By Carol Miller
The Better Care Reconciliation Act (BCRA), if honest, would keep the acronym and call itself Better Care for Rich Americans.
The bill developed by Senate Republicans 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 our state. 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, Governor Martinez’s 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 estimates that repealing the expansion in New Mexico will more than double uncompensated hospital care (a 107 percent increase) with an overall decrease of 25 percent in Medicaid payments to hospitals.
Special provisions in the ACA provided funds to modernize and expand the network of Community Health Centers (CHCs) throughout the state. New Mexico CHCs operate 160 sites – primary care, dental, schoolbased and behavioral health clinics; 80 percent 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 percent 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 BCRA changes would 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 who 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 BCRA 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 BCRA, whose consideration has been postponed at least until after the Fourth of July holiday, 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 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 asked to contribute the most
From ACA to Republican Death Panels