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 V.15 No.17 | April 27 - May 3, 2006 

On Assignment

Do the Math

Albuquerque’s uninsured draw national attention

Vivian Hairston has four children, one husband, one small business and four employees. In New Mexico, that’s more than a palindrome—it’s an equation that, oftentimes, leads to zero health insurance.

With nearly 400,000 New Mexicans currently without health care coverage, what started as bad math has become an epidemic—not just in the state, but everywhere. Affecting not only low-wage earners but also many middle-class workers, children and small businesses, and taking its toll through bankruptcies, unseemly medical bills and burdens on the health care system, America’s lack of insurance is quickly becoming everyone’s problem.

Now seems to be the perfect time to dwell on it—because from May 1-7, all around the country, organizers are converging for Cover the Uninsured Week, a four-year-old project aimed at awareness and outreach. According to Robin Hunn, field organizer with Cover the Uninsured Week in Albuquerque, as a result of events for the week last year, more than 1,000 kids in Albuquerque were signed onto Medicaid. This year, with events ranging from lectures to enrollment fairs to small business seminars, organizers are aiming at 2,000.

Still, Hunn says such progress is only a dent in the problem. She says there are approximately 60,000 children statewide who would qualify for Medicaid who aren’t signed up, with estimates of up to 25,000 of them in Albuquerque alone. Now that’s what we call irrational numbers.

Welcome to the Land of the Uninsured

Hairston’s dilemma is similar to many New Mexicans’. For years, she and her husband struggled to find coverage not only for their family but for the employees of their 16-year-old landscaping business as well. Yet she says because the system has become so expensive, they were never able to find plans they could afford.

“I hadn’t gotten new glasses [for a long time],” she says, “I hadn’t been to the dentist in three to four years. I don’t like the Medicaid system—it’s degrading, for one thing. I always felt we should be able to afford insurance because of our higher income, but we couldn’t. And then we didn’t qualify [for Medicaid]. We were applying for it every six months. But we really didn’t understand how the whole thing worked, so we just gave up. … I figured I would rather just pay for the doctor, and pray we don’t get sick enough to have to go to the hospital.”

Now, Hairston is one of the lucky ones. Even though she was never able to afford health insurance for her entire family through her own business, a few months ago she was able to sign on to an insurance plan through a part-time job with Avon. The plan covers her and her two youngest children (the two oldest are under her ex-husband’s plan and her current husband is under a separate plan), and it offers her a rate she can afford. Yet Hairston’s insurance problems are anything but solved, as she and her husband are still unable to offer health insurance to their employees.

Martha Doster knows the feeling. The owner of Martha’s Body Bueno, a local small business that has been operating for 30 years, she says she’s never been able to offer coverage to her employees. “Over the years, I’ve offered them health insurance, but they couldn’t afford it,” she says. “Other times, I couldn’t even think about offering it; I couldn’t even afford it for myself.” Currently, Doster does have insurance and wants to offer it to her four employees, but none can manage the monthly premiums.

She says one of the reasons it’s been so difficult to provide insurance for her employees in the past is because in order to sign onto group insurance, a minimum of three people need to be enrolled at all times. In the world of mom and pop businesses, she says, there usually aren’t many more than that number of employees, and there are often high turnover rates, making for an unstable situation when it comes to health coverage.

Indeed, the predicament is grim for small businesses, which make up a large part of New Mexico’s economy. “I’m worried about being able to continue to afford [insurance], everything else is going up too,” she says. “Being self-employed means the greatest number of taxes are taken [from you]—small business is taxed to death. But really, small business is who brings in the most sales tax, hires the most people and pays the most taxes. A lot of the country’s backbone is built on small business, yet they’re taken advantage of; it’s a shame.”

Doster, who has been invited to go to Washington, D.C. at the end of the month to talk about health insurance issues with Congress, also worries about the future of health care for the country. After a car accident in 1994, she was laid up for close to a year. “Had my business not been well-established, it would have failed,” she says. “[I was lucky because] I had insurance at the time. But that’s all it takes—one accident that hurts you and you’re paying for it for the rest of your life because you don’t have insurance.

“I have no idea what the answer is. Do we want to pay more in our tax base for coverage? I don’t know; I just know something has to happen. This whole country is spiraling—more, bigger, better, now, who cares about the future?—this is one more facet. There is a schism here of the working poor and the wealthy—and nothing in between.”

More Than One Emergency

The lack of insurance in the state and the country effects more than families and small businesses—it puts a huge burden on the hospital system. According to Jeff Dye, president and CEO of the New Mexico Hospitals & Health Systems Association, the biggest impact is on hospital emergency rooms as they absorb the cost of treating uninsured patients.

“It’s a vicious cycle,” he says. “Hospitals have a cost of providing services to the uninsured. When they take care of them, the cost is transferred to insurance carriers who then raise premiums, which affects employers. Then, employers tend to not offer insurance or employees can’t afford to take insurance with a higher premium—it goes in a circle. The problem is getting worse; proportionately, it’s getting worse nationwide.”

Dye says another problem in the system is that many of the uninsured who are treated in emergency rooms are sicker than they should be because they don’t have regular access to primary care. “In the grand scheme of things, it’s wasteful to the health care system when [those patients] could be seen at a lower level,” he says. “It’s a burden on busy ERs and trauma centers.”

He adds that the reason the underlying cost of health care and insurance continues to grow is mainly due to new advances in technology, as well as the mounting cost of hospital staffing. “Demand is increasing because of an aging population,” he says. “The Baby Boomers are a definite factor. There’s the aging of the population and the aging of health care professionals.”

Dye says there are currently workforce shortage problems in the industry, but not for lack of eager students who want to enter the field. “In our state,” he says, “there’s a pretty good supply of folks who want to become nurses. Now, people are applying for nursing schools and being turned down because there’s not the capacity to educate them. People at the front end of the pipeline are applying to schools, but the pipeline isn’t big enough to meet demand.”

Dye’s solution to the problem is simple: “We should do everything we can to maximize and expand the Medicaid program to cover as many folks as we can.”

Looking for Answers

Betina McCracken, communications director for the state’s Human Services Department, says more coverage is exactly what the state is aiming for.

In the last two legislative sessions, she says, a number of bills have passed that are working to help lower the number of uninsured in the state. The goals of legislation ran from public outreach to small business and the working poor to inform them on available programs, to requiring insurers to offer coverage to part-time employees, to raising the age in which unmarried dependents can stay on their parents’ insurance to 25. Also, as part of Gov. Bill Richardson’s “Year of the Child” legislation in this year’s session, a bill was passed that allows the state to provide assistance on insurance premiums for uninsured children and pregnant women who aren’t eligible for Medicaid.

According to McCracken, the state saw a small improvement in the rate of uninsured between 2003, when the rate was 21.1 percent, to 2004, when it dropped slightly to 21 percent.

“It’s a process,” says McCracken. “[The state] recognizes the problem won’t be solved overnight—we have to chip away at it through programs. There needs to be a public and private partnership to solve it.”

One of the programs that has the potential to make a big difference in the state is the New Mexico State Coverage Insurance (SCI) program. Established in July 2005 after passing in that year’s Legislative Session, the program offers low premiums to workers and small businesses in the state. Employers who wish to offer their employees health care can pay $75 per month per employee, while employees pay $0 to $35 per month, based on their income. If someone doesn’t have an employer who offers the program, they can sign up independently and pay both the “employer’s share” plus their premium every month. The program is only available to those who make up to 200 percent of the federal poverty level and haven’t voluntarily dropped a commercial insurance plan over the last six months. For employers to offer it, they can’t have dropped a commercial insurance plan over the last 12 months.

So far, McCracken says, 4,350 people are signed up under the program, 39 of which are signed up through a business. With this year’s and next year’s funding, the program can cover up to 20,000 people. To try to get word out on the program, a state-run campaign kicked off on Monday which will feature billboards and print ads advertising the program; radio ads are already in effect.

McCracken says the state is continuing to look at other ways to lower the number of uninsured. If you’re uninsured, call the state Health Insurance Alliance at (800) 204-4700 to find out about programs you may be eligible for.

Basic Arithmetic

Number of children in the state on Medicaid as of November 2005: 257,524

Number of bankruptcies nationally in 2001: 1,458,000

Number of bankruptcies nationally in 2001 caused by illness and medical bills: 729,000

Number of uninsured children in New Mexico as of 2004: 76,900

Percent of uninsured in New Mexico who are working: 84

Number of uninsured nationally: 46 million

Percent of uninsured that are children: 20

Rate at which health care spending in the country has increased since the ’60s: 10 percent a year

Percent in which premiums for family coverage have increased since 2000: 73

Percent of earnings growth since 2000: 16

New Mexico has the second-largest number of uninsured in the nation

Sources: Health Affairs, statehealthfacts.org, Cover the Uninsured Week

To find out about Cover the Uninsured Week events, visit www.covertheuninsured.org.

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