Vulnerable people are guinea pigs in dangerous Medicaid experiments

This week, our nation’s governors are descending upon the Land of Enchantment for the National Governors Association Summer Meeting. Their arrival comes at a pivotal time for health care in our country.

States are the laboratories of our democracy, and governors can provide critical leadership in addressing our nation’s health care challenges. Unfortunately, many governors across the U.S. — including New Mexico’s own Gov. Susana Martinez — are waging dangerous experiments with health care and Medicaid programs that threaten their states’ most vulnerable residents.

Rather than taking steps to best ensure coverage for those who need it most, some state leaders are going in the opposite direction. Failed efforts to repeal and replace Obamacare in Congress have been replaced by ill-conceived attempts at the state level to erode essential protections under the law. State leaders are challenging provisions like protections for those with pre-existing conditions in the courts. Governors are also reshaping safety net programs through special Medicaid waiver requests, encouraged by President Trump’s administration.

Some proposals — including Gov. Martinez’s New Mexico Centennial Care waiver request — are pulling from the private insurance playbook of punishing patients for emergency department visits that are ultimately not diagnosed as emergencies by instituting co-pays for non-emergency or “inappropriate” use of emergency room services. This practice puts patients in the unfair position of being their own doctors and diagnosticians, evaluating whether their head pain is a simple headache or a stroke or whether the nausea they’re suffering is only gas or a massive heart attack.

New Mexico and other states are also adding new monthly premium fees for low-income patients. Many are proposing to eliminate retroactive eligibility, an important protection for patients that covers medical bills incurred in the three months before a patient’s Medicaid application. This is problematic because many patients find out they qualify for Medicaid only after they get sick and incur significant hospital bills. Since application and enrollment takes time, retroactive coverage is essential to protecting low-income individuals and families from crushing medical debt. Sadly, the list goes on.

Other changes proposed by states and being reviewed by the Trump administration would institute work requirements as a condition of coverage, and cut screening and diagnostic benefits, to name just a few. If approved, these changes would drastically transform many of our states’ Medicaid programs, threatening care for millions of Americans — including many of the nearly 745,000 low-income children, pregnant women, adults, seniors and people with disabilities who rely on Medicaid in New Mexico. They are the most vulnerable among us, those most in need of coverage and those least likely to be able to absorb the impact of increased premiums and out-ofpocket expenses, especially in a state where a household family income is just over $45,500.

Unfortunately, this is happening at a time when Americans are more concerned about paying for health care than ever before. According to Consumers for Quality Care’s (CQC) Health Care Experience Study, Americans with private insurance and those who are currently enrolled in Medicare and Medicaid worry about health care costs even more than they worry about costs associated with retirement, college, housing or child care.

Even without these proposed changes that would drive costs up for low-income individuals and families, worries about costs are having a negative impact on care. A March 2018 West Health Institute/NORC at the University of Chicago survey found that a large number of people are skipping necessary medical care because of costs.

As the nation’s governors meet in Santa Fe, they must remember that the purpose of Medicaid is to help low-income patients access quality care, not hurt them. We ask that they carefully consider the impact their administrations’ Medicaid waivers will have on neediest patients in their states.