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New RGF brief: New Mexico has ample opportunities to reduce health care costs, improve quality

(Albuquerque, NM) – The Trump Administration failed in its efforts to completely repeal the health care law known as “ObamaCare.” Aside from the individual mandate which was repealed in separate tax reform legislation, the health care law remains relatively intact.

Nonetheless, state-level policymakers still have numerous reform measures that can be adopted to make health care work better. Often, those “levers” are available to state-level policymakers although some policy changes can be expedited and assisted with a more flexible administration in Washington.

A new policy brief by Roger Stark, By Roger Stark, MD, FACS, Adjunct Health Care Policy Analyst at the Rio Grande Foundation outlines in detail some of the ways in which New Mexico’s leaders could positively impact both the State budget and health care outcomes alike. The paper is available here.

While the federal health care law improved access to insurance, particularly in rural communities it can be a challenge to find practitioners, especially specialists. New Mexico has the highest percentage of births to moms on Medicaid, and the Medicaid systems is a large and growing burden on the State of New Mexico’s finances.

A few of Dr. Stark’s specific reform ideas include: Enact tort reform to reduce wasteful medical expenses, Expand and promote the use of association health plans, promoting telemedicine, and reforming scope of practice and professional licensing laws.

Stark will present these and other ideas at a presentation sponsored by the Rio Grande Foundation at the Marriott Pyramid on April 18, 2018 at a luncheon that will take place from 12 to 1pm. Seats are still available and can be reserved by clicking here or calling the Foundation at: 505-264-6090.

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Dr. Roger Stark Physician and Free Market Health Care Reformer: How States Can Make Health Care Better For Patients and Taxpayers

Albuquerque Event Notice

Click here for registration form.

With the (tentative) failure of Congress and the Trump Administration to completely repeal ObamaCare, the states continue to grapple with ways to make the Law work better for them.

The good news is that states still have some leeway within the law in order to make it work better and cost less. And, with an Administration in office that is more amenable to reform, now is the time for conservatives in governor’s mansions and state houses to make much-needed reforms to improve the deeply-flawed law.

Dr. Roger Stark is is the health care policy analyst at Washington Policy Center and a retired physician. He is the author of two books including The Patient-Centered Solution: Our Health Care Crisis, How It Happened, and How We Can Fix It.

Under the auspices of the Rio Grande Foundation and the Washington Policy Center, Stark’s paper “Federal administrative improvements to the Affordable Care Act and state options for health care reform” has been released in New Mexico.

He’ll be sharing his thoughts on the American health care system now as the Trump Administration’s initial reform efforts have failed. He’ll offer ideas on what, if anything might happen next in Washington on the health care reform front and offer insights into what might happen if needed reforms are not undertaken.

  • Location: Marriott Pyramid 5151 San Francisco Rd NE, Albuquerque, NM 87109
  • When: Wednesday, April 18, 2018, 12:00 noon to 1:00pm
  • Cost: Seating is limited and can be purchased at the discounted price of $30 until Friday, April 13, 2018; $40 after the 13th

Stark graduated from the University of Nebraska’s College of Medicine and he completed his general surgery residency in Seattle and his cardiothoracic residency at the University of Utah. After practicing in Tacoma he moved to Bellevue and was one of the co-founders of the open heart surgery program at Overlake Hospital. He has served on the hospital’s governing board. He retired from private practice in 2001 and became actively involved in the hospital’s Foundation, serving as Board Chair and Executive Director. He currently serves on the Board of the Washington Liability Reform Coalition and is an active member of the Woodinville Rotary. He and his wife live on the Eastside and have children and grandchildren in the area.

Click here for registration form.

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Vaping technology could improve health, cut costs

When it comes to the percentage of its population on Medicaid, New Mexico is at the top of the heap. An astonishing 44 percent of our state’s population is on Medicaid. This is a costly situation for taxpayers in the other 49 states who pick up nearly $5 billion of the program’s annual $6 billion cost in New Mexico.

While the Rio Grande Foundation spends a bulk of its time working to reform the Medicaid program itself, this does not mean that new technologies and/or improvements in the health of our population couldn’t have positive impacts on Medicaid spending.

According to the Centers for Disease Control (CDC), 480,000 people die from smoking in the United States alone every year. This is one of the leading preventable causes of death and disease in the nation. Yet, 37 million Americans continue to smoke, including more than 278,000 adults in New Mexico. The prevalence of smoking in New Mexico has a direct impact on taxpayer-funded health programs such as Medicaid, with an estimated cost of more $223 million on an annual basis.

Vaping is a leading alternative to cigarette smoking. The health effects of vaping are being studied and debated, but study after study has shown vaping to be far safer than smoking. The Royal College of Physicians and Public Health England have concluded that the use of current vapor products represents no greater than 5% of the risks of combustible cigarette use. That is because without combustion that results from lighting tobacco on fire, you remove most of the harms associated with cigarette use. A wide range of products in the U.S achieves this result, ranging from products currently on the market to products under review for future approval by the FDA. There is promise in a number of technologies that reduce the harm associated with cigarette use, even for those who can’t completely kick the habit of nicotine use.

There is already recognition in the U.S. that this could reduce cigarette use, resulting in taxpayer savings and increased public health. Mitch Zeller, director of the FDA’s Center for Tobacco Products has explained, “Newer and more novel forms of delivering nicotine… could be incredibly helpful to curtail cigarette smoking if (smokers) completely switched.”

“At the end of the day, it’s not the nicotine that causes disease and death,” Zeller continued. This may be part of the reason that vaping other smoke-free alternatives has risen in popularity among adult smokers looking to quit. According to a 2015 report from the CDC, nearly 48 percent of current tobacco smokers said they had tried e-cigarettes at least once. Among those who recently quit smoking, more than 55 percent said they’d tried the devices.

In other words, large numbers of Americans are already using e-cigarettes and vaping as a replacement for the far more harmful activity of smoking traditional cigarettes. Tens of millions of American smokers, however, may be looking for even more reduced risk alternatives to cigarettes and may not have found vapor products on the market that work for them. For that reason alone it is critical for the Food and Drug Administration (FDA) and the federal government in general to approve as many potential lower risk alternatives to cigarette smoking as possible. It is important that as Mitch Zeller has noted, “We have…an open mind.”

Better health outcomes for everyone and reduced Medicaid expenditures for taxpayers in New Mexico and throughout the nation; that is the very definition of a win-win. It is time the federal government and the FDA in particular work to expand access to cigarette alternatives like vaping rather than slowing the technology and its spread.

Paul Gessing is president of New Mexico’s Rio Grande Foundation, a non-partisan, tax-exempt research and educational organization dedicated to principles of limited government, economic freedom and individual responsibility.

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Sick leave not the (main) point of ballot measure

In October, a “sick leave” measure will appear on voters’ ballots. While touted as nothing more than an effort to require businesses to offer their employees paid sick leave, the reality is that sick leave is only one of many issues addressed in the lengthy and complicated measure.

If passed, the ballot measure will fundamentally transform the relationship between local businesses and their employees. Organizing for the Land of Enchantment is the group of out-of-state left-wing activists pushing the issue – OLÉ is the successor organization to the discredited ACORN. While it claims to work on behalf of those of modest means, Albuquerque’s economic woes will only be worsened if this measure is adopted. If it isn’t really about paid sick leave, what’s it all about?

1) Control Businesses: Employers who think “this doesn’t apply to me” or who already have generous sick-leave policies in place are in for a rude awakening. The same is true for all nonprofits and the smallest of businesses. All employers will be forced to comply with complicated new rules. For example, if an employee takes a sick day, for 90 days thereafter the employer faces a “presumption of retaliation” for any action like firing or other disciplinary action against the worker.

Employees could easily abuse this ordinance to tie an employer up in costly court proceedings. Making it more difficult to let employees go or discipline them may sound good for workers, but it is going to cause businesses to think even harder than before anytime they hire workers, especially those working for low wages and with fewer skills.

2) Boost Unions: This ballot measure provides a direct financial benefit to big labor. Albuquerque’s mandatory paid sick leave proposal specifically states the ordinance “shall not apply to workers covered under collective bargaining” – in other words, a union. Workers could soon see a portion of their paychecks diverted to union coffers as a means of protection for businesses.

Using local government to harass non-union employers and encouraging employers to unionize to obtain a “get-out-of-jail-free” card is a great way to boost the finances of a movement that continues to lose membership and popularity!

3) Tie Hands of Elected Officials: The ballot language contains an audacious line at its conclusion that attempts to tie the hands of future leaders of Albuquerque. It says, “This chapter may be amended, but … not in a manner that lessens the substantive requirements or its scope of coverage.”

Is such a provision really legal? It’s doubtful, but we won’t truly know until a future City Council decides to address some of the many problems with this ordinance. The fact that the advocates inserted such an outrageous provision into such a deeply-flawed ballot measure is one reason they are fighting so hard to keep its full text off voters’ ballots. It also sets a bad precedent for the courts, which might be inclined to allow such provisions to stand in other proposed ordinances.

Forcing businesses to pay for employee sick leave is in fact one of the justifications for the groups that have put this proposal on the ballot, but a limited, precise sick leave measure would take no more than a page. The complicated and arcane language of this (seven-page ordinance) requires voters’ careful consideration of its deleterious impacts.

If all that doesn’t convince voters, they should follow what works. Denver is arguably the fastest-growing major city in America with a 2 percent unemployment rate as of April. In 2011 Denver voters overwhelmingly rejected a far less ambitious mandatory paid sick leave proposal. The vote was a landslide, 65 percent to 35 percent. Albuquerque, on the other hand, already has unemployment of 5.6 percent, well above the U.S. average.

Voters should reject this measure, which piles more regulations on businesses and unfairly empowers both trial attorneys and unions, all under the pretense of paid sick leave.

The Rio Grande Foundation is an independent, non-partisan, tax-exempt research and educational organization dedicated to promoting prosperity for New Mexico based on principles of limited government, economic freedom and individual responsibility.

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Medicaid Reform Can Save New Mexico

Recently, U.S. Rep. Michelle Lujan-Grisham joined supporters of Obamacare in protesting the possibility that President Donald Trump will repeal or dramatically alter the law. She is not alone. Liberals are hoping to defend Obamacare, despite public-opinion polls, which continue to reflect majority opposition.

There are many (and often, conflicting) aspects to Obamacare, but if Lujan-Grisham truly represented the best interests of New Mexico, she’d be working as hard as possible to at very least reform the Medicaid portion of the law – which will bankrupt our state if it is not reformed quickly.

It is well-known that New Mexico is facing budget shortfalls. These problems are due to a combination of falling oil and gas prices and anemic economic growth.

However, it was Gov. Martinez’s misguided decision to expand Medicaid that could push New Mexico toward insolvency. While touted as an “economic stimulus,” in the upcoming fiscal year, nearly half – 928,000 – of New Mexico’s 2 million people will soon receive Medicaid, a government welfare program.

Despite (or more likely because of) expansion, New Mexico’s budget remains in a deficit and our unemployment rate remains second-highest in the nation at 6.7 percent.

This year, Medicaid expansion is expected to cost New Mexico “just” $45 million. After a few years of the federal government picking up 100% of the tab, New Mexico is now on the hook for 5% of expansion for half of one year.

Next year, with the feds still picking up 95% of the tab, New Mexico’s share of Medicaid expansion jumps dramatically to about $120 million. Over the five-year period from now until 2021 just the expansion cost of Medicaid (10% of which will soon be paid by New Mexico) will cost State taxpayers $778 million. That is money that we simply don’t have – and are not likely to have, barring a miraculous economic turnaround.

Tellingly, in Gov. Martinez’ latest budget proposal, Medicaid was among a tiny handful of spending areas that a significant increase. Schools, roads, courts, prisons, economic development, and just about every other priority our state might have will soon face the money-devouring maw known as Medicaid. Without decisive the welfare program will quickly devour the budget.

Lujan-Grisham apparently doesn’t care if Medicaid destroys New Mexico so long as ever-larger numbers of its citizens receive this government program. But President Trump is not as enthusiastic about Obamacare, or its expansion of Medicaid. He and Congress will likely address problems with the entire law, possibly in the form of Medicaid “block grants.”

A block grant means that a pool of money would be made available to the states. The revenue would be limited and, depending on details, states would be given some degree of freedom to make those dollars stretch to cover the neediest people in the state.

While specifics are being worked out, a block-grant solution would completely change the state’s incentives under Medicaid. As a recent “Progress Report” from the Legislative Finance Committee recommended, New Mexico should “efficiently and effectively use state funds to maximize the ability to draw down the federal Medicaid match, especially in light of uncertain state revenues.”

In other words, Medicaid encourages impoverished New Mexico to fleece taxpayers in the other 49 states. But grab-the-cash could be coming to an end.

With her eye on the governor’s mansion in 2018, Lujan-Grisham would be wise to bone up on ways to make limited Medicaid dollars work for New Mexico’s truly poor.

Paul Gessing is the President of New Mexico’s Rio Grande Foundation. The Rio Grande Foundation is an independent, non-partisan, tax-exempt research and educational organization dedicated to promoting prosperity for New Mexico based on principles of limited government, economic freedom and individual responsibility

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Experiences from Other States Show Merit of Dental Therapy

ALBUQUERQUE — With Santa Fe deeply divided between a Democrat-controlled legislature and a Republican-led executive branch, the potential for stagnation and stalemate is high as lawmakers convene for the 2017 session.

One issue that has generated support from across the political spectrum, won’t break the bank, and will result in both jobs and improved lives for thousands of New Mexicans is dental therapy.

The Rio Grande Foundation and Health Action New Mexico rarely see eye-to-eye, but on the issue of mid-level dental providers, both organizations are in lock-step support. Legislation will be put forth to address the issue by a bi-partisan group of legislators during the session.

The Rio Grande Foundation has released a new policy brief, “Enchanting, and Affordable, Smiles: Why Dental Therapy is Right for New Mexico.”

The paper, which was authored by Rio Grande Foundation Research Director Dowd Muska, details existing dental issues in New Mexico, including the lack of practitioners in rural communities. One Bloomberg analysis found that 40 percent of New Mexicans live in “dental deserts.” Also, the New Mexico Health Care Workforce Committee found that 18 of the state’s 33 counties have shortages of dentists.

Muska illustrates how the dental-therapy concept — which began in New Zealand — took root in Alaska, and then spread to other states, including Minnesota, Maine, and Vermont. This is a diverse group of states that, while generally in the northern part of the United States, like New Mexico, have large swaths of rural, underserved communities within their borders.

Furthermore, as Muska notes, Minnesota’s program has been in place for enough time to achieve results, including:

  • reduced wait times, with 77 percent of “patients who reported it had taken at least two months to get a previous appointment … getting the current appointment in less than one month”
  • decreased travel time for patients — for “93 percent of respondents, it took less than one hour to travel to the current dental appointment with the dental therapist, compared to 74 percent who traveled less than an hour to their last appointment”

In conclusion, dental therapy is a small but significant reform of New Mexico’s occupational-licensing laws that could have potentially large, positive impacts on the dental care received by our state’s rural population.

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Las Cruces TV interview: Preview of 2017 legislative session

Paul Gessing was recently in Las Cruces and sat down with Fred Martino of KRWG TV to discuss some of the issues that Rio Grande Foundation is working on and some of the issues facing our State in the 2017 legislative session.

The interview is about 15 minutes and can be found here:

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UNM Hospital no longer needs (as much of) your money

Every eight years, the University of New Mexico Hospital must ask Bernalillo County voters to renew their property-tax mill levy. The tax raises approximately $95 million per year and costs the owner of a $200,000 home between $300 and $400 annually.

The median overall property tax burden on a $200,000 home in Albuquerque is $2,698, so UNMH claims a significant proportion of your property-tax bill.

And while the hospital claims, rightly, that your tax burden won’t increase if the levy is renewed, the fact is that public-policy conditions have changed that should allow the hospital to require less of county residents’ hard-earned money.

A big portion of UNMH’s mission is “indigent care.” That means providing services for the uninsured and others who can’t pay for their own health care. But since the last mill levy passed, Obamacare took effect, with a primary mission of “insuring” indigent care via a massive expansion of Medicaid.

Whether you think Medicaid expansion was a good decision or not, UNMH has seen indigent care needs drop dramatically. In 2013, UNMH served approximately 27,000 county residents. UNMH is now serving less than half the uninsured county residents it did in 2013.

So why is UNMH requesting the same mill levy for a rapidly declining number of uncompensated-care cases? Perhaps it assumes that voters will blindly go along with yet another feel-good scheme to separate them from their money?

Voters should carefully consider not renewing the mill levy – and instead, force UNMH to come up with a different, smaller ask in the future. After all, it isn’t as if we’re not paying for Medicaid expansion already.

As federal taxpayers, we have been funding – and borrowing money to fund – Medicaid expansion for years. But over the next five years, New Mexicans will be on the hook for a bigger portion of the overall bill: $778 million, to be exact.

We know how bad our economy is. What no one knows is how we’re going to pay the huge new bill for Medicaid expansion.

Perhaps more troubling, as far as UNMH is concerned, is why a government-owned entity with a core mission that includes indigent care advertises its services. The Rio Grande Foundation requested data for the calendar years 2014, 2015, and 2016, and found the hospital spent $1.3 million over that time period on advertising.

Yes, the U.S. Postal Service, which like UNMH, is government-owned, advertises, but that doesn’t make it right or necessary. (And at least the post office charges its customers.) Why spend hundreds of thousands annually to tout that UNMH exists and that it is New Mexico’s “only Level I Trauma Center?”

UNMH already has a website set up in support of the mill levy. The deck is always stacked against those who oppose publicly funded entities in campaigns to either raise taxes or keep the tax revenue flowing in.

To the extent that any grass-roots opposition to the UNMH mill levy forms, it will be outspent dramatically. Amazingly, the hospital’s annual advertising budget far exceeds the annual budget of the Rio Grande Foundation.

There is nothing new about the forces of limited and responsible government being outspent, but with the amount and cost of indigent care on the decline, shouldn’t Bernalillo County residents have a fully informed debate about the UNMH mill levy before Election Day?

D. Dowd Muska (dmuska@riograndefoundation.org) is research director of New Mexico’s Rio Grande Foundation, an independent, nonpartisan, tax-exempt research and educational organization dedicated to promoting prosperity for New Mexico based on principles of limited government, economic freedom and individual responsibility.

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Bernalillo County Voters Should be Skeptical of UNMH Mill Levy

Every eight years, University of New Mexico Hospital (UNMH) must ask Bernalillo County voters to renew the Hospital’s Mill Levy. Bernalillo County imposes a mill levy for the Hospital at a rate approximating 6.400 on both residential and non-residential property in the County. This money is used to fund Hospital operations. Initially, $95 million will be collected annually although the exact number will fluctuate based on property values and economic conditions in the County. The trend <em>should </em>be upwards, however.
<ul>
<li>As of June 2016, UNMH served <strong>6,812</strong> uninsured county residents. If that trajectory holds through December that would mean the Hospital will serve 13,624 uninsured patients in 2016.</li>
</ul>
In 2013, UNMH served <strong>approximately 27,000 county residents. </strong>UNMH is now serving less than half the uninsured county residents as they did in 2013.

New Mexicans are paying the bills for both the ObamaCare Medicaid expansion that is reducing those “uncompensated care” rates, but UNMH wants to continue taking hundreds of dollars from both commercial and residential property owners throughout Bernalillo County <strong><span style=”text-decoration: underline;”>for another eight years!</span></strong>

As the Rio Grande Foundation’s Paul Gessing argues <a href=”https://www.riograndefoundation.org/downloads/rgf_unmh_mill_levy.pdf”>in a new issue brief</a>, voters should consider sending UNMH “back to the drawing board” for a smaller mill levy that reflects the falling costs of uncompensated care. The image below illustrates how the current UNMH mill levy impacts at least one property owner’s tax bill.

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New Mexico’s behavioral healthcare system needs new thinking

That’s the conclusion of research our organization has conducted on the public revenue and resources dedicated to fighting substance abuse and mental disorders in the Land of Enchantment.

Certainly the crisis is severe. Alcohol-related deaths are rampant. The drug-overdose rate remains among the highest in the country. More citizens here have mental illnesses than the national average, and the prevalence of suicide is greater here than in all but three states.

But what’s more depressing than the reality of the behavioral-health epidemic is state government’s inconsistent and failure-ridden attempts to address the problem.

In 2002, “Behavioral Health Needs and Gaps in New Mexico,” an investigation commissioned by the Legislature, concluded that there was “no identifiable behavioral health system leader with responsibility or authority across the behavioral healthcare systems in the state.” In addition, the “benefit packages of the various behavioral health systems within New Mexico” were “not organized to maximize available resources or to provide incentives to providing care that has been proven to be effective (evidence-based or promising clinical practices).”

In response to the report, legislators and then-Gov. Bill Richardson created the New Mexico Behavioral Health Purchasing Collaborative, overseen by the Human Services Department, to bring leadership, focus, and accountability to the state’s public system of behavioral healthcare. But reports by the Legislative Finance Committee have repeatedly found that the collaborative hasn’t performed nearly as well as its creators hoped.

Even worse, radical policy shifts — including “carving out,” then “carving in” behavioral-health services for Medicaid recipients, and the brutal, partisan fight over Gov. Susana Martinez’s 2013 suspension of Medicaid payments to nonprofit providers due to suspicions of fraud — have taken a heavy toll.

No one can change the mismanagement and chaos of the past. The goal now is to move forward with sound principles and policies. A good place to start is with the flawed assumption that the only thing wrong with New Mexico’s behavioral-healthcare system is a lack of revenue.

Our examination found that states with high-performing systems do not necessarily spend more on substance abuse and mental illness. The key is to use what funding is available in the most effective ways possible. In 2014, legislative researchers found that the state spent just “11 percent of its … funding on proven and effective (behavioral-healthcare) programs for adults, even though past studies have recommended greater spending on these services.”

An expansion of mental-health courts would be a wise investment. Diverting an offender with behavioral issues from jail is an early intervention measure proven to be effective. Columbia University’s Paul S. Appelbaum wrote that most recent research shows that participation “is associated with reduced rates of rearrest and reincarceration compared with ordinary handling by the courts and correctional system.” Mental health courts exist in the Albuquerque-Santa Fe region, but not elsewhere in the state. Otero County is exploring a court of its own, and others should follow.

For those with a chronic condition who refuse help despite multiple arrests and/or hospitalizations, a stronger approach is need. Assisted outpatient treatment is a court-ordered plan that can include medication, tests, therapy, training or counseling. In the words of the Treatment Advocacy Center’s Brian Stettin, that type of treatment “leads to reduction of hospitalization and criminal acts,” and reduces the number of “people … getting treated in jails or prison for mental illness.”

New Mexico adopted AOT earlier this year, but was one of the last states to do so. However controversial the process remains, it’s now incumbent upon local governments and the courts to use the tool to help behavioral-health sufferers and taxpayers alike.

Finally, New Mexico’s behavioral-health workforce is inadequate — a harsh reality exacerbated by the governor’s decision to expand Medicaid under Obamacare. For fiscal and economic reasons, there is little chance for a quick turnaround. But training public employees in mental health first aid, and expanding the state’s system of peer support, can help compensate for an insufficient number of professional caregivers.

Dowd Muska (dmuska@riograndefoundation.org) is research director of New Mexico’s Rio Grande Foundation, an independent, nonpartisan, tax-exempt research and educational organization dedicated to promoting prosperity for New Mexico based on principles of limited government, economic freedom and individual responsibility.