Conflating Health Insurance with Health CARE

By Deane Waldman, MD MBA - 01/08/20

Submitted to ABQ Journal, published March 2, 2020.

See:https://www.abqjournal.com/letters/new

Our politicians do not learn from history, even our own. House Bill 100 ("New Mexico Health Care Access Wins Final Approval," Los Alamos Post, Feb 19) just passed is touted to "increase[s] access to high-quality health care."Sadly, this is not true.

HB 100 will provide additional funds ("tools") to BeWellNM, New Mexico's ACA-created health insurance exchange, which provides subsidies to New Mexicans who make too much money to qualify for Medicaid and too little to afford private insurance and/or do not have employer-supported health coverage.

Full closure: From 2013 to 2019, I was the "Consumer Advocate" onBeWellNMBoard of Directors. I support its mission to improve access to care, not merely insuring more people.

Both our state representatives and the governor conflate the words insurance and access, implying they are the same. They most certainly are not!

When New Mexico expanded Medicaid, we received roughly $3 billion in federal funds. Since the expense (paid to insurance companies) was $3.417 billion, as reported in the ABQ Journal (Mar. 5, 2016), there was a $417 million shortfall. To balance the Medicaid budget, they had to cut reimbursements to doctors, which reduced access to care. Thus, by increasing the number of people with insurance, we decreased access to care.

Compare Texas with New York to show how coverage does not equal care. Texas has the highest uninsured rate of 17 percent while New York has the lowest at 5.4 percent, meaning many fewer New Yorkers are uninsured than in Texas. Yet, data on access to care tells a different story.

New York, with its low uninsured rate and high Medicaid enrollment (32 percent), satisfied the primary care needs of its population 45 percent of the time. Texas, with the highest uninsured rate and the lowest Medicaid enrollment (16 percent), did the best: Lone Star doctors met primary care needs of Texans 71 percent of the time.

I await evidence that providing more funds to New Mexico insurers translates into more timely access to care for New Mexicans.