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New Mexico health insurance

NM’s CO-OP sticks around, BCBS returns for 2017

In the past, New Mexico has struggled with public health and high rates of uninsured. But under the Affordable Care Act, the state has implemented Medicaid expansion and a federally supported state-based marketplace and seems to be moving in a better direction.

If you live in New Mexico, or you’re considering living there, you’re probably interested in issues that impact the overall health of the state’s residents. Quite a few factors might affect your own perception of the state’s attitudes toward providing health coverage and healthcare. This guide highlights the health- and ACA-related issues facing New Mexico.

New Mexico health ratings

When it comes to health, New Mexico faces several challenges that place it firmly toward the bottom half of most rankings. Among them, higher rates of uninsured and fewer primary care physicians and dentists than other states.

New Mexico ranked 37th in the 2015 edition of America’s Health Rankings, performing at #45 for lack of health insurance and #48 for infectious disease rates.

In terms of healthcare affordability and access, a Commonwealth Fund study puts New Mexico last in the nation. Think New Mexico launched a healthcare initiative in 2014 aimed at solving that problem and specifically tackling the issue of affordability and access. They recommend steps that will help to bring more price transparency to healthcare, and also more fairness by prohibit providers from charging different prices for the same procedure depending on who is paying the bill.

The Commonwealth Fund’s Scorecard on State Health System Performance 2015 rated New Mexico 33th among the 50 states and District of Columbia – up three spots from 36th in 2014.

New Mexico’s scorecard includes details on how the rankings are determined. While the state placed in the fourth quintile for Access and Prevention & Treatment Categories, it came in at #10 for Avoidable Hospital Use & Costs. New Mexico is challenged by high rates of uninsured adults (21 percent) and children (8 percent), as well as a large percentage of adults who go without dental visits and healthcare.

Trust for America’s Health has compiled additional details on overall public health in New Mexico; check out the 2016 listing of Key Health Data About New Mexico. A county-by-county comparison is also available.

How has Obamacare helped New Mexicans?

In 2012, about 24 percent of non-elderly New Mexico residents were uninsured – the fourth highest rate in the country. Several studies have predicted an average drop of about 4.7 percentage points after ACA implementation, to a rate of about 19.6 percent.

Following the 2014 open enrollment period, New Mexico had the nation’s 10th largest reduction in percentage uninsured — state’s uninsured rate dropped 4.9 percentage points from 20.2 percent in late-2013 to 15.3 percent at the end of 2014.

By late-2015, the state’s percentage of uninsured had dropped to 12.8 percent. The state still has one of the country’s higher uninsured rates, but it’s clear that the ACA, specifically Medicaid expansion, is helping to increase the number of people in the state who have health insurance.

According to the Kaiser Family Foundation, there are still 233,000 uninsured New Mexico residents. Forty-seven percent of them are eligible for Medicaid and another 13 percent are eligible for premium subsidies if they enroll in private insurance through the exchange.

2017 ACA exchange carriers, rates

Four carriers will offer 2017 health plans through New Mexico’s exchange – the same number as 2016, but not the same carriers.

Presbyterian will leave the exchange, and Blue Cross Blue Shield of New Mexico is returning after a 2016 hiatus. As such, participating carriers are expected to include:

  • BCBS of NM
  • New Mexico Health Connections
  • Molina
  • Christus

New Mexico Health Connections is the state’s Consumer Operated and Oriented Plan (CO-OP), which was established with a federal grant of nearly $77.4 million under the ACA. While several Obamacare CO-OPs announced their closure in recent years, New Mexico Health Connections remains in operation and, as noted above, will offer 2017 health plans.

Rates and plan offerings will be finalized and made public on or before 2017 open enrollment begins on November 1, 2016.

New Mexico enrollment in qualified health plans

In November 2013, the Kaiser Family Foundation estimated that the potential market for the exchange in New Mexico was 193,000 residents and that 118,000 of them would qualify for premium subsidies to lower the cost of their coverage. By mid-April 2014, when the first open enrollment period ended,32,062 people had finalized their enrollment in qualified health plans (QHPs) New Mexico’s exchange, and HHS reported that 78 percent of them received subsidies to lower their premiums.

During the 2016 enrollment period, a total of 54,865 people enrolled in private plans through New Mexico’s exchange. That is a 5 percent increase over 2015.

New Mexico and the Affordable Care Act

In 2010, both of New Mexico’s U.S. Senators – Tom Udall and Jeff Bingaman – were supportive of the health reform law. In the House, two representatives voted yes: Martin Heinrich and Ben Lujan. The third representative, Harry Teague, voted no. Heinrich has since replaced Bingaman in the Senate, and the House has two new representatives from New Mexico: Michelle Lujan Grisham and Stevan Pearce. Grisham supports the ACA, but Pearce opposes it. He is currently the only member of the New Mexico congressional delegation that opposes the ACA.

At the state level, Republican Gov. Susana Martinez was initially opposed to the individual mandate portion of the ACA, but she moved forward with Medicaid expansion under the law and worked with her Democratic legislature to implement the ACA without obstruction in New Mexico.

For individual coverage, New Mexico is one of a handful of states operating a partnership exchange, Be Well New Mexico, together with the federal government. For small businesses, the state is running its own SHOP exchange.

New Mexico Medicaid/CHIP enrollment

Expanding Medicaid eligibility to 138 percent of poverty has been a key component of Obamacare success in New Mexico. The state agreed to accept federal funding to expand Medicaid under the ACA and, as of early 2014, it was estimated that nearly 48 percent of the uninsured population in New Mexico would be eligible for expanded Medicaid or CHIP.

As of mid-April 2014, 30,147 people had enrolled in Medicaid through the New Mexico exchange. By June 2016, New Mexico Medicaid enrollment had grown 25 percent.

Enrollment in Medicaid continues year-round, so that number continues to increase, further lowering the uninsured rate in New Mexico.

Does New Mexico have a high-risk pool?

Before the ACA, individual health insurance was underwritten in nearly every state, which meant that pre-existing conditions could prevent a person from obtaining a policy, or could result in significantly higher premiums or policy exclusions. The New Mexico Medical Insurance Pool (NMMIP) was created to give people an alternative if they were unable to obtain individual health insurance because of their medical history.

Now that the ACA has been implemented, all health insurance plans are guaranteed issue, making high-risk pools largely obsolete. But NMMIP is one of a few state-run risk pools that is still operational and has no plans to terminate coverage.

Medicare in the state of New Mexico

New Mexico Medicare enrollment reached 372,685 in 2015, the 50th anniversary of Medicare. This is about 17 percent of the state’s population and consistent with average national enrollment.

Historically, about 82 percent of New Mexico’s Medicare recipients have qualified based on age alone, and the other 18 percent are on Medicare as the result of a disability.

Medicare spends about $7,060 annually per enrollee, which is relatively low compared with other states. New Mexico ranks 37th in terms of overall spending on Medicare with $2.5 billion per year.

About 31 percent of New Mexico Medicare beneficiaries select a Medicare Advantage plan instead of Original Medicare, which is on par with Medicare beneficiaries nationwide. Thirty-nine percent have stand-alone prescription drug coverage through a Medicare Part D plan. Nationally, about 45 percent of Medicare recipients select an Rx plan.

State-based health reform legislation

Here’s a summary of health reform-related bills in New Mexico:

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