New Mexico has a shortage of medical providers across most practice areas (as discussed in Part 1 of this series). So, as the 2023 legislative session gets rolling, what can be done about it?
1) While forward looking in nature, HB 75 passed in 2021 and was revised later on that same year makes New Mexico’s medical malpractice much more plaintiff and attorney friendly through the increase in damage award caps is causing a great deal of concern among providers even though it will not be implemented until 2024;
2) Stop taxing medical providers via gross receipts tax. The State is one of the few states in the entire nation that levies the equivalent of a “sales” tax on certain medical services. In New Mexico’s largest city, Albuquerque, the rate of taxation is currently 7.75 percent. Rates tend to be even higher in outlying areas of New Mexico. This could be part of a broad reform or more targeted.
3) Reduce Medicaid dependency. According to the American Hospital Association, Medicaid underpaid hospitals by$24.8 billion in 2020. For Medicaid, hospitals received payment of only 88 cents for every dollar spent by hospitalscaring for Medicaid patients in 2020.In 2020, 62 percent ofhospitals received Medicaid payments less than cost.
4) Expand scope of practice/telemedicine.
There are several additional ideas outlined in the report along with more detailed discussion of the ideas listed above. All of it can be found here.
The following appeared in the Las Cruces Sun News on Sunday, January 22nd, 2023.
In December the Legislative Finance Committee (LFC) published a report on New Mexico’s Medicaid program. Whether by design or accident, the report happened to coincide with the 10th anniversary of New Mexico’s Medicaid expansion. Then-Gov. Susana Martinez decided to accept the “ObamaCare” expansion dollars which, at the time, was 100% federally funded.
The LFC report is full of great information, but it doesn’t attempt to assess whether Medicaid expansion was worthwhile. Unfortunately, when it comes to government programs (especially here in New Mexico) increased spending and good intentions are not often followed by thoughtful assessment of whether the spending has achieved stated goals. Even less common are analyses of whether the new program itself was cost-effective in achieving those goals.
The media covered the LFC’s report which focused mostly on difficulties the Committee’s “secret shoppers” had in making appointments with doctors for Medicaid patients. For example, the LFC found that only 15 percent were able to make an appointment with a primary care doctor. Other doctors were not accepting patients, failed to return phone calls, or were no longer at that phone number. These findings highlight an important problem with Medicaid: having “coverage” (especially from a government welfare program) doesn’t mean you have access to medical care.
Less prominent in the news reports was the fact that the LFC reported that an astonishing 47 percent of all New Mexicans are on the program and a positively mind-blowing 77 percent of births are on Medicaid.
Ample reporting has been done about New Mexico’s medical provider shortage. While there are many reasons for that shortage, our State’s massive Medicaid population and the program’s low reimbursement rates for providers are certainly factors. Any doctor will share their views on the challenges of serving large numbers of Medicaid patients.
New Mexico’s extraordinarily high number of Medicaid recipients is at least partially to blame for the State’s low workforce participation rate. The LFC itself has noted that Medicaid and other government welfare programs, “can disincentivize work through either excessive benefits or reduction of benefits as recipient wages increase.”
Furthermore, the LFC report notes that Medicaid is the largest healthcare payer in New Mexico, and the state has the largest Medicaid program per capita in the country. Between FY19 and FY23, HSD projects total Medicaid spending to increase approximately 56 percent from $5.6 billion to $8.8 billion. In other words, by next fiscal year Medicaid alone will be spending more than New Mexico’s current General Fund budget.
Sadly, the LFC did not take up a detailed discussion of health care outcomes and the impact (or lack thereof) of Medicaid expansion. The LFC did note that, “the state continues to face poor health outcomes overall.” And, even more interestingly, while providing routine medical care for the poor was a stated goal of advocates for expansion, the LFC notes that “Emergency room visits for non-urgent reasons have increased, potentially leading to worse outcomes.”
After a decade of massive federal and state spending growth on Medicaid the LFC does not point to significant positive health care outcomes from Medicaid expansion for New Mexico’s population at large. Given the incredible impact this program has on state and federal budgets, it would be nice to know whether Medicaid expansion is having a positive impact or not. The LFC didn’t even mention the lack of evidence on health outcomes much less call for such research or upbraid the legislature for failing to conduct it already.
The largest and most expensive expansion of the American welfare state in the last 50 years seems to have resulted in bigger government and more government dependency. However, here in New Mexico with the highest percentage of people on Medicaid, evidence of improved health outcomes remains elusive.
Paul Gessing is president of New Mexico’s Rio Grande Foundation. The Rio Grande Foundation is 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
Thanks to legal help from the Liberty Justice Center, a non-profit, public interest litigation center, the Rio Grande Foundation and its president Paul Gessing have filed a lawsuit against the City under New Mexico’s “anti-donation clause” over the City’s “donation” of $250,000 of our tax dollars to Planned Parenthood. You can read more about the case here.
“New Mexico’s constitution prevents politicians from using taxpayer funds like their own personal piggy banks,” says Daniel Suhr, managing attorney at the Liberty Justice Center. “Albuquerque’s grant to Planned Parenthood is pure politics, and the state constitution prevents that kind of abuse of taxpayer dollars.”
“Taxpayers should not be compelled to subsidize Planned Parenthood or any other private group,” said Gessing, who is president of the free-market Rio Grande Foundation. “The anti-donation clause of New Mexico’s constitution is a bulwark for taxpayers against politically motivated earmarks just like this one.”
Sadly, Albuquerque’s City Council seems to have ignored New Mexico law which clearly states that “Neither the state, nor any county, school district, or municipality … shall directly or indirectly lend or pledge its credit, or make any donation to or in aid of any person, association, or public or private corporation …”
In a new policy brief which explores the shortage of medical providers in the State of New Mexico, the Rio Grande Foundation digs into an analysis of which areas of medical practice face the most acute shortages and compares New Mexico counties, New Mexico with its neighbors, and also looks at geographical trends regarding the availability of medical providers nationwide.
New Mexico is not alone in the Southwest in having a relative shortage of medical professionals. Compared to the Northeast and Midwest, there is already a shortage of healthcare workers in states in the South and West. Interestingly, the region where doctors are paid the least in nation is the Southwest, where many older adults who require healthcare services choose to retire.
Physicians in the north central part of the nation average pay of $319,000 per year. In the southeast, however, physician salaries are more than $40,000 a year less, running at around $277,000 a year. New Mexico’s average physician salary was even less, ranking third from the bottom of lowest-earning states with an average annual physician compensation rate of $261,000.
Our research does indicate that New Mexico has a serious shortage of health care workers in a variety of medical fields. These especially include primary care physicians, surgeons, registered nurses, OB-GYN’s, pharmacists and EMT’s. Fortunately, the state currently appears to have an adequate number of physician assistants, dentists, and nurse practitioners.
In a follow-up report Rio Grande Foundation will provide specific ideas on how policymakers, especially those here in New Mexico, can address the State’s medical provider shortage.
According to news reports, however, the Gov. has rescinded that requirement. Employees will be required to return NEXT month at the start of February. This is another case of poor leadership from the Gov. COVID (and remote work) has been going on for nearly 3 years now. The Gov. and her team should have figured out who needs to be in the office 5 days a week and who doesn’t (and how to manage them effectively) by now.
Could some state buildings be shuttered and sold off? Should the locations of gov’t buildings be shifted to reduce commute times? How can we make sure remote employees are actually doing their work?
The National Assessment of Educational Progress (NAEP) is known as “the Nation’s Report Card.” Sadly, the most recent “report card” represented failure for many states, not the least of which is my home state of New Mexico, which came in dead-last in all categories studied: fourth-grade and eighth-grade reading and math.
Sadly, especially for New Mexico kids, the additional tax dollars being spent by the state’s education system have not moved the needle. If anything, the needle has moved in the wrong direction.
Let’s compare New Mexico with lower-spending, reform-minded states, such as Arizona and Mississippi. Arizona neighbors New Mexico and has a similar demographic profile, including large Native American communities and a large Hispanic population. Mississippi has poverty challenges similar to New Mexico’s and has also struggled with poor education outcomes for decades. A common saying in New Mexico for years was, “Thank God for Mississippi,” as it was often the only state doing worse than New Mexico on many lists of social well-being and economic outcomes.
But Arizona and Mississippi have enacted serious reforms while New Mexico has not. Using NAEP test scores, it is easy to see which states have improved their education systems and which haven’t. We’ll use fourth-grade reading scores to make the comparison. Many education analysts argue that fourth-grade reading is especially critical because up until fourth grade, much of education involves learning to read. After fourth grade, it is difficult or even impossible to succeed in school without being able to read well.
In 2005, New Mexico outperformed Mississippi on fourth-grade reading and was tied with Arizona, with a score of 207. By 2022, Arizona outperformed New Mexico 215 to 202 while Mississippi outperformed both states with a score of 216.
Neither Arizona nor Mississippi dramatically increased K–12 spending. According to data from Statista, in FY 2022 Mississippi spent $10,089 per-student, while Arizona spent $10,639. That places them as the third- and fifth-lowest-spending states in the nation. The U.S. average is $15,047.
Today, New Mexico ranks 19th among states at, considering its dismal educational record, an astonishing $15,338 per student. That is higher than the national average despite other states’ having also increased spending over those years.
What happened? Arizona and Mississippi embarked on serious (albeit different) education-policy reforms while New Mexico did relatively little other than increase spending.
Arizona has had a charter-school law since the mid 1990s and continues to see charter schools grow in terms of options and students. It is ranked as the second-best charter law in the nation, according to the Center for Education Reform.
It will be interesting to see if Arizona (especially with its new choice law) and Mississippi can keep or accelerate the momentum. Sadly, New Mexico is one poorly performing state that has not gotten serious about either approach. The children in my state have suffered despite a large increase in government education spending. Better results are possible without breaking the bank, as Arizona and Mississippi have proven.
The following appeared in the Santa Fe New Mexican on December 24, 2022 and in numerous other news sources.
As the State’s Permian oil production boom continues in New Mexico the budget surpluses available to legislators each session grow as well. The latest announced budget surplus is $3.6 billion which is a positively mind-blowing 43 percent. This surplus is on top of already dramatic spending growth of 30 percent during the first four years of the Lujan Grisham Administration.
But I’m not here to rail about the size of New Mexico government (at least not this time). Rather, I’m here to remind legislators of both parties that such massive surpluses present rare opportunities to lead our State to a better future.
Gov. Lujan Grisham has already proposed rebates of $750 or $1,500 for New Mexicans depending on marital status. Rebates are a bi-partisan idea, one supported in the recent campaign by her Republican opponent Mark Ronchetti, though details differed. To be clear the Rio Grande Foundation does not oppose tax rebates if they are not an excuse to (yet again) punt on long-overdue tax reform. Returning a portion of the budget surplus is not going to move New Mexico’s economy forward and diversify it in the same way as long-overdue tax reform would.
The same can be said for an idea that often garners bipartisan support in Santa Fe: that is bolstering various permanent and “rainy day” funds. Quite honestly, New Mexico has numerous big problems facing it. There is no better time to address these problems than right now. If policymakers use the surplus to diversify and improve the State’s economy in ways that will make it more competitive with its neighbors, the well-being of future New Mexicans won’t be so contingent on the vagaries of oil and gas.
New Mexico’s litany of current economic challenges includes:
A low workforce participation rate that has historically lagged behind our neighbors and remains well below pre-pandemic levels and has even dropped in recent months;
A medical provider shortage that, while driven in part by regulations is worsened by gross receipts taxation of medical practitioners including Medicaid services;
Lack of economic diversity in a state that relies heavily on oil and gas for money and government (federal, state, and local) for employment opportunities;
Water and other infrastructure issues.
These problems (and more) can at least partially be solved by using New Mexico’s financial largesse wisely. New Mexico policymakers have long focused on government-driven approaches to these problems. State and local government spends a very high percentage of the economy.
Majority Democrats have an opportunity to not only pump more funding into their priorities, but they could show that they are pro-business and interested in using oil and gas revenues to diversify the State economy for a time when the oil and gas industry isn’t as bullish.
Republicans, rather than leaving the bold ideas to Democrats, should offer their own serious reform ideas and bills in the upcoming session. Ideally, the minority GOP could influence Democrats toward a more pro-growth agenda. Worst case, in two years they can point to their detailed policy ideas and use them to challenge Democrats for failing to take advantage of this unique opportunity.
Regardless of your political affiliation or beliefs we all must realize that 43 percent budget surpluses don’t come around often. We can’t solve all of New Mexico’s problems even with this massive surplus, but with strategic moves like those outlined here we can certainly move the needle.
Paul Gessing is president of New Mexico’s Rio Grande Foundation. The Rio Grande Foundation is 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
The Rio Grande Foundation recently led a diverse coalition of 19 state policy think tanks in submitting comments in opposition to the Federal Railroad Administration’s(FRA) proposed Train Crew Size Safety Requirements Rule (Docket Number FRA–2021–0032;RIN 2130–AC88). You can find the comments here.
As employers across the nation struggle to find enough employees, the Biden Administration wishes to impose a 2 person crew size mandate on railroads. In 2016, theFRA statedthat it could not “provide reliable or conclusive statistical data to suggest whether one–person crew operations are generally safer or less safe than multiple–person crew operations.” And, in 2019, theFRA concludedthat, “Accident/incident data does not support a train crew staffing regulation.”
As the letter states:
The proposed rule also ignores technological advances in rail safety made in recent years, including Positive Train Control (PTC). PTC is now operating on tens of thousands of miles of rail line across the country, tracking speed restrictions on a given portion of track, as well as signals and communications, while preventing human error. PTC’s safety advances make it unnecessary for two crew members to be present in the cab of the train.
This proposed rule fails to account for these technological innovations, as well as the safety record of many railroads, including thousands of Amtrak and commuter passenger trains that operate with only one crew member in the train cab.
The Biden Administration has made its contempt for the so-called “gig” economy clear. The Administration has proposed multiple rules which would force those workers into “employee” status even though being an Uber driver (for example) simply doesn’t fit nicely into that type of employment status.
The Rio Grande Foundation provided public comment in opposition to the following two Biden Administration rules which would force workers into these unnecessary and absurd boxes. You can click on our comments below:
Millions of workers nationwide enjoy the freedom of the “gig” economy while also providing useful services to even larger numbers of Americans. The Biden Administration’s attacks would be harmful to workers and American consumers alike.
According to the latest news reports New Mexico has a mind-blowing $3.6 billion budget surplus available to it when the Legislature convenes in January. This is, of course, derived largely from a production-driven boom in New Mexico’s oil and gas industry. Between now and January we and others will have plenty of time to discuss potential uses for the money. For now we’d like to simply help people grapple with the sheer size of this surplus.
The budget surplus alone is a mind-blowing 43% of the current $8.4 billion budget which is in itself a 30% bigger budget than when Susana Martinez left office.
The budget surplus is more than 7X the State’s “public safety” budget and 3.5X the entire higher education budget.
The State could ELIMINATE the entire gross receipts tax ($3.047 billion) for FY 2024 and still have nearly $600 million left over.
The State could ELIMINATE ALL personal and corporate income taxes ($2.107 billion for FY 2024 and still have $1.5 billion left over.
What WILL happen is anybody’s guess. With New Mexico’s continued economic struggles there are plenty of opportunities for the type of pro-growth tax reform the State sorely needs.
As a quick reminder, New Mexico’s state and local spending is already tops in the nation according to the website US Government Spending:
