By Denise Tessier
Taking its own advice – “It is time for New Mexico to bite the Medicaid expansion bullet” – the Albuquerque Journal has editorialized in favor of expanding Medicaid in the state (“N.M. Should Embrace Medicaid Expansion,” Sept. 30). Filling a slot normally taken by two editorials, the single missive is heavy on the editorial board’s ideological opposition, basically saying it didn’t want to endorse, but had to. It concludes by asking Gov. Susana Martinez to follow its example and “sign New Mexico up.”
It was a begrudging endorsement from a paper whose editorial position has consistently opposed the Affordable Care Act, from which the Medicaid expansion has its genesis, a paper that, in one of its annual Labor Day editorials (Sept. 6, 2010), injected this debatable claim:
Health care reform, which was based on the false promise of reducing costs, is even more unpopular now than when it was enacted.
But in the end, the Journal endorsed expansion: “. . . after weighing the pros and cons, the scales come down on the side of doing it.”
In the end, Journal editors could not ignore their own paper’s reportage, led by Winthrop Quigley’s consistent columns and news reports, buttressed by stories from other reporters.
But in endorsing, the editorial was careful to use “proponents say” before listing the “pros”: that adding 170,000 adults to Medicaid’s rolls will “inject billions of dollars into the state economy, develop a more robust health care infrastructure, especially in rural areas, and create thousands of jobs in the health care industry and in other businesses as a result of the increased economic activity.”
Support for these claims comes from Journal stories, most notably Quigley’s Aug. 23 report quoting University of New Mexico economist Lee Reynis, which said New Mexico would receive $6.2 billion in federal dollars over six years (“UNM Economist Tours Medicaid Jobs for State: Predicts Up to 10,000 A Year If N.M. Signs Up”) .
Add to that a story by Journal reporter Dan Boyd (Sept. 28 ), which reported that a Legislative finance Committee analysis found the state’s general fund “would take in as much as $98.5 million per year in new revenue through 2019 if New Mexico participates” in the expansion, factoring into this analysis potential revenue sources “such as increased income taxes that would be collected by the state if new jobs are created.”
Sunday’s editorial also acknowledged predictions that:
. . .having more people with access to routine and preventative care should help dampen costs overall by decreasing the use of emergency rooms for non-emergencies. And some say having nearly everyone covered for medical services will keep costs down in the long run for those who have insurance, as providers will no longer have to make up for people who don’t pay their bills by raising the premiums of the insured.
But in addition to using qualifying terms like “some say,” the editorial’s conclusion about these predictions was that:
Time will tell whether any of that is true.
It additionally casts doubt by saying:
While advocates say this will keep people out of hospitals, (University of New Mexico Hospital) is already citing the expansion as one reason it needs more acute care hospital beds.
Quigley explained the dilemma for New Mexico hospitals back in July (“Medicaid Expansion Next N.M. Debate,” saying that:
New Mexico’s hospitals have a big stake in the decision. Hospitals have received payments from the federal government to compensate them for treating indigent patients. Those payments ($20.4 million in New Mexico last year) disappear under the ACA because the act assumes everyone is covered and hospitals no longer see indigent patients. If Medicaid isn’t expanded, hospitals lose both the payments and coverage for indigent patients.
On the other hand, as Quigley noted, a New Mexico Voices for Children report found that “bringing $6 billion from outside the state would create jobs for more health care industry workers who would spend their incomes in local stores and buy services form local vendors. That spending would create more private-sector jobs. All of those employed people pay taxes, potentially generating more revenue for the state than the $500 million Medicaid would cost us.” That report has since been updated to reflect new estimates for the Medicaid expansion by the state’s Human Services Department.
Explaining its ideological dilemma, Sunday’s Journal editorial says:
With the feds picking up virtually 100 percent of the cost for the first three years of expansion starting in 2014 — although the state Human Services Department says it could be 97 percent — and 90 percent thereafter through 2020, what’s not to like?
A lot. A good argument can be made that it’s bad policy for the country. All this infusion of cash comes from the federal government, which doesn’t have any. So this is borrowed money.
And for New Mexico, at some point we need to be good at something other than poverty as a way of generating economic activity.
Plus, the state will have to cough up a larger share — an estimated additional $320 million to $500 million for 2014 through 2020.
It’s interesting to note that the editorial also includes national poll data on the ACA (“polls show America is divided on the Affordable Care Act as a whole,” the editorial says), but makes no mention of the Journal’s own New Mexico poll (“Majority in N.M. Backs Medicaid Expansion,” Sept.14, by Dan Boyd.) That poll put New Mexicans’ support for expansion at 53 percent, with 33 percent in opposition, and 11 percent undecided (3 percent said it “depends” on other factors).
It’s also interesting that as the editorially conservative Journal comes out appearing conflicted in endorsing the Medicaid expansion, conservatives on the national level – including presidential candidate Mitt Romney — are beginning to reclaim as their own the ideology behind “Obamacare,” also known as “Romneycare,” reflecting they are conflicted on the subject as well.
In the partisan war sparked by the 2008 election, Republicans conveniently forgot that this was something many of them had supported for years. The only thing wrong with the mandate? Mr. Obama also thought it was a good idea.
. . . Clear away all the demagogy and scare tactics, and Obamacare is, at its core, Romneycare across state lines. But today’s Republicans dare not own anything built on principles of economic conservatism, if it also protects one of the four horsemen of the social conservatives’ apocalypse: coverage for the full spectrum of women’s reproductive health, from birth control to abortion.
To be fair, as Kleinke points out, those whose views are further left are conflicted about the ACA as well. As he puts it:
The plan has few champions on the left precisely because it is not a government takeover of health care. It is not a single-payer system, nor “Medicare for all”; it does not include a “public option,” a health plan offered by a federal insurer. It is a ratification of market ideas, modified to address problems unique to health insurance.
Meanwhile, back home, the Journal’s endorsement could help Gov. Martinez in her decision whether to expand Medicaid. However, just this week, she addressed the New Century Economy Summit in Albuquerque by saying New Mexico must reduce its reliance on federal funding. According to the New Mexico Business Weekly, Martinez said the need for this reduction:
. . .is urgent. We cannot wait and we must make these policies and changes now.
The story goes on to say that Martinez specifically noted that between 2009 and 2011, Arizona saw a 4 percent increase in its per capita income, while New Mexico’s per capita income increase was 2 percent, Martinez said.
Keep this in mind when considering a critical angle that is missing from the Journal’s editorial — and much of the Medicaid discussion. That angle is:
How will Medicaid expansion affect New Mexico outcomes in terms of human life?
Such outcomes were quantified in July in a study published in the New England Journal of Medicine, which found that residents of three states that had expanded Medicaid after 2000 to cover low-income adults “were significantly associated with reduced mortality as well as improved coverage, access to care, and self-reported health.”
In other words, they lived longer, had better access to care and were healthier than residents of their neighboring states.
The states with expanded coverage were New York, Maine and Arizona. The neighboring states they were compared to – and found not to be faring as well — were Pennsylvania, New Hampshire, Nevada and New Mexico.
According to Martinez, Arizona is doing better than New Mexico economically. According to the New England Journal of Medicine, Arizona is doing better than New Mexico health-wise, thanks to Medicaid expansion. Perhaps, contrary to Sunday’s Journal editorial, Medicaid expansion is a no-brainer.
(As as side note: The Journal on July 26 ran an Associated Press summary of the New England Journal of Medicine-published Medicaid expansion study, but in cutting that story eliminated reference to the information that New Mexico was one of the comparison states, a significant oversight.)