The U.S. Senate’s Better Care Reconciliation Act (BCRA), if honest, would keep the acronym and call itself Better Care for Rich Americans.
The bill weaves upper-income tax breaks throughout a series of sections outlining large cuts to Medicaid, the elimination of guaranteed essential services, massive unfunded mandates to the states, repeal of assistance to small employers that provide employee health insurance, and the repeal of the Prevention and Public Health Fund.
Each of these take-backs is bad for many states, but the combination is deadly for the health care system of New Mexico, a state where nearly a quarter of residents and 99.3% of the land area are rural.
New Mexico remains dead last in job growth. We are among the handful of states most dependent on federal dollars because of the large percentage of federal lands, national laboratories, tribal lands, and military operations. New Mexicans also receive direct payments through federal employment, cash assistance, federal pensions, Social Security and disability.
The health care system in New Mexico has always been fragile. Medicaid expansion under the Affordable Care Act (ACA) made the first across-the-board improvement to the health system in the 40 years I have been working in the state. Without partisanship, Republican Governor Susana Martinez’ administration dramatically increased access through enrolling most uninsured New Mexicans into Medicaid.
Medicaid expansion strengthened hospital bottom lines replacing uncompensated indigent care with insurance revenues. The Commonwealth Fund, a private healthcare foundation, estimates that repealing the expansion in New Mexico will more than double uncompensated hospital care (107% increase) with an overall decrease of 25% in Medicaid payments to hospitals.
Special provisions in the Affordable Care Act provided funds to modernize and expand the state’s network of Community Health Centers, which provide healthcare for underserved populations. New Mexico CHCs operate160 sites – primary care, dental, school-based and behavioral health clinics. Eighty percent of these programs are located in rural areas. New Mexico CHCs provide more than 1.5 million patient visits every year. Forty percent of CHC revenues are from Medicaid.
The ACA expanded the National Health Service Corps, which recruits providers to health professional shortage areas, helping to staff hospitals and clinics. Despite this federal assistance, New Mexico meets only 39% of the need for health professionals. It will take more than 800 new medical professionals to fill the gaps in New Mexico’s 190 state and federally designated primary care health profession shortage areas.
Two other changes in the Senate healthcare proposal will be especially negative in New Mexico – one affecting small employers and the other impacting public health. After the passage of the Affordable Care Act, businesses with fewer than 25 employees became eligible for the Small Business Tax Credit. This helped small employers, many of whom had always wanted to provide health care for their employees but were not able to afford the insurance. Small businesses are a keystone of the private sector in New Mexico. It is beyond comprehension that the Senate’s bill specifically repeals the Small Business Tax Credit. It is hard to understand a law that gives numerous tax cuts to upper income people, while including a tax increase for small businesses providing insurance for their employees.
Also included in the Senate’s bill is a repeal of the Prevention and Public Health Fund. This will hit New Mexico very hard with the immediate loss of nearly $45 million dollars over five years. These cuts will increase health spending, because prevention programs lower costs. At a time when obesity and diabetes are at all-time highs in New Mexico, the state will lose $573,000 in chronic disease prevention funds every year, $2.8 million over five years. Half of all vaccines for children and adults are funded through the Prevention and Public Health Fund. In New Mexico repealing the fund will eliminate $700,000 a year to purchase and distribute vaccines, $3.5 million over five years.
Health care costs will not go down just because the federal government and upper income people make smaller contributions. The federal law requires states to take on many of the administrative roles and costs being dumped by the feds. This transfer of responsibility constitutes one of the largest unfunded mandates ever pushed onto New Mexico state government.
We must not go back to pre-ACA levels of uninsurance and delayed care. New Mexico is better than this. We have to protect public health, the health infrastructure of the state, and health care jobs. Federal tax breaks and cuts in health care funding will require state and local tax increases. And unlike the feds, in our state, those with the most must be required to contribute the most.
Carol Miller is a community organizer from Ojo Sarco, New Mexico (pop. 400) and an advocate for Geographic Democracy: the belief that the United States must guarantee equal rights and opportunities to participate in the national life, no matter where someone lives.
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