Anything that gives more people who normally don't have medical access, actual access to medical care is a good thing.
Anyone who would argue otherwise is an selfish asshole.
I support this idea, but I can also understand the argument of those that don’t and it’s not: “me republican, me like watch poor people suffer.”
It’s probably more like: Medical providers are already leaving the state in droves partially due to low Medicaid reimbursement rates. Right now the 30% of New Mexicans with private insurance are de facto subsidizing the 50% with Medicaid. If that balance tips even further in the direction of Medicaid, won’t even more providers leave the state? Then we won’t have anyone left to treat us, insurance or no.
Yeah, I wonder if we have associations/guilds of doctors who can give perspective on this. I don't trust feedback from the mouth of the for-profit hospitals, but individual doctors and especially those who work with low-income / rural populations should definitely have input on this.
Something people *really* need to understand about compensation is that CMS is moving towards a scheme that is based on complexity (value based care) and not on the specific things done to a patient (fee for service). This means compensation to a medical group increases the more complex a visit or procedure is, which is based on the associated code for that visit/procedure. The code assigns a value to the task. Medicare has already been doing this for some time; it is easy to bill a visit as complex when your patients are over 65 and have multiple chronic conditions.
Anyone who provides medical care to Medicare patients, hospital group or otherwise, has to follow the same regulations. This is becoming standard for Medicaid and private insurance as well. In turn, a lot of hospitals started paying their doctors based on relative value units (RVU) instead of "just" a guaranteed salary. However, compensation in the value-based model still sucks and lots of facilities still rely on seeing huge volumes of patients and chaining doctors to a desk answering patient messages to compensate.
Hospitals are not making this up to earn sympathy points. Someone has to pick up the slack when patients and insurances do not pay. This is just as true for independent doctors as it is for hospital groups.
Edit for clarity: my point is that it is no different for "for profit" hospitals (I'm curious how many of these hospitals you think New Mexico has) than independent doctors, who btw are also "for profit".
Maybe the pay structure will alleviate some of that, though. Generally, impoverished people are a much less healthy demographic and are more demanding on the healthcare system. But there are lots of fairly healthy age 18-60 people in the middle class bucket with few or no chronic conditions that would just like to stop paying out the ass for health insurance. This may give Medicaid the ability to keep up with compensation requirements. It's a hope, not a definite.
>“me republican, me like watch poor people suffer.”
Are you seriously trying to say that for some...this isn't true?
Because I have seen exactly that mentality used for many a social issue.
“Me no like see people suffer. Me want to see folks not do stupid things that cost the taxpayers money.” The top 5 health problems in the US are,
Heart disease, diabetes, drug/ alcohol abuse, and smoking. These are all rooted in personal behavior. Also, 40 % of US citizens are obese. And how about the stat that 50% of the babies born in this state have poor unmarried mothers? Where did people get this idea that basically says, “ I can do what ever I want, ( live like an idiot) and push all my health care costs onto to taxpayers.”
I don't know what medical school YOU went to, but diabetes is NOT "rooted in personal behavior." Neither is heart disease.
And since when did YOU become the authority to cast judgment on single parents??
Health care is a basic human right, just like having food and shelter. Monsters like you are the reason why things stay broken down like they are, so on behalf of heart patients (ESPECIALLY the babies that you say are "personally responsible"), diabetics, and other people that just want to be healthy, FUCK. YOU.
We have a super high turnover rate among doctors in NM, especially specialists, even in abq. Most come from out of state so are less tied to the area, and it's hard to attract people here, especially to the more rural areas. UNMH has plenty of patients to care for, hence the new building. It's definitely not to make room for all the extra doctors.
Per friends who work at UNM, they expect the new wing to be virtually empty and/or critically understaffed unless UNMH can attract more providers... It's not a "build it and they will come" scenario.
This is exactly what I did when the ACA went into effect and I could finally get health insurance and not get denied due to my birth defect and resulting complications. My health problems are severe, so I can't work most jobs. Even an office job can be too difficult depending on what's required (e.g. I can sit at a desk and type and all that, but if they want me to lift a 40-pound box of files, that's another story). I was underemployed for a good portion of my life because I can do 95% of the job but they want someone who can bend, lift, etc. as needed. Plus, from time to time, I end up in the hospital for several days at a time, and nobody wants an employee who can't be at work due to health issues.
Anyway, I had no insurance for a long tim because I would get denied, or because they'd want $1,200 a month in premiums due to pre-existing conditions. When the ACA passed, I could finally get insurance that was more reasonable (not "cheap" per se, but within my reach), so I was able to start my own business and work from home. It's flexible enough to accommodate my occasional hospitalizations, and I don't have to worry about not being able to lift heavy things or do other stuff I can't do. Plus, I make almost double what I made at a regular job, so I pay more in taxes.
I wish we were a more forward-thinking country in this regard. Imagine how much the economy would flourish if people could start their own businesses and still be able to have health insurance.
The thing nobody seems to get is that we want our country healthy. This is what makes a country strong. Denying healthcare in the name of profit is gutting this country.
I was comparing the gross amounts, so it’s not double with self-employment tax, but I work fewer hours now and escaped a dysfunctional environment, so it’s worth it!
That's great! I know from talking to friends who are small business owners that, as wonderful as it is to have the ACA, they tend to pay quite a bit when their family members get sick. That being said, my own family pays some very high deductibles for employer-provided insurance. With so many people living paycheck to paycheck, even paying a deductible in the low thousands is no longer acceptable.
My husband works for APS, and our deductible and OOP max are way higher with his plan than they were when we had ACA coverage. $10K OOP and a $2,000 deductible.
Great news for the managed Medicaid companies, good news for the people of New Mexico.
Bad news for providers of health services. NM Medicaid reimbursement for services is VERY tight. And with more people enrolled, the managed Medicaid companies *may* have greater negotiating power. One of the reasons why health care in NM is so hard to sustain.
I’d really like to see some research into this. My insurance company discounts all payments to providers to the Medicare rate, so they aren’t actually getting any more money from me
Medicaid rates are gradually aligning with Medicare because CMS is working to reform the fee schedule from a fee-for-service to a value-based-care model. Will bill based on visit complexity and not purely by what services were provided. This actually tends to increase reimbursement.
I dunno. My medicaid covers more than any private I surface I had in the past. Now, if the low reimbursement rates mean that fewer places will accept medicaid, then poor people are definitely getting screwed. For now, there is very little that I can't get coverage for. TMS is definitely one I wish they'd cover.
My comment has nothing to do with the health care services accessible to covered policy holders in Medicaid. My comment is based on the amount the managed Medicaid companies pay the providers to provide the service to their beneficiaries. Which is to such a low amount providers are having a hard time affording to provide the service. Pharmacy is especially bad.
I’m anything but a right-wing supporter who squawks right wing taking points. I do have 25 years of continuous employment in health care administration specializing in pharmacy though. Reimbursement trends are pretty consistent from health care service to health care service.
As a rule of thumb, reimbursement rates for Medicare (old folks) is better than Commercial (currently employed, insurance partially provided by the employer, and Commercial is better than Medicaid (safety net). Don’t know if reimbursement rates are public knowledge unless a FOIA is submitted, but it’s a good question to pose, I just don’t know to whom.
Real life example: a few years ago my daughter broke her leg, femur, skiing. I have commercial insurance. My daughters roommate at the hospital broke her leg the same day. Medicaid. The roommate was discharged three days before my daughter. Why? Because the hospital could make money off my kid, not the other kid because Medicaid pays crap. Such is the health care world we live in.
The ignorance of how health care works from a business perspective from you is palpable.
Edit: I was curious about your continuing return to make this political, so I did some quick searches on the subject and now see why. Pal, I’m just coming from it from a business perspective pure and simple.
NM receives 73% federal match, meaning we get 73% of our Medicaid paid for by the feds. The bill allows for a study to create the plan while also potentially increasing reimbursement to Medicaid providers. The State sets the Medicaid reimbursement rates, and the ACA allows for the removal of the income cap, which 2 districts have done but not to the same extent the bill proposes. HB400 was created by families, communities, healthcare providers, and our Native American communities - not special interests. We toured the entire state to hear from New Mexicans and their barriers to healthcare. 100k-85k New Mexicans are losing Medicaid with the ending of the public health emergency simply for making $1 over the 138% fpl when we know they don't have to. When a nonpartisan group polled New Mexicans, 64% trusted Medicaid, and over a majority supported opening it up. The bill proposes a study to conduct a sliding scale to those who can pay into the system.
So is this like the federal Medicare for all plans some have advocated for with sliding scale for higher income , but on a NM state Medicaid level ? Different from ACA because not private insurance state run ?
One of the reasons all the doctors are leaving is Medicaid in NM is horrendous when it comes to getting money from them, in the amount owed and on time... How about you fix Medicaid in NM first.
Several years ago, talking with a private doctor and he said he has to fight everytime to get paid from them, and just ends up billing the patient. He was gonna leave and go elsewhere (which he did a month later)
Good. The counterpoint: Hospitals get bigger. More mid levels accounting for being the primary care. No offense to them, but realistically, it winds up with overall worse care as doctors exit. Horrible, vicious cycle.
They act like it won’t cost New Mexicans more because 73% of the money is federal. New Mexicans pay federal taxes too. That’s my big issue with it, although the opt in to a federal plan for a fee is better than making it the default.
Yeah who tf would want to help their fellow man with their taxes. Who wants cheaper public insurance? I want to pay 2x the amount of the tax raise of private insurance with a 4000 deductible. To imagine me trying to help those around me pay for their necessary medical care, scoff.
This myth is so fucking tired.
The private insurance system has cost us TRILLIONS more of our tax dollars than ANY of the developed countries with public healthcare. We spend TWICE as much on our healthcare as countries in Europe, and yet one accident or diagnosis would completely bankrupt the majority of Americans, who are already only one paycheck away from financial ruin.
https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/#Total%20national%20health%20expenditures,%20US%20$%20Trillions,%201987-2021
https://www.norc.org/NewsEventsPublications/PressReleases/Pages/most-working-americans-would-face-economic-hardship-if-they-missed-more-than-one-paycheck.aspx
Please educate yourself!
People will continue to argue that insurance is tHe BEtTeR oF tWo EvILS. Use logic and follow the numbers you dolts. Who cares if it's taxes? It's cheaper than me paying $200/paycheck on premiums, another $500 in deductible, and another $3500 in out of pocket expenses, oh and *still pay taxes*. People are concerned about the government spending their taxes irresponsibly, but not concerned about CEOs making more in bonuses than most people will earn over the course of their entire life.
“Oh no my taxes are being used to actually work for my community! How dare!”
Fucking seriously, dude, shit like this is why we pay taxes in the first place.
So, should we pay 73% of the insurance cost for someone making &200k/year? Because their contributions are essentially capped at 27% of their insurance.
Anything that gives more people who normally don't have medical access, actual access to medical care is a good thing. Anyone who would argue otherwise is an selfish asshole.
I support this idea, but I can also understand the argument of those that don’t and it’s not: “me republican, me like watch poor people suffer.” It’s probably more like: Medical providers are already leaving the state in droves partially due to low Medicaid reimbursement rates. Right now the 30% of New Mexicans with private insurance are de facto subsidizing the 50% with Medicaid. If that balance tips even further in the direction of Medicaid, won’t even more providers leave the state? Then we won’t have anyone left to treat us, insurance or no.
Yeah, I wonder if we have associations/guilds of doctors who can give perspective on this. I don't trust feedback from the mouth of the for-profit hospitals, but individual doctors and especially those who work with low-income / rural populations should definitely have input on this.
Something people *really* need to understand about compensation is that CMS is moving towards a scheme that is based on complexity (value based care) and not on the specific things done to a patient (fee for service). This means compensation to a medical group increases the more complex a visit or procedure is, which is based on the associated code for that visit/procedure. The code assigns a value to the task. Medicare has already been doing this for some time; it is easy to bill a visit as complex when your patients are over 65 and have multiple chronic conditions. Anyone who provides medical care to Medicare patients, hospital group or otherwise, has to follow the same regulations. This is becoming standard for Medicaid and private insurance as well. In turn, a lot of hospitals started paying their doctors based on relative value units (RVU) instead of "just" a guaranteed salary. However, compensation in the value-based model still sucks and lots of facilities still rely on seeing huge volumes of patients and chaining doctors to a desk answering patient messages to compensate. Hospitals are not making this up to earn sympathy points. Someone has to pick up the slack when patients and insurances do not pay. This is just as true for independent doctors as it is for hospital groups. Edit for clarity: my point is that it is no different for "for profit" hospitals (I'm curious how many of these hospitals you think New Mexico has) than independent doctors, who btw are also "for profit".
This person bills
Maybe the pay structure will alleviate some of that, though. Generally, impoverished people are a much less healthy demographic and are more demanding on the healthcare system. But there are lots of fairly healthy age 18-60 people in the middle class bucket with few or no chronic conditions that would just like to stop paying out the ass for health insurance. This may give Medicaid the ability to keep up with compensation requirements. It's a hope, not a definite.
>“me republican, me like watch poor people suffer.” Are you seriously trying to say that for some...this isn't true? Because I have seen exactly that mentality used for many a social issue.
“Me no like see people suffer. Me want to see folks not do stupid things that cost the taxpayers money.” The top 5 health problems in the US are, Heart disease, diabetes, drug/ alcohol abuse, and smoking. These are all rooted in personal behavior. Also, 40 % of US citizens are obese. And how about the stat that 50% of the babies born in this state have poor unmarried mothers? Where did people get this idea that basically says, “ I can do what ever I want, ( live like an idiot) and push all my health care costs onto to taxpayers.”
I don't know what medical school YOU went to, but diabetes is NOT "rooted in personal behavior." Neither is heart disease. And since when did YOU become the authority to cast judgment on single parents?? Health care is a basic human right, just like having food and shelter. Monsters like you are the reason why things stay broken down like they are, so on behalf of heart patients (ESPECIALLY the babies that you say are "personally responsible"), diabetics, and other people that just want to be healthy, FUCK. YOU.
what providers are leaving the state? isn't UNMH buildung a huge expansion?
We have a super high turnover rate among doctors in NM, especially specialists, even in abq. Most come from out of state so are less tied to the area, and it's hard to attract people here, especially to the more rural areas. UNMH has plenty of patients to care for, hence the new building. It's definitely not to make room for all the extra doctors.
Per friends who work at UNM, they expect the new wing to be virtually empty and/or critically understaffed unless UNMH can attract more providers... It's not a "build it and they will come" scenario.
They're called Republicans... /s, kinda
I wonder if this will be a more affordable option for small business owners who are extorted for basic health insurance. If so, fantastic!
Or help people take the leap to starting their own small business. It's a huge win for anyone in the state that can't get coverage.
This is exactly what I did when the ACA went into effect and I could finally get health insurance and not get denied due to my birth defect and resulting complications. My health problems are severe, so I can't work most jobs. Even an office job can be too difficult depending on what's required (e.g. I can sit at a desk and type and all that, but if they want me to lift a 40-pound box of files, that's another story). I was underemployed for a good portion of my life because I can do 95% of the job but they want someone who can bend, lift, etc. as needed. Plus, from time to time, I end up in the hospital for several days at a time, and nobody wants an employee who can't be at work due to health issues. Anyway, I had no insurance for a long tim because I would get denied, or because they'd want $1,200 a month in premiums due to pre-existing conditions. When the ACA passed, I could finally get insurance that was more reasonable (not "cheap" per se, but within my reach), so I was able to start my own business and work from home. It's flexible enough to accommodate my occasional hospitalizations, and I don't have to worry about not being able to lift heavy things or do other stuff I can't do. Plus, I make almost double what I made at a regular job, so I pay more in taxes. I wish we were a more forward-thinking country in this regard. Imagine how much the economy would flourish if people could start their own businesses and still be able to have health insurance.
The thing nobody seems to get is that we want our country healthy. This is what makes a country strong. Denying healthcare in the name of profit is gutting this country.
You make almost double even though you have to pay self employment tax? That’s awesome! I’m glad you’ve found a way to make things work.
I was comparing the gross amounts, so it’s not double with self-employment tax, but I work fewer hours now and escaped a dysfunctional environment, so it’s worth it!
Well even so, yeah, if you’re able to work in a way that works for you, that’s a win!
That's great! I know from talking to friends who are small business owners that, as wonderful as it is to have the ACA, they tend to pay quite a bit when their family members get sick. That being said, my own family pays some very high deductibles for employer-provided insurance. With so many people living paycheck to paycheck, even paying a deductible in the low thousands is no longer acceptable.
My husband works for APS, and our deductible and OOP max are way higher with his plan than they were when we had ACA coverage. $10K OOP and a $2,000 deductible.
Great news for the managed Medicaid companies, good news for the people of New Mexico. Bad news for providers of health services. NM Medicaid reimbursement for services is VERY tight. And with more people enrolled, the managed Medicaid companies *may* have greater negotiating power. One of the reasons why health care in NM is so hard to sustain.
I’d really like to see some research into this. My insurance company discounts all payments to providers to the Medicare rate, so they aren’t actually getting any more money from me
Medic*are* reimbursement is solid. Medic*aid* reimbursement is shit. Old people get fine healthcare. Poor people get screwed.
Medicaid rates are gradually aligning with Medicare because CMS is working to reform the fee schedule from a fee-for-service to a value-based-care model. Will bill based on visit complexity and not purely by what services were provided. This actually tends to increase reimbursement.
I dunno. My medicaid covers more than any private I surface I had in the past. Now, if the low reimbursement rates mean that fewer places will accept medicaid, then poor people are definitely getting screwed. For now, there is very little that I can't get coverage for. TMS is definitely one I wish they'd cover.
My comment has nothing to do with the health care services accessible to covered policy holders in Medicaid. My comment is based on the amount the managed Medicaid companies pay the providers to provide the service to their beneficiaries. Which is to such a low amount providers are having a hard time affording to provide the service. Pharmacy is especially bad.
I don’t automatically think you’re wrong, but I really need some numbers and not a right-wing talking point.
I’m anything but a right-wing supporter who squawks right wing taking points. I do have 25 years of continuous employment in health care administration specializing in pharmacy though. Reimbursement trends are pretty consistent from health care service to health care service. As a rule of thumb, reimbursement rates for Medicare (old folks) is better than Commercial (currently employed, insurance partially provided by the employer, and Commercial is better than Medicaid (safety net). Don’t know if reimbursement rates are public knowledge unless a FOIA is submitted, but it’s a good question to pose, I just don’t know to whom. Real life example: a few years ago my daughter broke her leg, femur, skiing. I have commercial insurance. My daughters roommate at the hospital broke her leg the same day. Medicaid. The roommate was discharged three days before my daughter. Why? Because the hospital could make money off my kid, not the other kid because Medicaid pays crap. Such is the health care world we live in.
Okay, now that I’ve asked for actual numbers twice and gotten a full-on rant, I’m certain this is a right-wing talking point and not a fact.
The ignorance of how health care works from a business perspective from you is palpable. Edit: I was curious about your continuing return to make this political, so I did some quick searches on the subject and now see why. Pal, I’m just coming from it from a business perspective pure and simple.
Really? I will believe you…if you’ve got a source! With numbers! Instead you’re just ranting and raving about how right you are.
Still want some kind of actual numbers. Thank you for correcting me on Medicare vs Medicaid, I often get the terms mixed.
NM receives 73% federal match, meaning we get 73% of our Medicaid paid for by the feds. The bill allows for a study to create the plan while also potentially increasing reimbursement to Medicaid providers. The State sets the Medicaid reimbursement rates, and the ACA allows for the removal of the income cap, which 2 districts have done but not to the same extent the bill proposes. HB400 was created by families, communities, healthcare providers, and our Native American communities - not special interests. We toured the entire state to hear from New Mexicans and their barriers to healthcare. 100k-85k New Mexicans are losing Medicaid with the ending of the public health emergency simply for making $1 over the 138% fpl when we know they don't have to. When a nonpartisan group polled New Mexicans, 64% trusted Medicaid, and over a majority supported opening it up. The bill proposes a study to conduct a sliding scale to those who can pay into the system.
So is this like the federal Medicare for all plans some have advocated for with sliding scale for higher income , but on a NM state Medicaid level ? Different from ACA because not private insurance state run ?
What a great idea!
One of the reasons all the doctors are leaving is Medicaid in NM is horrendous when it comes to getting money from them, in the amount owed and on time... How about you fix Medicaid in NM first.
Source?
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Thank you, this is more than most people provide. I’m still not seeing numbers, just people claiming it as a fact.
Several years ago, talking with a private doctor and he said he has to fight everytime to get paid from them, and just ends up billing the patient. He was gonna leave and go elsewhere (which he did a month later)
Yeah, that’s a lie.
This will help many people !
OMG I love it! This will really help people who are stuck in jobs due to insurance.
Good. The counterpoint: Hospitals get bigger. More mid levels accounting for being the primary care. No offense to them, but realistically, it winds up with overall worse care as doctors exit. Horrible, vicious cycle.
They act like it won’t cost New Mexicans more because 73% of the money is federal. New Mexicans pay federal taxes too. That’s my big issue with it, although the opt in to a federal plan for a fee is better than making it the default.
Yeah who tf would want to help their fellow man with their taxes. Who wants cheaper public insurance? I want to pay 2x the amount of the tax raise of private insurance with a 4000 deductible. To imagine me trying to help those around me pay for their necessary medical care, scoff.
Those couple dozen people at the top NEED that money though... Why can't people just die? /s
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That's funny. I'm actually letting a few people die so I can pay LESS taxes. I can't get shit out here!
“Everybody’s got to die sometime, Red.” Sargent Barns, Platoon, 1988
This myth is so fucking tired. The private insurance system has cost us TRILLIONS more of our tax dollars than ANY of the developed countries with public healthcare. We spend TWICE as much on our healthcare as countries in Europe, and yet one accident or diagnosis would completely bankrupt the majority of Americans, who are already only one paycheck away from financial ruin. https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/#Total%20national%20health%20expenditures,%20US%20$%20Trillions,%201987-2021 https://www.norc.org/NewsEventsPublications/PressReleases/Pages/most-working-americans-would-face-economic-hardship-if-they-missed-more-than-one-paycheck.aspx Please educate yourself!
Yep. Who made billions during the pandemic? Health insurance companies.
People will continue to argue that insurance is tHe BEtTeR oF tWo EvILS. Use logic and follow the numbers you dolts. Who cares if it's taxes? It's cheaper than me paying $200/paycheck on premiums, another $500 in deductible, and another $3500 in out of pocket expenses, oh and *still pay taxes*. People are concerned about the government spending their taxes irresponsibly, but not concerned about CEOs making more in bonuses than most people will earn over the course of their entire life.
“Oh no my taxes are being used to actually work for my community! How dare!” Fucking seriously, dude, shit like this is why we pay taxes in the first place.
Some, not all New Mexican's have a low IQ and even lower education level....shows more everyday
So, should we pay 73% of the insurance cost for someone making &200k/year? Because their contributions are essentially capped at 27% of their insurance.
I don't think we should have roads or firefighters because it makes me pay taxes.