It sort of felt like a party at a recent health fair at the Rio Arriba County Health Commons in Española. And perhaps it is something to celebrate when you can get lunch, hear some traditional mariachi music by El Trio de los Gallos, and get immunized against pneumonia and whooping cough for free, all at the same time.
Nevertheless, Henrietta Ganes was a little hesitant about the shots. "This is really, really a great idea." Ganes had heard about an increase in whooping cough cases. She says she's going to bring her 18 year-old son to the health fair to get his shot, too. "It's not a laughing matter. The pneumonia, I'm asthmatic. I think I need to get it. Now that they are doing it here, I'm one of those, 'get it done, hurry up and give it to me so I can go'."
Healthcare is the fastest growing sector of the wage economy in New Mexico and two recent reports suggest expanding the state's Medicaid program would add 10,000 jobs per year. That's putting pressure on Governor Susana Martinez to include 170,000 low income adults in the federally subsidized health insurance program that is run by the state. But a quarter of New Mexico's residents, mainly low income children and seniors, are already enrolled, and some officials are warning the Governor that expanding the program would spell fiscal disaster.
It's not easy all the time for people living in Rio Arriba County. A recent analysis found 75 percent of healthcare expenditures were made outside the county, meaning most patients travel to other counties to see the doctor. Meanwhile, the unemployment rate is higher than the state average and nearly one out of four residents doesn't have health insurance.
So putting multiple agencies under one roof is part of an effort by county officials to make healthcare more accessible and to increase efficiency by getting different organizations into situations where they have to work together on a regular basis. It didn't use to be like that.
Lauren Reichelt says Rio Arriba county used to be known for providers not working together. She has been the Director of Rio Arriba County's Human Services Department since before the state of the art Health Commons building was built. "And so my office was in my bosses car," she explains, " and we had all the files stored in boxes in the trunk. Then, they had me in a building, I came to work one Monday and it had just collapsed over the weekend."
Now, the state Department of Health, the County, and organizations like El Centro Family Health share offices and exam rooms at the Health Commons. It's given them the opportunity to be up in each other's business all the time. "We are organized by function," Reichelt explains, " and that means we work together and we get to know each other and we build trust. We've worked on grants together, increased referral rates."
But how the state would pay for an influx of adult Medicaid recipients is exactly what has some people concerned about expanding the program.
The economy isn't doing so well in New Mexico. The state was recently ranked worst in the nation by Bloomberg.com. 50-thousand jobs were lost during the recession, but employers are hesitant to hire and fewer than 3-thousand jobs have been gained.The federal government pays 4 dollars for every dollar the state pays for current Medicaid recipients. And while the feds would pay for the entire expansion until 2016, New Mexico would be on the hook for 10 percent of those new costs by 2020. According to the Human Services Department, that could mean $500 million in increased Medicaid spending in seven years, on top of the $1 billion the state already spends annually.
Democratic Representative Ben Ray Lujan represents Northern New Mexico's 3rd District. "We have to understand the big picture as well," Lujan argues. He says it would be a big mistake not to expand the program and asks, "What's happening with those hidden costs that are hitting people today?"
Officials from the Martinez Administration were unwilling to grant an interview on tape for this story. However, a Human Services Department spokesman said in a written response:
We must weigh all of the considerations at hand, including how we best provide services to those most in need. There are still many questions that need to be answered by the federal government before any final decision can be made.
Meanwhile, at least one health insurance provider is placing a bet. Blue Cross Blue Shield is planning their first unit devoted specifically to managing care for Medicare and Medicaid patients.