Alibi V.28 No.3 • Jan 17-23, 2019 

Commentary

Health Security Can Happen

Legislation would create a self-insuring state

Max Bartlett
Max Bartlett
August March

Well, I gotta admit it looked rather dismal here about last week. What with at least a couple of perplexed and health-hexed citizens coming forward to tell their tale of expensive medications, denied coverage and ultimately tragical consternation about a system that ultimately governs their lives on this big blue marble, I wasn’t sure it was ever gonna get better.

Turns out that one of the folks we wrote about last week has ostensibly been contacted by their insurer, asking the former to submit a complaint form in order to get a “tier exception.” No that ain’t an episode out of “Star Trek,” it’s the name of the bureaucratic process that may keep the lifesaving medicine coming. We’ll keep you posted.

The other thing that gave us cheer here was a visit by longtime union member Max Bartlett, who happens to be the chair of the group working on an innovative approach to healthcare in the state of New Mexico. That new methodology—up for review by an administration that is hot for healthcare reform—would mean a huge and productive sea change for most New Mexicans, ending the nearly nightmare scenario reviewed last week in favor of blue skies and a properly managed statewide healthcare system.

The plan calls for one large insurance pool where everyone in the plan—N.M. citizens—share the risk. All would have access to this coverage under the Health Security Act, regardless of income, health or employment status. Under the aegis of the act, the state would set up its own health insurance plan and operate like a cooperative. Private, for-profit insurance would shift to a solely supplemental role.

Funding for Bartlett’s long-sought after program would come from monies currently being spent at the state and federal level on healthcare as well as individual premiums (sliding scale) and employer contributions.

Bartlett spoke at length about the proposal as we sat in the conference room at Alibi HQ waiting for the coffee to brew in the next room. Here’s a transcript of our conversation about healthcare in the Land of Enchantment.

Weekly Alibi: We’ve been talking about healthcare in Weekly Alibi, and last week, I wrote about some of the problems that manifest with for-profit healthcare.

Max Bartlett: And the point I was trying to make was that for private, for-profit health insurance, the purpose of the company is to make a profit. With the health security plan, the purpose will be to provide healthcare for all New Mexicans. Those are different fundamental goals.

That’s important to note. How do you envision the plan manifesting and changing the healthcare industry in New Mexico?

It’s a universal coverage plan. It ensures that New Mexicans all have healthcare coverage that is comprehensive and affordable, and offers complete freedom of choice for providers; there will no longer be “networks” under the proposed Health Security Act.

The program will completely shift the role of insurance in New Mexico, much as Medicare did in 1965. For most people, it means that private insurance companies will be able to offer supplemental insurance, but the bulk of healthcare will be provided through the plan. It is essentially comparable to the entire state self-insuring. There are many large corporations that self-insure. They are big enough to bear the risk. This will be like old-fashioned insurance; everyone will be in one big pool—young, old, employed, unemployed, healthy, not-so-healthy. By pooling the risk like that, that’s how you get the real benefit of insurance.

Who is sponsoring this legislation in 2019?

On the Senate side, the sponsors are Carlos Cisneros, who is from Taos, Jerry Ortiz y Pino from here in Albuquerque and Bill Soules from down in (Las) Cruces. Cisneros is a longtime sponsor of the bill. The principle sponsor two years ago was Howie Morales.

Now, he’s the Lieutenant Governor. So that makes some sense in that this bill could well be part of the new progressive agenda up in Santa.

That’s right. And the governor’s been supportive of the legislation. There’s a great deal of excitement right now because this is the first time in 16 years that we’ve had a governor receptive to the plan.

What exactly will enactment of this act mean to the average New Mexican?

For a lot of us, having a full choice of providers without having to be locked into networks will be a huge advantage. Under the current system, when you go to visit your doctor, he knows, roughly, that there are a hundred or more insurance plans with different coverages, which his patients have. But he obviously can’t keep track of every single plan and what it offers. So, when he’s trying to treat you, he doesn’t take such differences into account. That’s a complication for the provider which would be eliminated under the plan. Eighty-five percent of New Mexicans would be under one plan; physicians will know exactly what is available. Billing procedures would also be vastly simplified.

But will the plan work?

The other great thing about the Health Security Act is that it isn’t some sort of off-the-shelf or academically created plan. It’s something that has evolved and was developed here locally over the past two decades, with input from literally thousands of New Mexicans. The [current] bill has been refined to match current circumstances here in this state. As a matter of fact, we like to say that it is so uniquely New Mexican that it is covered with red and green chile.

What sorts of history and values informed the creation and evolution of the Health Security Act?

Back in the ’90s, before the Clinton administration, there was a growing consensus [among union members and working people] that we had serious problems with providing healthcare, particularly in New Mexico. At that time, we were approaching a level where 25 percent of the population in the state lacked healthcare coverage. I first got involved in this issue in 1991. Things seemed so bleak on the national front that some of us started talking—unions and community groups—about what we could do to initiate healthcare reform. It dawned on us that maybe we could effect something at the state level, rather than waiting for the country to warm to the idea. Initially we thought this would be a challenge for New Mexico, it being a poor, rural state. Perhaps we couldn’t afford to do it was the thinking.

But after doing some research, we discovered the Canadian plan. It’s different from our plan, but it started in the province of Saskatchewan and expanded outward. “Wait a minute,” we thought, Saskatchewan is a large, rural, poor province—it’s very much the Canadian equivalent of New Mexico. After much study a different version of the bill was sent to the New Mexico Legislature in 1993 with the support of 15 unions and community groups.

How are we going to pay for this sort of universal coverage?

It doesn’t involve any new taxes. It will involve pooling all the governmental dollars that are already being spent on healthcare, including Medicaid, Medicare, state employee’s state insurance. That will provide between 60 and 62 percent of the funding. The rest of the cost will be paid for by income-based sliding scale premiums paid by those enrolled in the program, as well as by employer contributions. Employer contributions will be determined by company size and the size of respective payrolls. This model will reduce costs.

How much support is the bill getting this year?

There are over 160 organizations supporting this healthcare legislation. And it’s crucial to understand that these are organizations that are not necessarily supporting a general concept like progressivism, but rather supporting the Health Security Act as a practical measure for their employees and colleagues.

It seems your support is rather comprehensive, you’re talking about a huge swath of people in this state who’ve voiced support, que no?

You’ll notice that the list of supporters is more than just a list of progressive organizations and people; it’s a broad based group of people who are coming together through this legislation. We’ve also had 35 counties and municipalities endorse this legislation—Santa Fe is one of them, but so is Roswell. The Albuquerque City Council just re-affirmed their support of the act, on a 9-0 vote.

What are the chances for passage this year?

Well, Brian Egolf, the speaker of the house, right after the election, told KSFR Radio that he thinks it’s almost a certainty the bill will pass the house.

But everyone keeps talking about the conservative nature of the New Mexico Senate, about the conservative Democrats in that body that seem to stifle a lot of progressive legislation …

The Senate is more complicated, but the tide is turning because citizens are stepping forward to tell us that the current system no longer works and cannot work any longer.