From the Friday, November 2, 2007, issue of New Mexico Business Weekly
By Thomas Munro
NMBW Staff
Supporters of Gov. Bill Richardson's far-reaching universal health insurance plan, including insurers and providers, say the Legislature must take an "all or nothing" approach to it in the upcoming session. Detractors, angered by what they see as a sell-out to private insurers, are urging the "nothing" vote.
Others say there is room for a more gradual approach.
Liz Watrin, president of Blue Cross Blue Shield of New Mexico, said her organization supports both universal health care coverage and "universal responsibility" as described in the governor's Health Solutions New Mexico plan.
"All the pieces must hang together," Watrin said. "If they do not hold together, there will be unintended consequences."
Those pieces include mandates requiring individuals to carry coverage, businesses to offer coverage, insurers to accept pre-existing conditions and providers to accept all insurance, among many other mandates. The plan would create a Health Coverage Authority to consolidate and lead the regulation of health insurance.
Jim Hinton, CEO of Presbyterian Healthcare Services, which is both a provider and an insurer, praises the governor for appreciating "the need for a partnership between the public sector and the private sector."
To Hinton, the state's experience with the Medicaid Salud program is strong evidence of the effectiveness of such partnerships.
"It is seen as one of the most successful Medicaid systems in the country," Hinton said. "Medicaid beneficiaries have some of the best health care outcomes in the state. The state has won, providers have won and patients have won."
Containing costs
Max Bartlett, vice chairman of the Health Security for New Mexicans Campaign, doesn't see it that way.
"The main thing is, [the public-private partnership approach] doesn't get at the problem of containing costs," Bartlett said. "A tremendous expense goes into marketing, administration and profit."
Bartlett, whose organization endorses an alternative to the governor's plan called the Health Security Act, said the governor is ignoring the results of a taxpayer-funded study by Princeton, N.J.-based Mathematica Policy Research Inc., which indicated the Health Security Act was the only one of three models that would save money over time.
The other two models involved public-private partnerships.
"Substantial numbers of supporters of our campaign have been reacting with outrage, saying the governor is abandoning the public to buttress up the profits of the insurance industry," Barlett said.
Does it make sense?
But Hinton questions whether a plan like the Health Security Act, which would establish a single cooperatively run insurer to provide basic universal coverage, makes sense.
"Why should people with an employer who are already using the employer-provided insurance be displaced?" Hinton asked.
Bartlett said the Health Security Act would not eliminate private insurers but would likely push them to offer supplemental insurance.
The governor's plan calls for Mathematica to do another cost analysis, and Bartlett said his group is trying to get the state to use the same assumptions it did in the earlier study to develop a fair comparison.
Charlotte Roybal, executive director of patient advocate Health Action New Mexico, is just glad to see a bill on the horizon.
"We're very excited it's come to where it's at," Roybal said.
Her group pushed for the Mathematica study, and Roybal said the governor "perhaps decided [against single payer] too early, before the study was released."
Roybal said there are many issues still to be resolved, and she would be happy to see the Health Coverage Authority created first.
"We think that would be a good start," Roybal said.
That would not be the ideal start for Hinton and other insurers who want to avoid a piecemeal approach.
"Everybody I've talked to both believes in the notion of a broad health care authority and is cautious of what its authority will be," he said.
Rate-setting is a concern
Hinton said his industry is particularly concerned about the possibility the authority will be empowered to set rates, which currently are set by the market and are fellow-travelers with low per-person health care costs.
Hinton, putting on his provider hat, said other concerns have been suggested by the experience of Massachusetts, which has a health coverage model that is in many ways similar to the governor's proposal.
"In concept, universal coverage would mean that there are fewer uninsured patients, and costs from them that currently are shifted onto the insured would be reduced," Hinton said. "But what happens if 400,000 people not currently in the system have a physician card for the first time and start to get care?"
Massachusetts, for one, is having a tough time paying those bills. But Hinton isn't scared off the concept.
"The question is, are we better off trying some things as opposed to accepting the status quo?"
