Friday, March 11, 2016

The NM Medicaid Dilemma 

This column is also appearing in the current edition of the ABQ Free Press.

Say someone offered you three or four dollars if you gave them a dollar bill? A no-brainer, right? Apparently not in the befuddled halls of the Roundhouse. Here's the story.

The bean counters are now reporting that the state Medicaid budget is $86 million short. The healthcare program for low income New Mexicans was expanded by President Obama and Gov. Martinez signed off on it. Because the Feds give generous matching funds for every Medicaid dollar the state spends, if we don't come up with that $86 million we will actually come up short $416 million. With the horrific economic impact such a drastic cut in spending would have on an already ailing economy, you would think Santa Fe would be in a rush to fill the budget gap, take the federal match and keep Medicaid up and running at full strength.

But getting $86 million from a state budget already ravaged by the collapse in oil revenue, weak tax collections from a weak economy and years of excessive tax cutting, has the austerity hawks in the Martinez administration and Legislature looking at cutting the program instead of fully funding it, leaving on the table that $416 million.

If reimbursement rates for medical professionals are slashed dramatically many will join the exodus out of the state. Reducing care for the 850,000 low income New Mexicans who receive it could mean an even less healthy and less prepared work force. Healthcare has been one of the few sectors showing robust job growth and if this Medicaid debacle is not resolved that will end. Remember, this state has the highest jobless rate in the nation.

Before the conservatives go off the rails over Medicaid being too generous and that it can withstand severe cuts,  keep in mind that Medicaid covers single adults who make up to $16,242 a year. A family of four making  up to $33,465 qualifies. Our economy and wages are so in the cellar that it's expected that well over 900,000 residents--nearly half the state's population--will qualify for Medicaid by July 2017. This is not a population with alternatives. 

The recent legislative session ended with a round of self-congratulations and back slapping but now we are seeing the budget lawmakers crafted is akin to flying on a wing and a prayer. They did not do the heavy lifting necessary to ensure proper funding for Medicaid or the rest of state government.

Behind this Medicaid crisis looms political nonsense. Namely, the insistence by Martinez and her fellow Republicans that taxes can never be raised for any reason.  Never mind if it could mean you get a ride to the cemetery instead of the ER.

Martinez reluctantly signed on to the Medicaid expansion. A number of other Republican governors refused. She had no choice because of the hundreds of thousands in need here. If she opposed the expansion she might have lost her re-election bid. Now that she is no longer running she is pursuing he national ambitions and has put the state in her rear-view mirror.

Hope is not a sound budget strategy but that's what the Governor and the Legislature have  given us. They hope oil prices jump and they hope the economy reinvigorates resulting in a leap in state revenue that solves the Medicaid crunch. If not, don't worry. It's just a bunch of poor people who don't vote and don't contribute to political campaigns.

The mismanagement in Santa Fe is bad enough during good times but in bad times like these it is dangerous. True and responsible leadership would have a handful of House Republicans join with Democrats and raise the gasoline tax to begin solving the crisis. They could also agree to sweep into the budget millions of dollars for pet projects approved by the Legislature but left gathering dust, sometimes for years.

In these ever more challenging times the state desperately needs bold leadership, but right now we'd settle for some that knows that getting four bucks for spending one is a good deal.

This is the home of New Mexico politics.

E-mail your news and comments. (jmonahan@ix.netcom.com)

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