While New Mexico is among states that will feel a major economic impact from changes in the federal health care law, New Mexico has no Republican senators involved in private meetings about the bill in Washington, D.C.
The American Health Care Act, passed by the U.S. House of Representatives as a proposed replacement for the Affordable Care Act, is being revised in the U.S. Senate. Though Republican leaders in the Senate say they want to pass health care changes by July, they have offered no details on their proposals.
Under a special rule put forward by Senate Majority Leader Mitch McConnell, R-Ky., the bill would bypass committee review and go directly to a vote in the full Senate, where Republicans hold a 52-46 majority with two Independents. The amended bill would then need House approval before heading to President Donald Trump to become law.
"It's very strange, taking something that affects one-sixth of the economy and ... doing the changes quickly without public hearings," said Barbara Webber of Health Action New Mexico, a consumer advocacy organization. Any rollback in Medicaid coverage for low-income New Mexicans, she said, would be devastating for the state.
"It would trigger a depression for New Mexico when you talk about the loss of that many jobs," she said. "And then there is the moral and ethical concern for the many people who would lose their health care."
On Thursday (June 15), New Mexico's two senators, Tom Udall and Martin Heinrich, both Democrats, joined others in introducing the "No Hearing, No Vote Act" in an attempt to require a public committee hearing prior to a Senate vote on what Democrats call "TrumpCare" legislation.
One congressional analysis indicates between 13 million and 23 million people with private health insurance or government-supported Medicaid might lose coverage if the House-passed version advances unchanged. The bill not only rolls back a recent Medicaid expansion, but changes the level of assistance for middle-income consumers who buy health plans on the healthcare.gov government exchange.
A report released June 14 by the Commonwealth Fund and the Milken Institute School of Public Health at George Washington University indicates that 924,000 jobs would be lost nationally by 2026, mostly in health care.
New Mexico and other states that expanded Medicaid to low-income working adults under the Affordable Care Act, also known as "Obamacare," would see the largest percentage of job losses. The state now has 187,000 people on Medicaid under the expanded program for adults.
"States that expanded Medicaid have deeper and further losses," reported the Commonwealth Fund. "Having earned more federal funds, they lose more when Medicaid matching rates fall."
Under the traditional Medicaid program, enacted in 1965 and expanded to cover children in 1997, the federal government pays about 75 percent of the cost for health insurance or direct services for children, the disabled and those living in poverty. But as former President Barack Obama sought to expand insurance coverage, he leveraged Medicaid to cover more adults who are not in poverty, but might be too poor to afford health insurance.
As an incentive, the federal government is paying a larger share for these patients, 95 percent of costs today, scaling back to 90 percent in two years.
In January 2013, Gov. Susana Martinez was one of the few Republican governors to accept the expanded insurance program, approved at a time when the state was seeing an increase in revenue from higher energy prices.
The expansion reaches individuals earning about $15,800 a year in New Mexico, or $32,319 for a family of four. The Affordable Care Act boosted the Medicaid population by more than 60 percent, with total enrollment standing at 787,110 in March.
The proposed cutbacks would force the state to close the door on new enrollment and eliminate the program for those adults or drastically reduce benefits, depending on a final bill. That would translate into fewer health care jobs.
No one knows exactly what a final Senate bill will look like - and senators from expansion states already are asserting that current enrollment numbers will be maintained.
But the Commonwealth Fund report estimates 11,000 job losses through 2026, with 3,700 of those coming immediately if Medicaid expansion is repealed. By 2026, the economic loss to the state would reach $1 billion.
Lee Reynis, a researcher and economist with the Bureau of Business and Economic Research at the University of New Mexico, is not surprised by those numbers. She did an analysis of the Medicaid expansion program that found the economic boost from additional federal dollars significant.
"Medicaid expansion was huge," she said. "That was a large chunk of money coming into the state and it clearly made a difference."
More important, however, was that the Affordable Care Act got more people covered by insurance and into medical care. And retaining those insurance gains is the challenge ahead, she said.
As part of a condition for accepting the expansion, Martinez was one of six governors to receive the assurance from the federal government that if federal dollars were reduced, the state obligation to the newly insured could be re-evaluated and perhaps ended.
No one knows exactly how that would work, but state Rep. Deborah Armstrong, an Albuquerque Democrat who chairs the Health and Human Services Committee in the New Mexico House of Representatives, said, "I don't think we can just stop it. You can't just flip a switch on any of this stuff. They have to go through a process, it can't happen overnight."
Udall, who is vice chairman of the Senate Indian Affairs Committee, expressed concern about the potential impact on tribal communities.
"It's clear to me that any potential changes to the national policy regarding Medicaid and heath insurance programs like those contained in the [American Health Care Act] will directly impact Tribal communities and Native lives," Udall said in a statement. "I would like to urge the majority - on all committees - to follow regular order, hold hearings, and seek Tribal consultation on any proposal that would cut access to life-saving health coverage programs."
Heinrich said the lack of transparency in the bill is "irresponsible, especially when millions of people stand to lose their health coverage."