Dede Feldman

It is no secret there are flaws in the current process used by the state’s Division of Insurance to evaluate health insurance rate requests. The recent Blue Cross Blue Shield case is one illustration of these deficiencies.

The existing process for reviewing rate increase requests is outdated and leaves policyholders in the dark. This lack of transparency and fairness in rate setting is unacceptable.

This legislative session I am working with the insurance superintendent, Public Regulation Commission, the Attorney General’s Office, and some members of the insurance industry to address this issue.

SB 208/499 (a combined bill) requires transparency and protects consumers and companies alike. The burden must be on health insurance companies to prove to the superintendent and policyholders that large rate increases are reasonable and not excessive. If insurers truly need to raise rates on New Mexico families, then I believe they should be willing to open their books and justify their requests. Many of my colleagues, Democrats and Republicans, agree.

Let me be clear – I believe health insurance companies should be solvent. They have a right to premium payments that are sufficient to cover claims, to make a fair profit and to ask for a timely decision. However, a fair profit should be determined by a fair hearing, one where all relevant facts are fully disclosed – in plain and simple language.

In addition, New Mexico families deserve a meaningful voice in the rate review process, as well as large companies. It’s called fairness.

Several responsible health insurers are on board with my proposal. They recognize the need for a more open and rigorous process that will protect them as well as their subscribers from disasters like the Blue Cross case. They are not interested in making some kind of insiders’ deal with the Department of Insurance. They also understand that new federal laws will force a federal version of transparency on them if the state does not clean up the process and give the superintendent better tools with which to work.To those insurers, thank you for being on the side of fairness.

A more fair process

In an environment of 20-30 percent annual rate increases, consumers need to know whether their rates are fair and reasonable. Senate Bill 208 and 499 ensures that everyone gets ready access to the relevant financial information, posted online, and has the opportunity to comment, in addition to the assurance that all this will be weighed by the superintendent against an updated legal standard already adopted in a number of states.

Both policyholders and insurance companies can present their positions in an open hearing. The attorney general can intervene for consumers. The superintendent must support his decision based on the evidence, and the PRC review – if requested by a policyholder or an insurer – must be done by a hearing officer before the commission rules as an appellate body.

Will all of this result in lower health insurance rates? Will rates increase at a more moderate rate? That is yet to be determined. However, what we will have is a more transparent and fair process. A process where there is greater certainty that a rate increase is merited, that the health insurance company gets sufficient premium to be financially sound, and that an increase does not unfairly reward health insurance companies at the expense of policyholders.

Feldman, a Democrat, represents District 13 in the New Mexico Senate. For more information, check the Legislature’s website for the Senate Judiciary substitute for SB 208 and 499.

Dede Feldman

Last year, as the Republicans and Democrats continued to battle over the Affordable Care Act on the national stage, New Mexicans were rolling up their sleeves and beginning to implement the new law here. A joint legislative and executive working group, with a diverse group of stakeholders from the business and insurance sector, as well as ordinary citizens, met for eight months to examine issues like Medicaid and insurance changes and make recommendations for a uniquely New Mexican health insurance exchange.

I hope our new governor will not turn her back on the opportunities this bill opens up for New Mexicans, and the jobs it has already created here in the state.

In only nine months, New Mexico has received nearly $90 million to support our high-risk pool (which allows people with preexisting conditions to obtain insurance), expand community health centers in rural and underserved areas, increase training for much needed nurses, doctors and other needed health care providers, among other things.

In a time of budget constraints, this funding has not required a state match, and the jobs created in clinics, universities and hospitals are a much-needed boost to rural communities where the health care sector is the prime economic mover.

Many other funds have flowed to the private sector to help employers pay for insurance for their employees. PNM, Intel, Sandia, UNM, LANL and the state’s own Retiree Health Program have benefitted from a program to help them pay for health benefits for their early retirees – and buck the trend of reduced benefits and increasing co-pays for this population, largely in their 50s.

As the state continues to plan for full implementation of the bill in 2014, we have benefitted from $3 million to plan for our own health insurance exchange (the feds will set one up for us if we don’t), synch state insurance law with new federal rules, and improve our system of reviewing insurance rate hikes. These planning funds will continue, with full funds already appropriated for the state to set up the exchange through 2015.

And there is more to come. Ultimately, New Mexico will gain  $6 billion to $8 billion from the new law in the next decade, according to Sen. Bingaman’s office.

Unprecedented control

One overlooked feature of the new health care act is that it gives an unprecedented amount of control to the states to build on their own programs and fill in the gaps as they see fit. In New Mexico, for example, we have been able to build on an existing Medical Insurance Pool for high-risk patients.

And although we do not currently have a health insurance exchange (a more consumer-friendly marketplace where individuals and small employers can purchase policies more easily and cheaply), the idea has been repeatedly proposed by Republican legislators and supported by Democrats, gaining enough support in 2007 to pass the Senate.

This fall, the working group convened as a result of last year’s Senate Joint Memorial 1 proposed we establish a New Mexico exchange as a non-profit organization, outside of state government. This marketplace, which would be coordinated with the Medicaid program, would include small group as well as individual policies, and have the power to negotiate with insurance companies in a robust fashion. The group left open the door to join a regional exchange if that seems possible in the next three years that the federal government gives the states to have their exchanges ready to go.

This legislative session there will be several bills introduced to further this recommendation. The governor should support the idea.

Benefits keep trickling in

Meanwhile, despite the much-ballyhooed efforts in Washington and Virginia to repeal the Affordable Care Act, the benefits of the health care bill just keep on trickling into New Mexico. Just this month, seniors on Medicare became eligible for a free annual check-up and will no longer be required to pay co-pays on preventive screenings for cancer and diabetes. Last year, about 15,000 seniors got a $250 rebate if they fell short on paying for prescription drugs, and starting this year they can get a 50 percent discount on brand-name drugs if they fall into the donut hole, a coverage gap created by the prescription drug bill several years ago.

On this year’s tax forms, small businesses with fewer than 25 employees can file for tax credits for up to $35,000 if they cover employees who earn less than $50,000 a year. According to the IRS, over 25,000 small businesses in the state are eligible.

Finally, the state’s department of insurance is implementing a new requirement that health insurance companies pay more of the health care premiums they receive on actual care, and not on profits and administration. If they don’t comply, consumers will get a rebate.

Whatever your views about the Affordable Care Act, it just doesn’t make sense to turn back now – not when so much money is on the table, there to build our health-care workforce, help our small businesses and provide more accessible, affordable care to thousands of New Mexicans who are currently struggling to keep their heads above water.

Feldman, a Democrat, represents N.M. Senate District 13. She was the sponsor of SJM1, which created the Health Care Reform working group, and is the chair of the Senate Public Affairs Committee.

Sen. Dede Feldman (Photo by Heath Haussamen)

The results of the recent election present tough choices for Democratic legislators, adding to the majority party’s task in dealing with a huge budget shortfall. The double whammy of lost seats and a slow recovery isn’t as bad as in some states, but it could make for some dramatic moments in the session to come.

Ten years ago, in 2001, after another heartbreaking election in which Democrats felt cheated by a Supreme Court that handed the election to Bush, the New Mexico Senate opened with a bang. A coalition of three Democrats and the entire Republican delegation united to overthrow President Pro Tempore Manny Aragon. The surprise move came after several days of standoff, broken when then-Gov. Gary Johnson convinced Republicans to support Sen. Richard Romero.

This year, with the loss of eight Democrats in the N.M. House, and the immediacy of a Republican administration, things are looking a little shaky for current Speaker Ben Luján. Unlike the New Mexico Senate, Democrats in the House usually vastly outnumber Republicans, so there is little chance of a coalition. But this year the numbers are close – 37 Democrats to 33 Republicans – which means it takes only a shift in three Democratic votes to allow the Rs to elect a different speaker.

The south rises again

Newly elected Susana Martinez is not the only southerner in the spotlight. Three southern Dems say they want Las Cruces Rep. Joseph Cervantes to be speaker. A few years ago, Cervantes was ousted as House Judiciary chairman when Rep. Ben Luján successfully fought off a challenge from the young Turks, who then included Reps. Ken Martinez and Cervantes.

For Democrats, surviving the 2010 election, with all its rhetoric about taxes, the deficit, and the “horrors” of the Richardson administration, was an achievement. Elsewhere, it was even worse. Republicans took control of 19 more legislative chambers, and gained approximately 680 seats. They took back 10 governors’ seats from the Democrats, including the one here in New Mexico.

Even liberal bastions like Maine flipped entirely, with Republicans now controlling the Legislature and the governor’s mansion.

One question for the Dems in the N.M. House (and the Senate) is whether they want to unite to fight for their core principles – education, health care, a decent safety net – or whether they want to cooperate in the downsizing of government that will surely be coming from the fourth floor of the Roundhouse. The leadership struggle may be an indication that there are some who want to go right.

Or not. It may simply be a personality battle, or a geographic split. Either way it might be useful to recall what happened to us in the Senate 10 years ago. Here’s the short version:

‘Odd men out’ force change

For 13 years, Sen. Manny Aragon controlled the N.M. Senate with a combination of charm, brilliance, and, in the final years, secret deals and unpredictable outbursts. His combative style during the Johnson administration drew cheers from supporters and howls from detractors, with the divide growing steadily. It also led to gridlock, with veto after veto, and special session after special session.

The divide was especially painful to Democrats, who took a regular drubbing from Republicans who decried the “Manny and Ray show” in what many felt was almost a racial slur. The attack was especially intense in the wake of Aragon’s controversial consulting contract with Wackenhut Corrections, a private prison corporation then bidding to operate N.M. prisons.

On the opening day of the 2001 session, as expected, Manny Aragon was nominated by Sen. Joe Fidel, on behalf of the Democratic caucus, and Sen. Joe Carraro was nominated on behalf of the Republican Caucus. Sen. Cisco McSorley, long discontent with Sen. Aragon, nominated Sen. Richard Romero, and, in a surprise move, was seconded by Sen. Leonard Tsosie of Crownpoint. That made three votes for Romero. With the absence of Sen. Linda Lopez, then in the hospital with complications from childbirth, it was clear that the “odd men out” had deprived the other two parties of the majority needed to win – 21 votes. And then the jockeying for votes began.

The results are well known. Aragon lost the presidency to Romero by one vote, but Romero did not allow a Republican-controlled coalition. Democrats maintained their committee chairs, and a budget based on Democratic values – but accomplished in a more inclusive and compromising fashion – was passed, and not vetoed by the governor.

But Democratic division persisted for the next four years and was only dissipated when newly elected Gov. Richardson insisted that Manny and Richard hold hands.

‘Coalition’ could have been forestalled

Could the “coalition” have been forestalled? Yes, if the Democrats had dealt with their differences over leadership openly in their caucus and chosen a leader that might not be the first choice, but with whom we could all live. But pride and personality intervened and Sen. Aragon, in particular, was not willing to step down, even though he knew, in the end, that he did not have the votes.

Fortunately, for House Democrats, there is ample time to come to an agreement on leadership and maintain the power of the Democrats before the session. But it will take an honest discussion of where Democrats want to go from here and not just a calculation of who can garner the most votes (from whatever direction) to be speaker of the House.

Senator Dede Feldman has represented District 13 since 1997.

Dede Feldman

I’ll be heading to Washington this week, along with legislators from other states who have been designated to lobby the Senate on behalf of the White House Working Group of State Legislators for Health Care Reform. The other legislators include Sen. Karen Keiser of Washington, Rep. Sharon Treat of Maine and Rep. Krysten Sinema of Arizona.

The visit comes as Democratic senators, unable to muster 60 votes for a pubic option, are considering alternatives, including a private national plan administered by the Office of Personnel Management (OPM) — which administers the congressional health plan — and a buy-in to the Medicare program for people aged 55-64.

Our group had earlier gathered signatures of 1,000 state legislators to support a robust public option, and during the summer and fall we have been holding town halls and other events to support reform.

Many of us are chairs of health committees and are involved in Medicaid or our own “public option” programs like the state coverage insurance (SCI) program here. We’re focused on how these reforms are going to be implemented – since it’s the states that will be catching the ball from Washington.

We’ll be meeting with the White House staff and visiting with senators and their staffs, including that of Sen. Bingaman and Sen. Udall.

I’m going to be stressing the urgency of “bridge” funding to carry our Medicaid and SCI programs forward until the full reforms kick in. Due to our current budget crisis, we’re on the verge of ending SCI and “restructuring” Medicaid, which means cuts in benefits, more co-pays, fewer programs and lower reimbursements for providers. Other states are doing the same thing.

As far as alternatives to the public option go, I hope they can save as much money — $25 billion, according to the Congressional Budget Office — as the public option, as well as increase competition and keep insurance companies premiums down. Most important, these policies must be affordable, which means that middle-income people must have adequate subsidies to purchase them.

The questions we’re going to be asking are whether these alternatives will really be national in scope, simple, portable and not just a costly, high-risk pool for those who can’t get coverage elsewhere.

For more information call me on my cell at 505-220-5958 or e-mail me at dedefeld@comcast.net.

Feldman, a Democratic state senator from Albuquerque, chairs the Senate Public Affairs Committee.

Dede Feldman

As we head into the special session, projections of our state’s budget shortfall get worse and worse. And the specter of massive cuts — or even a few tax increases — looms larger every day. Letters and e-mails are flying about who’s going to get cut.

At one recent town hall in my district, a constituent came up to me afterwards in tears because I had told the crowd that the State Coverage Initiative (SCI), one of the state’s few affordable health insurance programs, might get cut.

“I have cancer,” she said, “and I’m on the program.”

Her remarks got me to thinking how high the stakes were in this economic downturn and how easy it is to forget some basic principles. So here they are, my guidelines for making these hard budget decisions.

• Don’t make cuts that cause people to die. Yes, some cuts in funding will have that dire of an effect. One AIDS patient, for example, left a message on my answering machine asking me to think very carefully about cutting Medicaid funding for the AIDS waiver, which now goes mostly to medications and counseling. His life, literally, hangs in the balance.

The AIDS & HIV-positive patients are not alone. There are thousands of medically fragile children, seniors in nursing homes with life threatening conditions, cancer patients and others served by the Medicaid program, which will need $300 million just to stay afloat next year.

• Salary reductions, if there are to be any, should be done on a sliding scale, not across the board. What sense does it make to cut the meager salary of an educational aide who makes $8 per hour the same percentage as an administrator who makes $100 an hour? Yet, this may be the effect of across-the-board cuts, particularly if it is the administrators who decide how to implement reductions.

• Don’t cut off your nose to spite your face. As much as some folks resent federal funding, it is a fact of life that our Medicaid program gets four federal dollars for every state general fund dollar that we put into health care services for almost 500,000 low-income New Mexicans. Cuts to the program are magnified four-fold, and that doesn’t even count the major economic role that the health care sector plays here, especially in small communities.

At a recent committee meeting we were told by one economist that, as a result of the “multiplier” effect,” $300 million taken out of this program means a loss of about 15,000 jobs — in hospitals, clinics, medical offices and associated areas. Ironically, the health-care sector has been one of the fastest growing ones here in the past decade, with a gain of about 30,000 jobs until the recession hit.

• Those who profit from the recession must do their share — and pay up. As is often the case in recessions, the pain is not equally shared. As small businesses struggle to stay afloat, mortgages are foreclosed and bankruptcies escalate, the parking lots at Wal-Mart and other discount stores have filled up. Often these out-of-state corporations have eluded taxation because of a loophole in our tax code called “combined reporting.” These out-of-state companies are not paying their fair share.

Feldman, a Democratic state senator from Albuquerque, chairs the Senate Public Affairs Committee.