Strategies for Increasing Consumer Participation in the Policy Process: Week 14

Why the need for consumer participation in the policy process? Citizen involvement has been an important part of government from the inception of the United States. Culturally speaking, “respecting citizens’ rights and limiting government” are important parts of policy making and the government as a whole (Zheng & Liao, 2014, p. 114). According to the Pew Research Center, 72% of Americans are politically active (Pew Research Center, 2013). But what about the other 28% of Americans?

Citizen Participation

Lack of citizen involvement in the policy making process is a result of the “disconnect between the policy process and people’s daily lives” (Kraft & Furlong, 2015, p. 486). This disconnect stems from two possible factors: inability to see evidence of political or governmental influence and an unbelief in an individual’s ability to be influential. With the former, individuals don’t truly see evidence of how the government affects their daily lives. Citizens may see high-powered politicians on CSPAN and view these individuals as being almost foreign – part of another world, one that they aren’t familiar with. With the latter, individuals don’t believe that they have much, if any, influence when it comes to government and politics. For example, a citizen may choose not to vote in the presidential election because they feel that their one vote will have no effect on the outcome of the election.

Bridging the Gap

In order to increase citizen or consumer participation, this disconnect must be identified, and solutions created that deal directly with these two issues. Strategies utilized to improve consumer participation must help citizens see that politics directly influences their lives and that they have significance and influence to help make necessary changes. And even more important, the methods used must be relevant to the times.

Media and the Undocumented

Currently, social media is one of the greatest tools utilized to empower, educate, and influence individuals to be active in the political arena. This is evident in the California Endowment’s #Health4All campaign that addresses lack of access to affordable health care for the undocumented population (California Endowment, 2015a). The foundation is currently utilizing Twitter, Facebook, and YouTube to educate the public on the consequences of lack of healthcare coverage for the undocumented and a call for action. Further still, the foundation has created partnerships throughout the state of California with other media outlets such as Univision, Telemundo, California Black Media, Valley PBS, and New America Media in order to expand their reach (California Endowment, 2015b).

Most recently, Fresno County in California is facing the possibility of losing health care (via the safety nets talked about in week 3) for the undocumented. As a result, the California’s Endowment partner Communities for a New California took to the “switchboard” and utilized phone calls to increase awareness and gather support.

The strategies utilized by the California Endowment are great examples of ways in which increased citizen participation can be garnered. Perhaps additionally, finding a way to explain how the health of the undocumented affects the health of other individuals in the community will show how this issue and the government’s current policies may influence their own quality of life.

References

California Endowment. (2015a). #Health4All. Retrieved from: http://www.calendow.org/prevention/health4all/

California Endowment. (2015b). Get covered. Retrieved from: http://www.calendow.org/prevention/get-covered/

Kraft, M., & Furlong, S. (2015). Public policy: Politics, analysis, and alternatives (5^th ed.). Thousand Oaks, CA: CQ Press.

Pew Research Center. (2013, May 2). Seven in ten Americans politically active, online and off. Retrieved from: http://www.pewresearch.org/daily-number/seven-in-10-americans-politically-active-online-and-off/

Zheng, Y., & Liao, Z. (2014). Improving citizen participation via e-government: The why and how. In A. Manoharan (Ed.), E-government and websites: A public solutions handbook (pp. 112-134). New York, NY: Routledge.

Sustaining Innovative Environments: Week 13

If health policy were to be changed by allowing undocumented individuals to receive coverage via Medicaid and/or the marketplace, would this change be sustainable over the long term? A competing question would be: Are the current health policy environment and programs for the undocumented sustainable?

To review, consider the current environment for undocumented immigrants in the state of New Mexico. Undocumented immigrants (New Mexico Association of Counties, 2014):

• Remain ineligible to receive Medicaid or purchase coverage under the marketplace (Jerome-D’Emilia & Suplee, 2012).
• May seek care at emergency departments under EMTALA, but will probably receive a bill after they’ve been discharged.
• May purchase coverage via their employer if coverage is offered and if individuals are able to pay.
• May be eligible for coverage under the state’s Indigent program.
• May seek care at any FQHC.
• May seek care at free clinics.*

*Regarding free clinics, the sustainability of these clinics should be weighed with questions regarding the current environment. Clinics such as these depend upon volunteers and donations in order to exist – but could such a model be maintained over the long term?

Thinking About Costs

In today’s environment, cost is a significant determinant for sustainability of health policy and programs. (The previous post discusses the financial aspects of Medicaid and funding for undocumented immigrants in more detail.) Alt-White and Pranulis (2011) state that the most common factors of cost are cost benefit, cost effectiveness, and cost utility. In order to fully assess cost factors and variability, additional research and data collection is needed. The following questions must be addressed:

• What are the associated costs for maintaining the current policy and program environment for the undocumented population? To include:
  • Use of emergency medical services.
  • Use of Indigent care.
  • Use of FQHCs.
  • Associated costs related to public health (communicable disease outbreaks such as tuberculosis or those associated with the current immunization schedule)
• Is there a net benefit or a net cost in implementing additional healthcare coverage for the undocumented population? What are the benefits/costs per person annually?

Of course, any innovation in health policy related to the undocumented population must also consider the current immigration policy environment.

If the current policy and program environment results in overall net benefits and can be maintained financially over the long term, then innovation may not be needed at this time. However, considering the size and spread of undocumented immigrants across the U.S. a much more thorough analysis is needed. An analysis that consists of difficult questions to address given the sensitive nature of documentation status and the associated fear of being discovered, detained, and deported.

References

Alt-White, A., & Pranulis, M. (2011). Disseminating results as a mechanism for sustaining innovation. In J. Harris, L. Roussel, S. Walters, & C. Dearman (Eds.), Project planning and management: A guide for CNLs, DNPs, and nurse executives (pp. 179-193). Sudbury, MA: Jones and Bartlett.

Jerome-D’Emilia, B., & Suplee, P. (2012). The ACA and the undocumented. American Journal of Nursing, 112(4), 21-27.

New Mexico Association of Counties. (2014, July 9). The future of the safety net in New Mexico. Retrieved from: http://www.nmcounties.org/wp-content/uploads/2014/08/THE-FUTURE-OF-THE-SAFETY-NET-IN-NEW-MEXICO-FINAL-REPORT.pdf

Healthcare Financing: Week 12

Whenever a change in policy is recommended, the inevitable question always follows – where will the money come from?

The U.S. budget is already strained and the costs of healthcare are increasing. According to the Congressional Budget Office (2014a), “if current laws remained generally unchanged, federal debt held by the public would exceed 100 percent of GDP [gross domestic product] by 2039 … a trend that could not be sustained indefinitely.”  The latest data from 2012 shows that the U.S. – taxpayers, insurance companies and government programs – has spent approximately $2.6 trillion dollars on health care and that among this, Medicare accounts for the greatest amount of public spending.

(CBO, 2014b)

Medicaid

For the purpose of this blog, I wanted to focus on financing in regards to Medicaid. As mentioned in previous posts, programs such as Medicaid help to provide healthcare coverage for individuals with low incomes. Individuals may include children, adults, elderly, and the disabled. Each state varies in the amount that is spent, and each state also has the flexibility to determine qualifications, requirements, and expansion of the program (CBO, 2014). In the state of New Mexico, the latest data shows that approximately $3,294,911,999 was spent on Medicaid in 2013, placing 33^rd among states in the most amount spent on Medicaid (Kaiser Family Foundation, 2015). In addition, since New Mexico was one of the states who decided to expand Medicaid, that number is expected to increase significantly.

So, where does all of this money come from? Some of the money for this program comes from the federal government and the rest comes from the state. Although the process is a little more complicated, the following video wonderfully explains the complexities of Medicaid funding.

As explained in the video, the federal government pays approximately $0.50 – $0.83 per Medicaid dollar while the state government must pay the rest. Although the federal government may provide special grants to help the states pay for Medicaid, alternative sources of financing can be utilized such as taxes (e.g. tobacco).

Healthcare Coverage for the Undocumented

What would this mean for programs that increase healthcare coverage for the undocumented? This would require more funds. If rules were changed and legal documentation status was not a requirement to receive Medicaid, and assuming that there are approximately 70,000 undocumented immigrants as estimated, the state would need to find a way to obtain an additional $406,210,000 (based on numbers from 2011 that showed New Mexico spent $5,803 on Medicaid per enrollee) (Pew Research Center, 2014; Kaiser Family Foundation, 2015). On an already strained economy, this would pose a significant challenge.

References

Congressional Budget Office. (2014a, July 15). The 2014 long-term budget outlook. Retrieved from: https://www.cbo.gov/publication/45471

Congressional Budget Office. (2014b, July 15). The 2014 long-term budget outlook. Retrieved from: https://www.cbo.gov/sites/default/files/45471-Long-TermBudgetOutlook_7-29.pdf

Kaiser Family Foundation. (2015). Total Medicaid spending. Retrieved from: http://kff.org/medicaid/state-indicator/total-medicaid-spending/

Pew Research Center. (2014, November 18). Unauthorized immigrants in the U.S., 2012: Unauthorized immigrant population, by state, 2012. Retrieved from: http://www.pewhispanic.org/interactives/unauthorized-immigrants-2012/

Innovators and Change Agents: Week 11

Multiple components are needed in order for change or progress to occur. In order to provoke change, there must be a sense of urgency. In order to create that sense of urgency (an environment that is ripe for change), individuals must use various forms of communication to effectively get their point across (Campbell, 2008).

In today’s society, social media is a great widespread tool used to help create this sense of urgency in order to gather and unify a group of individuals or organizations to work towards change. Almost every organization, company, and even departments of government use social media. As mentioned previously, the California Endowment utilizes social media via Twitter, Facebook, and YouTube, bringing greater awareness to the issue of healthcare coverage for the undocumented.

Regarding change theories, take another look at how change occurs. The following video by the Ford Foundation explains how social change occurs, the components required to create a movement of change, and a few real world examples.

Delving even further into “engaged individuals” referred to in the video will help to reveal change agents (as individuals) – the catalysts for the desired change. Agents of change influence others. They are vital in bringing engaged individuals together to help mobilize a movement of change. Innovators create solutions for the problems that need to be addressed. Change agents convince these groups and organizations that such innovation is needed. The California Endowment’s #Health4All campaign promotes the innovative idea that the health of just one individual affects the health of the entire community.

And change agents aren’t limited to a certain field, as many immediately think of Apple and Steve Jobs as the poster child for the term “change agent.” Nurses and nurses as healthcare providers are agents of change in health policy.

“As change agents, nurses bring expertise and resources to the table to help create healthier local and global communities; but often our voices are not heard, and we find ourselves left out of the healthcare conversation. As health collaborators and communicators, we are called upon to synthesize and disseminate our nursing knowledge.” (Ressler & Glazer, 2010).

Healthcare providers encounter urgent issues every day. They understand the barriers that prevent a patient from receiving proper medical care and many times, they know the type of innovation that is needed to remove these barriers. By being active on these front lines, they are in a position to be these agents of change.

References

Campbell, R. (2008). Change management in health care. The Health Care Manager, 27(1), 23-29.

Ressler, P., & Glazer, G. (2010, October 22). Legislative: Nursing’s engagement in health policy and healthcare through social media. The Online Journal of Issues in Nursing, 16(1). doi:10.3912/OJIN.Vol16No01LegCol01

Change Theory: Week 10

Change is necessary in order to progress. Stachowiak’s brief on theories related to policy change summarizes six different theories classified into global theories or advocacy strategy/tactic theories (n.d.). One such global theory is “Policy Windows” or Agenda Setting. Kingdon (2011) describes the policy window as a moment of opportunity during which advocates can “push their pet project or concern” (p. 165).

For the issue of healthcare coverage, the policy window appears wide open at the moment. The current political environment is one in which the ACA, immigration reform and legislation such as the DREAM Act are some of the most popular issues being addressed. This political environment is ripe for change in both healthcare and immigration. For example, the Health for All Act introduced by California Senator Ricardo Lara calls for all individuals regardless of documentation status to receive healthcare coverage. At the time of the writing of this post, the Health for All Act was placed under consideration by the California legislature. Organizations such as the California Endowment and representatives like California Senator Ricardo Lara recognize a need for change and are taking this open window of opportunity to bring to light the issue of healthcare coverage for the undocumented. Both saw an issue that needed to be addressed and utilized manpower, research and other resources in order to push the issue.

However,…

Despite the policy window being open, government agenda is limited and thus the specific issue of healthcare coverage for undocumented immigrants must compete with or be overshadowed by other legislation such as H.R. 399: Secure Our Borders First Act of 2015, S. 153: Immigration Rule of Law Act of 2015, H.R. 38: Preventing Executive Overreach on Immigration Act of 2015 and on the side of healthcare, multiple legislation calling for setting of the congressional budget for 2016 and budgetary levels up through 2025.

In keeping the focus on the state of New Mexico, this year’s legislative session failed to address healthcare coverage for the undocumented as many other issues took precedence. In fact, an important measure designed to help individuals with severe mental illness* failed because although the measure passed the House, time ran out for the Senate to vote. Needless to say, legislation regarding changes in health policy for the undocumented is in the right political environment, but must wait a little while longer.

*Kendra’s Law would allow the court of law to order individuals who are considered a danger to themselves and their surrounding community to undergo treatment for severe mental illness (Contreras, 2015).

References

Contreras, R. (2015, March 25). Partisan fighting killed ‘Kendra’s law’ for mentally ill. Albuquerque Journal. Retrieved from: http://www.abqjournal.com/559789/politics/legislature-blog/partisan-fighting-killed-kendras-law-for-mentally-ill.html

Kingdon, J. (2011). Agendas, alternatives, and public policies. Glenview, IL: Pearson.

Stachowiak, S. (n.d.). Pathways for change: 6 theories about how policy change happens [PDF document]. Retrieved from: http://www.organizationalresearch.com/publicationsandresources/pathways_for_change_6_theories_about_how_policy_change_happens.pdf

Private Sector: Follow Up with the California Endowment

Source: California Endowment, http://health4allca.org/

I recently had the chance to speak with Josue Chavarin, program associate with the California Endowment who is the Campaign Deputy for the #Health4All campaign. More information regarding the private sector and the California Endowment may be found in this previous post. The following is a summary of our discussion:

The #Health4All campaign was started in 2012 in response to the implementation of the Affordable Care Act (ACA). Although the ACA was intended to provide healthcare access and coverage for all individuals, the undocumented population was left out. The individuals who initiated this campaign believed that the exclusion of undocumented immigrants went against the fundamental goals of the ACA. At the start, the California Endowment was the only organization in the state (and possibly nation) addressing this issue.

Although the campaign goes by the same name as Senator Ricardo Lara’s Health for All Act, the two are not related. The intent behind the California Endowment’s #Health4All campaign is to raise awareness regarding this issue while addressing misconceptions and presenting the facts. For example, many believe that undocumented immigrants are simply “takers” who “take” services and do not contribute. However, through thorough research and data collection, evidence shows that many in the undocumented population pays taxes, contributes to social security [despite not being eligible], and comprises working households.

The benefits of healthcare coverage for the undocumented are seen from both the economic and public health standpoint. Increasing access and coverage for preventive care makes economic sense due to the resulting yield in savings. In addition, the health of one individual is not limited to that sole individual – the health of one impacts the entire community. It is through commissioning research and surveys, utilizing existing statistics, and verifying the validity of the existing statistics, that despite initial pushback, the public has now become more receptive to the campaign’s message.

To add to the information provided by Mr. Chavarin regarding undocumented individuals: An individual who does not have a social security number can request a taxpayer identification number from the IRS for the sole purpose of filing taxes – meaning that a social security number is not a requirement to file taxes (IRS, 2011). In addition, undocumented immigrants pay for social security via payroll taxes although they will never receive social security benefits. In 2010 undocumented immigrants paid approximately $10 million towards state and local taxes, with 50-70% of the population filing and paying income taxes, and an additional $15 billion annually to social security (Santana, 2014). 

References

Internal Revenue Service. (2011). 2011 basic tax information. Retrieved:http://www.irs.gov/pub/languages/multi-gateway_files_dec_2011_english_fy12.pdf

Santana, M. (2014, November 20). 5 immigration myths debunked. CNN. Retrieved from: http://money.cnn.com/2014/11/20/news/economy/immigration-myths/

Privacy in the Electronic Age: Week 9

Along with freedom, privacy is highly valued in the American culture. Take a look at just some of the many U.S. current events pertaining to privacy:

1. NSA Surveillance and the U.S. Patriot Act: the Edward Snowden leak case put a spotlight on the government’s surveillance methods of U.S. citizens, especially telephone metadata.

2. Workplace monitoring: some companies monitor employee’s emails in addition to work habits to combat “insider threat” (Lawrence, 2015).

3. Use of drones: unmanned aircraft are used for surveillance by the FBI, U.S. Customs and Border Patrol, and by other businesses for commercial purposes with minimal regulations in place (Drones and privacy: A looming threat, 2015).

And the healthcare industry is not to be left out, despite the establishment of the Healthcare Insurance Portability and Accountability Act (HIPAA) in 1996:

4. Anthem Inc. breach: a large health insurer in the U.S., where personal information for 80 million individuals was exposed. Many warn that this is just the beginning of such large security breaches in healthcare as medical identity theft is on the rise (Abelson & Creswell, 2015).

Source: CSID, 2015.

Privacy and the Undocumented

Privacy is also a top concern for undocumented immigrants for fear that exposure of their documentation status would result in immediate deportation. In the electronic age of healthcare, personal information such as social security numbers or lack thereof are readily accessed from multiple points within the system in addition to the number of individuals (i.e. clinic staff) with access to this information.

As mentioned in a previous post, undocumented individuals will often refrain from seeking needed medical care for fear of being detained and deported. In relation to this, there are U.S. citizens who have family members who are undocumented and living within their household. Again, the fear of detainment and deportation of their family members may prevent these legal residents from applying for needed health care coverage and other related assistance programs, many of whom are children (Sommers, 2013).

Legislation calling for healthcare coverage for the undocumented should also address concerns regarding privacy. If undocumented immigrants are approved for government assistance, their personal information such as documentation status would be made readily available to an increasing amount of individuals at the state and/or federal level. In order for this type of legislation to be successfully implemented, there would need to be secure measures in place to ensure that this sensitive information is not shared in a way that results in the detainment and deportation of individuals. However, undocumented immigrants may be prevented from applying for these programs due to the aforementioned fear of being “discovered.”

This issue of privacy shows the interconnection between the issue of healthcare reform for the undocumented and immigration reform. As long as these two issues remain in conflict, there will be difficulty in both proposing and implementing such legislation.

References

Abelson, R., & Creswell, J. (2015, February 6). Data breach at Anthem may forecast a trend. New York Times. Retrieved from: http://www.nytimes.com/2015/02/07/business/data-breach-at-anthem-may-lead-to-others.html?_r=0

Drones and privacy: A looming threat. (2015, March 19). The Economist. Retrieved from: http://www.economist.com/blogs/democracyinamerica/2015/03/drones-and-privacy

Lawrence, D. (2015, March 12). Companies are tracking employees to nab traitors. Bloomberg Business. Retrieved from: http://www.bloomberg.com/news/articles/2015-03-12/companies-are-tracking-employees-to-nab-traitors

Sommers, B. (2013). Stuck between health and immigration reform – care for undocumented immigrants. New England Journal of Medicine, 369: 593-595. doi:10.1056/NEJMp1306636

The Private Sector: Week 8

“Private sector provider (PSP) behavior is influenced by the interplay of policy-makers who set policy, enact legislation, enforce regulations and purchase care for their populations, people who do or do not buy products and services from PSPs, and the providers themselves who bring their experience, skills and motivations to their encounters with clients” (Smith, Brugha, & Zwi, 2001).

The private sector is an integral part in the advancement of health policy. The behaviors of private clinics, hospitals, and other health-related companies are affected by the laws and regulations that the government enacts and vice versa. In fact, some argue that the rising cost of healthcare is rooted in the private sector – namely insurance and pharmaceutical companies (Weisbrot, 2011).

The private sector could also be highly influential when it comes to advocating and making known specific issues in healthcare. Take, for example, the California Endowment.

The California Endowment was founded as a result of WellPoint Health Networks, a for-profit subsidiary of Blue Cross of California and is “independently governed and operated” (California Endowment, n.d.). In addition to addressing various health-related issues such as a multicultural approach to health, this foundation started the #Health4All campaign. The intent of this campaign is to bring to the forefront the importance of healthcare coverage for the undocumented. The campaign emphasizes the importance of healthcare coverage for each individual regardless of documentation status as vital to the health of the state as a whole. In addition, the economic and social contributions made by this population are used to provide an argument to the belief that undocumented individuals are simply using up limited resources in the community without contributions of any kind (Attempts were made to contact a representative from the foundation regarding the #Health4All campaign and its effects on health policy. However, at this point, I have not heard back from them.) The campaign has been widespread with the use of celebrities and widespread social media (the video shown in the post for week 5).

The impact or “failure” of this campaign and the associated Health For All Act would set a major precedent for the rest of the nation, including New Mexico.

References

The California Endowment. (n.d.). The California Endowment: Overview. Retrieved from: http://www.calendow.org/about/overview.aspx#

Smith, E., Brugha, R, & Zwi, A. (2001). Working with private sector providers for better health care: An introductory guide. Retrieved from: http://www.who.int/management/partnerships/private/privatesectorguide.pdf

Weisbrot, M. (2011). Problems of U.S. health care are rooted in the private sector, despite right-wing claims. Retrieved from: http://www.cepr.net/index.php/op-eds-&-columns/op-eds-&-columns/problems-of-us-health-care-are-rooted-in-the-private-sector-despite-right-wing-claims

Medicare, Medicaid, and the Affordable Care Act: Week 7

Studies have shown that the uninsured are less likely to receive adequate health care, are more likely to go without screening for important diseases such as breast or colon cancer, and are less likely to receive adequate treatment for chronic diseases (Kraft & Furlong, 2015). Federal and state programs such as Medicare and Medicaid were created to address such disparities among the uninsured with the Affordable Care Act being the most recent response to this issue. 

Medicare & Medicaid

Medicare began in 1965 to help individuals 65 years and older with basic healthcare needs (Kraft & Furlong, 2015). For the poor and disabled, Medicaid was created that same year. In 1997, the Children’s Health Insurance Program (CHIP) was created for children who live in poverty (Kraft & Furlong, 2015).

In 2013 approximately 38% of New Mexico’s total population received coverage through either Medicare or Medicaid (see figure below). Preliminary data for total Medicaid and CHIP enrollment in 2014 saw a 32.16% increase from enrollment in 2013 (Centers for Medicare and Medicaid Services, n.d.).

Given the prevalence of poverty in New Mexico, many depend upon such federal and state programs to receive coverage for healthcare. Although these programs have allowed for increased coverage and subsequent care among these vulnerable populations, those who are undocumented remain left out.

Affordable Care Act

As mentioned in previous posts, the ACA does not allow for undocumented individuals to obtain health insurance. Although individuals who have immigrated to the U.S. legally are able to purchase coverage via the health insurance exchange, they are not eligible to receive Medicaid or CHIP if they have been in the states for less than five years (Jerome-D’Emilia & Suplee, 2012).

In connection with the ACA, the state of New Mexico decided to expand their Medicaid so that individuals who make approximately 133% or less of the federal poverty level may qualify for coverage (U.S. Department of Health and Human Services, 2014). Although this expansion has helped much of the uninsured population – especially those who do not qualify for Medicaid and at the same time cannot afford private insurance – the health insurance status of a significant portion of the population, an estimated 70,000 undocumented individuals in New Mexico, remains unchanged (Chokshi, 2014). These individuals must continue to rely upon charity organizations and other such charity programs for the coverage and care that they seek.

References

Centers for Medicare and Medicaid Services. (n.d.). New Mexico. Retrieved from: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/new-mexico.html

Chokshi, N. (2014, November 21). The undocumented immigrant population explained, in 7 maps. The Washington Post. Retrieved from: http://www.washingtonpost.com/blogs/govbeat/wp/2014/11/21/the-undocumented-immigrant-population-explained-in-7-maps/

Jerome-D’Emilia, B., & Suplee, P. (2012). The ACA and the undocumented. American Journal of Nursing, 112(4), 21-27.

Kaiser Family Foundation. (2015). Health insurance coverage of the total population. Retrieved from: http://kff.org/other/state-indicator/total-population/

Kraft, M. & Furlong, S. (2015). Public policy: Politics, analysis, and alternatives. Thousand Oaks, CA: CQ Press.

U.S. Department of Health and Human Services. (2014). How the health care law is making a difference for the people of New Mexico. Retrieved from: http://www.hhs.gov/healthcare/facts/bystate/nm.html

Public Sector Influence on Healthcare Policy: Week 6

New Mexico

 According to the U.S. Census Bureau, New Mexico is the second poorest state in the nation with a poverty rate of 21.9% (U.S. Census Bureau, 2014). Among non-elderly, approximately 19% of New Mexicans across all races and ethnicities were uninsured in 2013, well above the national average (Kaiser Family Foundation, 2015).

This past Friday, I drove the four-hour, desert-filled route from southern NM to the state’s capital of Santa Fe. There I joined many other nurses to meet our representatives and discuss issues related to policy and healthcare. (Perhaps a reflection of New Mexico’s economy and issue of poverty, I was surprised to learn that none of the legislators received an annual salary – making all of their work solely voluntary.)

Among the plethora of issues being addressed during this current 52^nd NM legislature, the following pertained to the uninsured, underinsured, and related health disparities (New Mexico Legislature, 2015):

• House Bill 99: identify and address local and tribal health needs

• Senate Bill 385: additional recruitment and research to encourage health undergrads to serve in healthcare careers in medically underserved areas

• Senate Joint Memorial 1: requesting the formation of a task force to analyze health disparities and recommendations for the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community

• Senate Joint Memorial 3: request the creation of a basic health program task force to explore the possibility of implementing a program that would cover those ineligible for Medicaid with low incomes.

Although not a bill, the senate joint memorial 3 could potentially bring to greater light the issue of the undocumented in relation to healthcare coverage and access to care within the state. 

The Safety Net

As mentioned in previous posts, the uninsured and undocumented must rely on a so-called “safety net” for access to and coverage of healthcare (New Mexico Association of Counties, 2014). These include:

• Hospitals
• Counties (Indigent Care)
• New Mexico Medical Insurance Pool
• University of New Mexico (UNM) Care
• Santa Fe Project Access
• Federally Qualified Health Centers (FQHCs)
• Indian Health Service 

Many of these safety nets exist because of funding from the public sector, such as the Department of Health and Human Services and the New Mexico Department of Health. Although such programs (and more) exist throughout the state, many have limitations when it comes to documentation status and funding. As such, the undocumented population must rely on the county with limited resources, the high-risk medical insurance pool, FQHCs, and their own pockets.

References

Kaiser Family Foundation. (2015). Uninsured rates for the nonelderly by race/ethnicity. Retrieved from: http://kff.org/uninsured/state-indicator/rate-by-raceethnicity/

New Mexico Association of Counties. (2014, July 9). The future of the safety net in New Mexico. Retrieved from: http://www.nmcounties.org/wp-content/uploads/2014/08/THE-FUTURE-OF-THE-SAFETY-NET-IN-NEW-MEXICO-FINAL-REPORT.pdf

New Mexico Legislature. (2015). 2015 Regular Session Bill Locator. Retrieved from: http://www.nmlegis.gov/lcs/bill_locator.aspx?year=15

U.S. Census Bureau. (2014, September). Poverty: 2012 and 2013. Retrieved from: http://www.census.gov/content/dam/Census/library/publications/2014/acs/acsbr13-01.pdf