Industry waits to ‘see what happens’ with ACA

March 06--Editor's note: The Daily Times is publishing a two-part series about the changing landscape of health care in our country. We asked leaders in San Juan County's health care industry to weigh in on what changes to the Affordable Care Act could mean for the county's residents and health care facilities.

A Q&A with Jeff Bourgeois, president and CEO of the San Juan Regional Medical Center in Farmington, was published Sunday.

FARMINGTON -- As lawmakers and President Donald Trump discuss repealing the Affordable Care Act, many local health care officials have expressed uncertainty about what the changes will mean for county residents and health care facilities.

When the ACA was signed into law in 2010, it expanded Medicaid to provide coverage for all adults ages 18 to 65 below the federal poverty level, regardless of their age, family status or health.

Previously, Medicaid only provided coverage for certain low-income individuals, including those who receive Supplemental Security Income and families, children, pregnant women, the elderly and people with disabilities. Under the ACA, states could decide whether or not to participate in the Medicaid expansion. New Mexico was among the states that opted in.

The question now is what happens if the law is rolled back.

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Counties to pick up cost?

"We're having that conversation now with county leadership and the state Legislature," said Liza Gomez, manager of the San Juan County Health Care Assistance Program. Formerly known as the Indigent Fund, the program fund health care needs of uninsured and under-insured residents. "What we know for sure is that there will be a cost-shift back to counties if there is no replacement (for the ACA), as all those qualified for Medicaid will no longer have coverage. However, we're still mandated by the state to provide care."

Gomez said that after the Medicaid expansion went into effect, her office saw a 70 percent decrease in claims.

"There are definitely problems with the ACA," she said. "It's not affordable for everyone, some rates have skyrocketed. There will be problems without the ACA also. But the county will still respond and do the best we can to help our residents. We'll just have to see what happens."

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NM disproportionately affected

Casey Crotty is the CEO for the San Juan Independent Physician Association, which helps independent medical providers with issues like insurance contracting and physician credentialing. Like Gomez, he is uncertain about what direction health care will take under the new administration.

"I truly don't know what will happen," he said. "I don't see the ACA being pulled altogether, but I can see maybe a state block grant being implemented."

Crotty said a repeal of portions of the Medicaid expansion could affect hundreds of thousands of New Mexico residents. Out of the state's 2.1 million residents, 775,000 are enrolled in Medicaid, due to the state's high poverty, unemployment and low education rates.

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"New Mexico is No. 1 in the country when it comes to percentage of the population who are on Medicaid," Crotty said. "So we'd be risking 35 percent of the population not having insurance if Medicaid is removed. It's a really challenging situation."

Crotty believes the ACA was a good first step but said the law needs to be adjusted because costs are too high and are not sustainable. But coming up with a replacement is essential, he said.

"In the health care world, we had just figured out what the ACA was, and now we're just kind of scratching our heads wondering what comes next," he said. "If it's not replaced, it will cause a lot of problems."

'We will continue to care'

Laura Crawford is the Northwest Region director for Presbyterian Medical Services, which provides primary and other forms of medical care to many residents at or below the poverty level.

"It's really up in the air," she said, of the health care situation. "Literally, the bottom line is that no one knows what's going to happen."

She echoed sentiments that Medicaid expansion in New Mexico was a positive step that provided a large group of previously uninsured individuals with insurance.

"If that part went away, we'd be moving backward," she said. "However, PMS takes care of people regardless of whether or not they can pay, so if Medicaid goes away, it will affect individuals but will not change our services. That's why we're here, and we will continue to care for our community."

Crawford said her agency would find a way to continue providing care for patients who could suddenly find themselves uninsured.

"We would get funding to help take care of those people. It may have to go back to the way it once was (before the ACA), when the county received indigent funding," she said.

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The interim CEO for New Mexico's health insurance exchange, beWellnm, is also in wait-mode.

"That's the caveat, we really don't know what's going to happen," said Linda Wedeen. "But we're still living under the ACA and that hasn't changed, so we're moving forward."

Potential increase in joblessness

Before the ACA, 22 percent of New Mexicans were uninsured, compared to the current 10 percent, she said.

"We attribute that to the ACA," she said. "If it goes away, the uninsured numbers will go back up, and that's a hardship on the state in general. If people can't afford insurance, it's a hardship for hospitals. And if people don't get medical care because of lack of insurance, you could also see a loss in overall jobs. It all has a spiral-down effect."

RELATED: New Mexico's health exchange enrollment is underway -- Trumpcare, not Obamacare, could be a job killer

Despite discussions of changes to the health care system, the New Mexico exchange experienced the same enrollment numbers this year as last year, Wedeen said. That's about 45,000 new or renewed enrollments. But, Weeden said, her office has heard from many residents who are confused.

"They don't know what's happening," she said. "So our role is to help them get through the confusion, and let them know we can still help them get through the process. We want them to know they can come to us and can visit our website for help."

Leigh Black Irvin is the business editor for The Daily Times. She can be reached at 505-564-4621.

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