SENATE JOINT MEMORIAL 3

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

INTRODUCED BY

Gerald Ortiz y Pino

FOR THE LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE

A JOINT MEMORIAL

REQUESTING THE NEW MEXICO LEGISLATIVE COUNCIL TO CHARGE THE INTERIM 2015 LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE WITH CONVENING A BASIC HEALTH PROGRAM TASK FORCE TO EXPLORE THE FEASIBILITY OF IMPLEMENTING A BASIC HEALTH PROGRAM TO COVER INDIVIDUALS WITH LOW INCOMES WHO ARE NOT ELIGIBLE FOR MEDICAID.

     WHEREAS, the federal Patient Protection and Affordable Care Act, also known as the "Affordable Care Act" or "Obamacare", provides that states may establish a health insurance program for low-income individuals who do not quality for medicaid coverage; and

     WHEREAS, the individuals who may be covered under a basic health program are adult citizens of the United States with household incomes of one hundred thirty-eight percent to two hundred percent of the federal poverty level, also known as the "FPL", as well as noncitizen, legal permanent residents with incomes below two hundred percent of the FPL who are excluded from medicaid coverage during their first five years of residence; and

     WHEREAS, the Affordable Care Act also provides individuals and families with incomes below four hundred percent of the FPL premium tax credits and cost-sharing subsidies on qualified health plan coverage available through state health insurance exchanges; and

     WHEREAS, to assist states in funding a basic health program, the federal government would give participating states ninety-five percent of what the federal government would have provided to enrollees in the form of premium tax credits and cost-sharing subsidies that they would have received had these individuals and families purchased qualified health plans instead of enrolling in a basic health plan; and

     WHEREAS, the state of New Mexico used to provide health coverage through the "state coverage insurance" or "SCI" program to adults who did not qualify for medicaid and whose incomes fell below two hundred percent of the FPL; and

     WHEREAS, since January 1, 2014, the state of New Mexico has exercised its option under the Affordable Care Act to expand medicaid coverage to otherwise ineligible adults with incomes below one hundred thirty-eight percent of the FPL; and

     WHEREAS, adult New Mexicans whose incomes are above one hundred thirty-eight percent of the FPL must now purchase health insurance on the private market, either through the New Mexico health insurance exchange or elsewhere; and

     WHEREAS, the average monthly premium on the New Mexico health insurance exchange for a qualified health plan is two hundred thirty-two dollars ($232); and

     WHEREAS, the Affordable Care Act requires that basic health program premiums be lower than the second-lowest-cost plan offered at the "silver" level, or an eighty percent actuarial value, of qualified health plans on the New Mexico health insurance exchange; and

     WHEREAS, the state of Minnesota has implemented a "look-alike" health coverage program for low-income adults, and for an enrollee with an income at one hundred seven percent of the FPL, premiums are just thirty-three dollars ($33.00) a month, with a thirty-three-dollar ($33.00) annual deductible and a three-dollar ($3.00) co-payment per primary care or specialty care office visit; and

     WHEREAS, even with 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, for the average qualified health plan enrollee with an income of one hundred seventy percent of the FPL, the urban institute states that the monthly premium would be eighty dollars ($80.00) with a federal subsidy; the annual deductible would be seven hundred fifty dollars ($750), and co-payments for primary care would be ten dollars ($10.00) per visit, and for specialists, the co-payment would be thirty dollars ($30.00) per visit; and

     WHEREAS, the basic health program has the potential for increasing the number of insured New Mexicans, thus increasing access to health care services and decreasing the amount of uncompensated care in the state;

     NOW, THEREFORE, BE IT RESOLVED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO that the New Mexico legislative council be requested to charge the chair of the interim 2015 legislative health and human services committee with convening a basic health program working group during the 2015 interim to analyze the feasibility of implementing a basic health program in the state to increase access to health coverage for low-income adults who are not eligible for medicaid coverage; and

     BE IT FURTHER RESOLVED that the chair of the legislative health and human services committee be requested to invite to participate in the basic health program working group experts in the areas of health coverage, actuarial science, health care finance, public benefits and public finance, including representatives from the office of superintendent of insurance, the human services department and the legislative finance committee; and

     BE IT FURTHER RESOLVED that the basic health program working group be requested to study and make recommendations regarding:

          A. the options that New Mexico has for financing the basic health program using federal grants;

          B. whether state funds should be allocated to keep premiums and cost-sharing affordable for low-income New Mexicans;

          C. what safeguards may be available for avoiding any adverse risk pooling or for adverse selection;

          D. the possibilities for reducing "churn" between public and private health coverage;

          E. the effect of a basic health program on the New Mexico health insurance exchange;

          F. the costs of administering a basic health program; and

          G. any legislation necessary to create a basic health program; and

     BE IT FURTHER RESOLVED that copies of this memorial be transmitted to the president pro tempore of the senate, the speaker of the house of representatives, the chair of the legislative health and human services committee, the chair of the legislative finance committee, the secretary of human services and the superintendent of insurance.