SENATE JOINT MEMORIAL 2

52nd legislature - STATE OF NEW MEXICO - first session, 2015

INTRODUCED BY

Jacob R. Candelaria

FOR THE LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE

A JOINT MEMORIAL

REQUESTING THE SUPERINTENDENT OF INSURANCE TO CONVENE AN INNOVATION WAIVER WORKING GROUP TO MAKE RECOMMENDATIONS TO THE GOVERNOR AND THE LEGISLATURE ON THE VALUE OF APPLYING FOR AN INNOVATION WAIVER UNDER THE FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT AND TO CREATE A COMPREHENSIVE, SUSTAINABLE HEALTH CARE SYSTEM TO ADDRESS THE HEALTH CARE NEEDS OF NEW MEXICANS.

     WHEREAS, New Mexico ranks among the states with the highest uninsured rates for health coverage in the United States; and

     WHEREAS, the Kaiser family foundation reports that at least one-third of uninsured adults went without needed medical care due to cost in 2013; and

     WHEREAS, the Kaiser family foundation reports that people without health coverage often face costly medical debt whenever they do seek care, with nearly forty percent of uninsured adults reporting outstanding medical bills, even when their incomes are as high as one hundred thousand dollars ($100,000) per year; and

     WHEREAS, the human services department reports that New Mexico's expansion of medicaid eligibility has resulted in the enrollment of one hundred seventy-one thousand adults; and

     WHEREAS, to offer health coverage that is more affordable to Americans with modest incomes, the federal Patient Protection and Affordable Care Act, also known as the Affordable Care Act, provides for premium tax credits and cost-sharing subsidies through health insurance exchanges to offset the high cost of health coverage; and

     WHEREAS, as of September 2014, the New Mexico health insurance exchange reported that it had enrolled approximately seventeen thousand one hundred individuals, although only half of that number were newly insured; and

     WHEREAS, the New Mexico health insurance exchange reports that, as of September 2014, the rate of New Mexicans lacking any health coverage had fallen from twenty-one and six-tenths percent to fourteen and five-tenths percent; and

     WHEREAS, the New Mexico health insurance exchange reports that it projects that another eighty-five thousand individuals will be enrolled through medicaid or through the New Mexico health insurance exchange by February 2015, dropping the rate of people living without health coverage to one hundred ninety- seven thousand individuals, or nine and six-tenths percent; and

     WHEREAS, eighty percent of New Mexico health insurance exchange enrollees received financial assistance for qualified health plan coverage in 2014, but sixty-six percent of New Mexicans do not know that tax credits are also available to pay for health coverage, according to the New Mexico health insurance exchange; and

     WHEREAS, even with federal premium tax credits and cost-sharing subsidies, the New Mexico health insurance exchange reports that fifty-six percent of New Mexicans have cited affordability as the primary reason why they do not have health insurance; and

     WHEREAS, a recent Harvard school of public health study has found that many Americans experience fluctuations in income that mean that eligibility will shift between public coverage programs such as medicaid and private insurance, creating a "churn" between programs that can result in one- or two-month periods without coverage; and

     WHEREAS, in addition to increasing access to needed care and reducing personal medical debt, maintaining health coverage and reducing the rate of uninsurance is of benefit to health care providers and reduces uncompensated care costs; and

     WHEREAS, the "National Health Expenditure Projections, 2012 to 2022" report by the federal centers for medicare and medicaid services states that health spending will be twenty percent of the United States' gross domestic product by the year 2020; and

     WHEREAS, health care expenditure projections show an unsustainable course for New Mexico; and

     WHEREAS, health care spending in January 2014 represented seventeen and seven-tenths percent of the United States' gross domestic product, which represents an all-time high; and

     WHEREAS, the center for economic and policy research reports that the United States' health care system is "possibly the most inefficient in the world", spending double per capita on health care compared to other industrialized countries yet having worse health outcomes, including a lower life expectancy than other industrialized countries; and

     WHEREAS, the center for economic and policy research reports that if the United States can get health care costs under control, budget deficits will not rise uncontrollably in the future, but if health care costs continue to skyrocket, it will be almost impossible to prevent exploding future budget deficits; and

     WHEREAS, access to timely and quality health care is hindered in New Mexico by large health disparities that exist among people of differing ethnicities and races, between rural and urban residents and among individuals of varying incomes and employment status; and

     WHEREAS, targeting certain health risks and addressing sets of health needs is hindered in New Mexico by the fact that there is no comprehensive data collection system to allow for a system-wide review of health care utilization in New Mexico; and

     WHEREAS, access to timely and quality health care is further hindered by New Mexico's chronic and serious lack of health care professionals in thirty-one of New Mexico's thirty-three counties; and

     WHEREAS, New Mexico lacks a comprehensive strategy for addressing the effects of the lack of health insurance, unaffordable health coverage, disparities in access to quality health care, health professional shortages, utilization patterns and health care costs; and

     WHEREAS, New Mexico's unique population and high rates of poverty, "churning" between public and private health coverage, geographic barriers and the lack of health insurance mean that many New Mexicans will continue to struggle to access affordable health coverage for the near future; and

     WHEREAS, Section 1332 of the Affordable Care Act allows states to apply for an "innovation waiver" to implement in the year 2017 a health care coverage system that overhauls the current state health system to provide coverage that:

          A. is as comprehensive as the coverage available through the New Mexico health insurance exchange;

          B. is no less affordable than coverage available through the New Mexico health insurance exchange;

          C. will cover as many New Mexicans as the New Mexico health insurance exchange; and

          D. will not increase the federal deficit; and

     WHEREAS, New Mexico has an opportunity to tailor the provisions of the innovation waiver to the needs of the state without losing federal subsidies;

     NOW, THEREFORE, BE IT RESOLVED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO that the superintendent of insurance be requested to convene an innovation waiver working group composed of experts in health care delivery, policy and finance as well as related areas; and

     BE IT FURTHER RESOLVED that the innovation waiver working group be requested to analyze the potential, under the auspices of a federal innovation waiver, for designing a comprehensive, sustainable health care system that:

          A. addresses the effects of the lack of health insurance, unaffordable health coverage, disparities in access to health care and uncompensated care on New Mexicans;

          B. provides for the collection of data and the examination of variations in health care utilization; and

          C. bends the health care cost curve in the state; and

     BE IT FURTHER RESOLVED that the innovation waiver working group be requested to meet at least monthly from April through December 2015; and

     BE IT FURTHER RESOLVED that the legislative council service and the legislative finance committee be requested to provide staff and administrative support to the innovation waiver working group; and

     BE IT FURTHER RESOLVED that the innovation waiver working group be requested to examine the following:

          A. the federal legal requirements for implementing the waiver, including the provisions of Section 1332 of the Affordable Care Act and related regulations and guidance;

          B. the type of state legal action required to implement the innovation waiver;

          C. information about coverage, quality and health care costs to ensure future sustainability;

          D. potential changes in health care enrollment, such as automatic enrollment for eligible medicaid recipients and "no wrong door" for applying for enrollment among myriad coverage options;

          E. the cost of a transition to a comprehensive, sustainable health care system under an innovation waiver as well as the availability of funds to cover the transition;

          F. the potential impact of the innovation waiver's implementation on the state's current health coverage systems, including the state medicaid program and the New Mexico health insurance exchange; and

          G. the potential impact of the innovation waiver on the health care delivery sector; and

     BE IT FURTHER RESOLVED that the innovation waiver working group be requested to develop recommendations for any state legislation that may be required to apply for and implement an innovation waiver; and

     BE IT FURTHER RESOLVED that the superintendent of insurance be requested to prepare and present the findings of the innovation waiver working group to the legislative health and human services committee and the legislative finance committee by December 1, 2015; and

     BE IT FURTHER RESOLVED that copies of this memorial be transmitted to the governor, the superintendent of insurance, the director of the legislative council service and the director of the legislative finance committee.

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