By Sen. Jeff Bingaman

In the two years since Congress passed the health insurance reform law, called the Affordable Care Act (ACA), there has been a lot of debate about its merits. As we move closer to implementing some of the most significant pieces of that law, I’d like to highlight reasons why New Mexico will be one of the nation’s biggest winners from the improvements in the ACA.

Nearly one in five New Mexicans lacks health insurance, making New Mexico the state with the second-highest rate of uninsured in the country. The cost of treating the uninsured is being passed along to those who have insurance, which is one of the reasons health care premiums are rising at an unacceptable rate. The ACA is intended to correct that.

A recent poll from the Kaiser Family Foundation indicates that most Americans strongly support many of the provisions contained within the new law—like provisions that allow young adults up to age 26 to be covered under their parents’ insurance and those that forbid insurance companies from denying coverage to people with pre-existing conditions.

The new law has three main goals that will help improve our nation’s health care delivery system.

1. Expand health care coverage and ensure that health care is affordable for everyone. New Mexicans are already benefitting significantly from provisions put in place by the ACA, such as Medicare expansion, help scrutinizing unreasonable premium increases, and the removal of lifetime limits on health benefits (annual limits on health benefits will be restricted in 2014). New Mexico has also already received nearly $54 million to create new community health center sites in medically-underserved areas of our state and enable our 140 existing centers to increase the number of patients served. Over the next ten years, the nonpartisan Congressional Budget Office projects that 93% of the country will have health insurance coverage. This in turn will help us reduce our national health care spending by well over $1 trillion over the next three decades.
2. Improve the quality of health care. In the past, hospitals and care providers were often paid per service, so there was incentive to select treatment options that might not have been the most effective or preventive. The ACA changes that system so that hospitals and providers are paid for results—meaning that health care should improve while it also becomes less expensive. Another way to improve the quality of health care is to make preventive care accessible for everyone. Preventive care lowers both the cost of and need for future treatment, and is now completely covered under Medicare. Other important preventive services that are now covered through private insurance, thanks to the ACA, are immunizations for children, mammograms and cervical cancer screening, and colonoscopies.
3. Rein in rapidly rising costs of health care and health care inefficiencies. As much as one-third of health care spending does not improve anyone’s health. The ACA addresses this by establishing new payment models based on coordinated value-based care and by requiring insurers to justify premium increases and spend at least 80% of premiums on medical care (not CEO salaries or administrative costs). These and other common-sense provisions will improve the transparency and efficiency of health care—in a fiscally responsible manner.

And New Mexicans are already benefitting from the law.

Here are a few examples:

• 122,000 New Mexican children gained access to health care because insurers could no longer deny them coverage based on a pre-existing condition such as cancer or diabetes [more information]
• 21,500 New Mexicans age 26 or younger have health insurance because they are now allowed to remain on their parents health care plans
• Nearly all of New Mexico’s 320,000 Medicare beneficiaries have begun receiving free preventive services [more information]
• New Mexico received $9.4 million in health promotion and prevention funds, helping three out of every five New Mexican seniors receive free annual wellness visits with their doctor or other preventive services
• New Mexico has also received $5 million for maternal, infant, and early childhood home visiting programs that bring health care professionals to meet with at-risk families to provide health care, developmental services for children, child abuse prevention programs, and nutrition evaluations

The ACA will improve the way we receive health care in New Mexico and across the country. These and other changes have already been implemented, and the law will be fully implemented in January of 2014. My website has other useful links, and I hope you’ll continue checking back in as changes are implemented.