Let’s Talk New Mexico on April 10 explored the Impacts federal Medicaid cuts might have on the state. Host Kaveh Mowahed spoke to New Mexico Healthcare Authority Secretary Kari Armijo, President of the New Mexico Hospital Association Troy Clark, and Dr. Nancy Wright, a pediatrician in Las Vegas. Here’s an excerpt, which started with an email from listener LD, who wrote that without Medicaid, they would not be able to continue working since they have a disability.
KUNM: Secretary Armjio, people with disabilities and those in long-term care account for almost a third of the Medicaid dollars spent. Medicaid is the last resort for many of those folks and others like LD count on it in order to hold a job. If cuts in New Mexico do become inevitable, which groups might have a higher priority?
KARI ARMIJO: LD is raising a very important point. Most individuals on Medicaid are working. You can work a minimum wage job. You could work maybe two minimum wage jobs and still qualify for Medicaid. In terms of the question from LD, in terms of prioritization, it's really hard for me to answer that question. We've talked about all of these really vulnerable groups -- individuals with disabilities, seniors in need of long-term care, babies, pregnant women. Medicaid is also the primary payer of about 90% of all behavioral health services in New Mexico.
KUNM: I'm sure you've thought about this, and this is a tough question, but if you did have to cut back, what would go first?
ARMIJO: I'm not sure I can answer that question. Obviously, the Affordable Care Act implemented the Medicaid expansion that now covers about 260,000 low-income adults who previously were not eligible for Medicaid, because when Medicaid was created, it was primarily for individuals with disabilities, seniors and children that has become a really, really critical part of the Medicaid program -- 260,000 New Mexicans. It would be really, really hard to cut off that coverage. You know, that would just increase uncompensated care. We would just, all of a sudden see those uninsured rates go up. We get that enhanced federal financing for that group at 90% and that is one of the things that's on the table in terms of reducing that federal participation. But I think right now in New Mexico, the best way I can answer that question is that we're going to try and keep everything that we can intact, and
KUNM: And when uninsured rates go up, hospital visits, emergency room visits go up. Everyone Answers, the hospitals. Yeah. Troy Clark, you want to add something.
TROY CLARK: In New Mexico, we have a constitutional mandate that we have a balanced budget. We do not spend any more than the dollars that come in. That's not what's happening at the federal level. So I recognize there are people at the federal level trying to say, we spend $4.5 trillion more than we have coming in. This is not sustainable. I get that.
If I'm in another state, and I've worked in other states in my career, Medicaid might make up eight to 10% of my population. And if I take a cut, I take a reduction, if I'm a physician that makes $300,000 a year, maybe I make $290,000. That's probably not going to change where I'm located and whether I stay in practice. In New Mexico, that's not the case. You know about 40% of our population is on Medicaid. Depending on which county you're in, you may make up 30% of the population of a certain provider. You may make up 80% of the population provider’s income. You take that any kind of cuts to the Medicaid program, your income is going to be cut so drastically that we may not have that provider anymore. And that could be a physician, that could be a hospital, that could be a home health agency, even for those who do have commercial insurance, because if the provider is not there. They can't provide the care to those who even have commercial insurance or Medicare.
So this cut on Medicaid has a broader implication the state of New Mexico, for all of our residents, which makes it more complicated, I think, like Dr Wright was saying, Medicaid is complicated, and it's even more complicated in the state of New Mexico because of how integral it is as a part of our health care ecosystem,
KUNM: Dr. Wright, you come to us from one of those rural areas Troy was just kind of describing in Las Vegas. Do his comments ring true for you?
DR. NANCY WRIGHT: They very much do. Las Vegas is in San Miguel County, and we're one of the many counties in New Mexico who don't have any obstetric services. If Medicaid is cut even further, I don't know how we can ever bring obstetric services back. My daughter is attending college in Arizona. How can I expect her to come home if there's no women's care specialist anywhere around or if she gets pregnant and she has to drive many miles over a mountain pass in order to deliver? You know, I'm thinking of that as a parent, but I know that if I wanted to start a new business in Las Vegas, I'm not going to be able to attract young professionals to Las Vegas, because they're going to want to start their family. It's hard to start a family if there's no obstetrics available.
By the way, I'm at a federally qualified health center now. I'm employed at El Centro Family Health. Way more than 70% of my patients now are on Medicaid. I don't know the exact amount, but if, say, 90% of my patients are on Medicaid, and you're saying there's going to be a 25% cut in Medicaid, really, I have to pay my staff. I have to pay the housekeepers. I have to pay my electricity bill, I have to pay my malpractice premium. So all of these costs add up before I'm even paid. And if you get to a level where it costs more for me to see a patient than I'm getting reimbursed for, then no, I can't continue to be a pediatrician in Las Vegas. I'll have to go somewhere else.