Republicans unveiled a plan to repeal the Affordable Care Act last week. U.S. Senator Martin Heinrich has been a vocal critic of repealing the healthcare law. He spoke with KUNM's Ed Williams about what changes to the ACA could mean for this state.
HEINRICH: Almost immediately we would see tens of thousands of people who have insurance today either through the exchanges or through Medicaid expansion kicked off of their coverage, which is unacceptable. In addition it would be, financially, a disaster for the state. We’re seeing literally billions of dollars flow into the state because of the ACA. That would be lost revenue. It’s of a scale that could not be made up at the [state] legislature. And we could easily see rural hospitals close, because they would lose out on the revenue that they’re now seeing through Medicaid expansion.
KUNM: The GOP released a plan recently that would turn Medicaid into a block grant system. What impact would that have here?
HEINRICH: I would say that block grants mean defunding Medicaid expansion, not funding Medicaid expansion. And people forget that Medicaid is incredibly important for the kids who are covered, but it’s also how we cover much of our nursing home [expenses] as well. These things will have enormous impacts on people’s lives. And the plan that’s been put out so far by Speaker Ryan would be an absolute catastrophic disaster for the state of New Mexico.
KUNM: Republicans want to reduce costs to the federal government, and the ACA does need to be tweaked and fixed in some places. So is there a possibility for some productive work to happen now?
HEINRICH: We’ve been able to do that on individual issues, but that’s a different approach—that’s an issue-by-issue, if-it’s-broke-lets-fix-it approach. What they want to do is throw the entire baby out with the bathwater, and that would be an utter disaster for so many families who currently get coverage, who didn’t have it before, and who are able to be more contributing members of our economy because of that coverage.
KUNM: Are you saying that’s what you expect to happen, that it’s going to be a complete repeal? The Democrats are not in an advantageous position right now, and looking on from a distance I think a lot of people are nervous and wondering what to expect.
HEINRICH: I think there’s a deep divide within the Republican Party. There are many members, within the House in particular, who simply want to repeal health care reform and see what happens which would cause chaos in our insurance and health care fields like we haven’t seen in decades. There are others who realize just what those impacts would be and who are trying to take a much more sober approach to this. I think we have to prevail on them to slow this down and say, ‘if you’re going to repeal you better tell us, you better be transparent, what are you going to replace it with?’ And right now they simply don’t have an answer.
KUNM: One thing a lot of people, especially in Northern New Mexico are very concerned about is the impact that changes to Medicaid would have on access to addiction treatment services. That’s how a lot of people pay for their treatment. The opioid epidemic is not a local issue anymore—are you hearing this kind of concern from other senators in other states?
HEINRICH: I am, in fact I was just hearing this exact same concern from my colleague Joe Manchin from West Virginia. And there are other senators who have the exact same challenges today around opioids and prescription drugs. There are many, many people whose only access to treatment for addiction is either through their ACA insurance or through programs like Medicaid, and if we take that away we’re just going to see this epidemic get worse. I think that would be unconscionable.
KUNM's Chris Boros discussed the ACA further with Ed Williams.
BOROS: So those were pretty strong words from Senator Heinrich. He is a Democrat. What are Republicans saying about the issue?
WILLIAMS: Well Senator Heinrich said Republicans don't have a plan to replace the ACA. They do have something of a plan, even if it's in the early stages. Last week Paul Ryan, the Republican House Speaker, said the GOP would move towards a system that would use tax credits to help pay for insurance plans and they would also scale back Medicaid payments to the states that expanded Medicaid a few years ago under the ACA. At the state level, both Republicans and Democrats are expressing uncertainty over what that would mean here. New Mexico is one of the states to expand Medicaid and now we're not able to pay for it. So Republicans at the state capitol have had some ideas on how to fix the budget issues that have come along with The Affordable Care Act. For example, Republican State Representative Jason Harper introduced a tax overhaul that could send more money to the state's Medicaid fund and last week Governor Martinez announced a plan that would stop paying for coverage for people in the states high-risk insurance pool. That would save something like $42 million for the state.
BOROS: Why has the ACA caused so many financial problems here in New Mexico?
WILLIAMS: Mainly because our state has such a high poverty rate. There's a lot of people here that couldn't afford to buy health coverage on their own before the Affordable Care Act. So when the governor decided to expand Medicaid to cover low-income and working folks, a whole bunch of people signed up.
BOROS: So wait, how many people?
WILLIAMS: Now, Medicaid enrollment in New Mexico is supposed to reach something like 920,000 people by this summer and that's almost half the state's population. So the federal government has covered all the cost of Medicaid at first but the state has to pay part of the cost soon and we just don't have enough money to do that because we're in the middle of a budget crisis. Also, more than 50,000 people have signed up for non-Medicaid plans and there have been problems there, too. Several big insurers have pulled out of the state exchange.
BOROS: Yeah, but there are already a lot of people on Medicaid here before Obamacare right?
WILLIAMS: Yeah, a bunch of the people that are on Medicaid now qualified before the ACA but if Republicans change the way the whole program works, that could affect everyone on Medicaid, not just the new enrollees.
BOROS: Now, if Senator Heinrich told you that a lot of people already pay for addiction through coverage they got from the Affordable Care Act, but doesn't the state pay for those services too? I mean, would changes to the ACA really affect addiction treatment?
WILLIAMS: Yeah, the state does give money and quite a bit for treatment programs. But the problem is that it stopped paying for detox. Before you get into treatment, you have to detox right? So Medicaid pays for certain kinds of detox that's done in a certain type of hospital. So now if you want to get into detox then you have to drive to one of the few places that takes Medicaid. So if those places go away, it's not clear how people will be able to get into addiction treatment at all.