Republican efforts to repeal and replace the Affordable Care Act passed a major hurdle Thursday after the House of Representatives voted for a new health law, the American Healthcare Act. KUNM’s Chris Boros spoke with Ed Williams of the Public Health New Mexico project about reactions in New Mexico.
BOROS: How did our representatives vote?
WILLIAMS: Steve Pearce voted for it, our lone Republican in Washington. Ben Ray Lujan and Michelle Lujan Grisham both voted against the bill along with every other Democrat in the House.
BOROS: What would the House bill mean for the state insurance exchange here in New Mexico?
WILLIAMS: Too early to tell. I spoke with Dr. Martin Hickey, who is CEO of New Mexico Health Connections, which is the low-cost insurance option on the state exchange. He basically said they’re still trying to unpack what the bill would mean for insurance markets here.
HICKEY: We’ll adapt to it, as we always have. So, am I scared about it? No, we’ll deal with whatever’s there, absolutely.
WILLIAMS: So he’s not ringing the alarm bells, yet. He says it’s not all that clear at this point what the impacts of the bill would be as written—and of course it has to go to the Senate so the final bill will look somewhat different than this one. But Hickey did say that one of the potential problems is uncertainty—insurance markets don’t like uncertainty and there’s a lot of that going around right now, and it’s likely to increase with this new law. So if that doesn’t change, there could be some potential rate increases for coverage in New Mexico down the line.
BOROS: Who would be impacted most if the American Healthcare Act becomes law?
WILLIAMS: We’re hearing a lot of concern from groups like the AARP about rate hikes for older Americans. The ACA set the ratio for insurance rates for older Americans at 3 to 1—that means you can’t charge a senior more than three times what you would charge a healthy young person for coverage. The American Healthcare Act as it is now ups that ratio to 5 to 1, so that’s a significant cost increase for senior citizens.
BOROS: But most older people get healthcare through Medicare, not Medicaid or state exchanges right? So would they really be impacted?
WILLIAMS: Right, if you’re 65 or older you can get Medicare, which is funded separately. But the AHCA repeals the payroll tax on higher income workers, and that tax helps pay for Medicare. So that might be a good thing for you if you’re making quite a bit of money, but the AARP and others are saying it could destabilize Medicare by taking away that funding.
And at the moment there’s just a lot of nervousness about what’s going to happen. Here’s Gene Varela, who’s director of the New Mexico AARP chapter.
VARELA: The fact is, this impacts people 50 to 64 years old who already have the challenge of getting access to healthcare, and now you’re going to tell them that you’re going to have to pay more for your insurance just because of your age.
WILLIAMS: Varela also said a lot of people in New Mexico are covered by Medicaid as well as Medicare, so if there are changes to Medicaid those people could really see some changes in coverage.
BOROS: What are the cuts to Medicaid in this bill and what would it mean for New Mexico?
WILLIAMS: [There are] huge cuts to Medicaid. The latest estimates are something like $880 billion—with a B—over the next ten years. New Mexico has a huge amount of people on Medicaid since Governor Martinez expanded that program here under the Affordable Care Act. That’s how a lot of people pay for addiction treatment and general healthcare.
BOROS: What about pregnancy and women’s health under Medicaid?
WILLIAMS: Right now Medicaid pays for 70 percent of births in New Mexico. That is huge, that’s more than any other state. Then there are programs like Planned Parenthood—the House plan would cut federal funds to Planned Parenthood, which could obviously be a serious problem for Planned Parenthood clinics.
I spoke with Shaya Torres, who’s with Planned Parenthood of the Rocky Mountains.
TORRES: Overall, this disproportionately affects women. Insurers can claim having given birth, having had a C-section or having been a survivor of domestic violence is also a pre-existing condition.
BOROS: Did she just say domestic violence would be a pre-existing condition?
WILLIAMS: Before the ACA some insurance companies in other states were denying coverage for things that were results of domestic violence, like depression or other conditions that can be trauma-related. That was banned under the ACA, but the House plan now would let states opt out of the pre-existing condition requirements. New Mexico would have to ask for a waiver.
But that gets to the core of why a lot of people here are worried about this—the American Healthcare Act gives a lot of decision-making power to the states, and we're in a budget crisis here in New Mexico. Our state needs to find ways to save money, especially in the money it’s spending on Medicaid. So the question a lot of people are asking is, if it’s up to the states to decide, will they end up saving money by cutting benefits?
KUNM’s Public Health New Mexico project is funded by the W.K. Kellogg Foundation and the McCune Charitable Foundation.
