receive coverage primarily due to their employer’s
policy limitations and exclusions.
Coverage is currently supplied by the pool if an
individual has received:
Employer and employees pay for an employees NMMIP policy. In general, an employer must pay the same dollar amount for health insurance as they do for similar employees.
Thirty-two states currently have, or will have
implemented by summer, 2003 similar medical insurance pools.