New Mexico

Less than one year ago, in February 2020, I wrote a lengthy post about a great idea that New Mexico was attempting to put through which, had it succeeded, would have generated up to $125 million per year to be used primarily for reducing individual market premiums:

New Mexico would raise a state health-insurance tax and dedicate the new revenue to programs intended to make health care more affordable under a proposal that passed the state House on Sunday.

Rep. Deborah Armstrong, D-Albuquerque, described the legislation as an unusual opportunity to generate more revenue for health care without increasing the total amount consumers now pay.

The increased state tax would partially replace a federal tax that’s being repealed, she said, meaning health insurance carriers would actually be charged less in taxes than they are now, even after the state increase.

The legislation, House Bill 278, would raise about $125 million in annual revenue when fully phased in — the bulk of it dedicated to a new fund for health care affordability, according to legislative analysts.

New Mexico Superintendent of Insurance Announces Premium Decreases for 2021

Santa Fe, NM –New Mexico Superintendent of Insurance Russell Toal announced today that health insurance premiums will decrease significantly for individuals and families purchasing their own coverage through beWellnm (New Mexico’s Health Insurance Exchange). Average plan prices dropped in the Bronze, Silver, and Gold plan categories across the state. Silver plans, the most common plan purchased on the individual Exchange, will decrease between 8.1 and 13.5 percent on average. Small businesses will experience a 6.7 percent average premium decrease on beWellnm.

The Office of Superintendent of Insurance (OSI) reviews health insurance filings annually to determine whether rates are reasonable and fair.

“After a rigorous review of health insurance filings, our office is pleased to report that premiums are going down in 2021,” said Superintendent Toal. “Not only are rates decreasing, but New Mexico will have more health plans competing in the marketplace than ever before”

New Mexico is the latest state to post their preliminary 2021 rate change filings for both the individual and small group markets. There's several key things to note here:

Yesterday I posted a long, wonky explainer about the fallout of the ACA's Health Insurer Tax (HIT) being repealed in December 2019.

As I explained, the HIT is one of a several taxes/fees which were originally included in the Affordable Care Act which have either never actaully been enforced or whcih have only been enforced sporadically, and which have now been completely eliminated going forward.

The impact of repealing these taxes on the federal deficit/federal debt is obviously not good...this will collectively increase the already-runaway national debt by several hundred billion dollars over the next decade. That's a whole separate discussion.

In the short term, however, this raises a fascinating one-time opportunity for states to step in and generate some much-needed revenue to be used to reduce healthcare costs for tens of thousands of their residents.

A couple of weeks ago, BeWell NM, the name of the New Mexico ACA health exchange, held their latest board meeting. There's two key things to keep in mind about New Mexico:

First, they've been officially operating as a state-based exchange while "piggybacking" off of HealthCare.Gov since the very first Open Enrollment Period in 2013-2014...but they announced over a year ago that they're following Nevada's (and Idaho's) lead in splitting off onto their own full exchange, starting in 2021.

Second, as I reported back in August, there was an unusual development on the New Mexico ACA individual market:

CHRISTUS HEALTH PLAN LOSES QUALIFIED HEALTH PLAN STATUS

MLR rebate payments for 2018 are being sent out to enrollees even as I type this. The data for 2018 MLR rebates won't be officially posted for another month or so, but I've managed to acquire it early, and after a lot of number-crunching the data, I've recompiled it into an easy-to-read format.

But that's not all! In addition to the actual 2018 MLR rebates, I've gone one step further and have taken an early crack at trying to figure out what 2019 MLR rebates might end up looking like next year (for the Individual Market only). In order to do this, I had to make several very large assumptions:

Back in June, the New Mexico Insurance Dept. posted the preliminary 2020 rate change filings for the ACA individual and small group markets. At the time, the vcarriers were requesting the highest average premium increase in the country for next year: An increase of 13.0%.

The main source of this double-digit hike was New Mexico Health Connections, one of just a handful of original ACA Co-Op carriers to survive. They were requesting a whopping 30% average rate hike for 2020, and with over 1/3 of the market share, this was more than enough to drag the statewide average up. A second carrier, Presbyterian, only sells off-exchange but was requesting a 16.3% increase which also pushed the average up.

Well, today the approved rate filings have been released, and there's several eyebrow-raising developments.

First of all, there's this (first noted by Sabrina Corlette):

CHRISTUS HEALTH PLAN LOSES QUALIFIED HEALTH PLAN STATUS

The New Mexico Office of the Superintendent of Insurance website just posted the preliminary 2020 insurance rate filings. Here's the full list, which includes a mish-mash of Individual Market, Large Group and Small Group Market policies, with a Pediatric Dental standalone plan thrown in as well.

It's worth noting that the NM carriers are being very careful to separate out on & off-exchange policies into separate listings even though they're all part of the same risk pool, and they're even separating out off-exchange "Mirrored" policies, which refers to CSR Silver Switching; this is a very good thing.

I've cleaned up the listings and plugged in the weighted average rate increases in the table below this one:

 

In the 5 1/2 years that I've been operating this website (has it really been that long?), I was surprised (pun intended) to realize that out of the 5,600+ blog entries that I've posted, only 2-3 have mentioned "Surprise Bills" (also known as "Balance Billing", although I think there are some differences between the two):

(sigh) Well, it was a good run while it lasted. As I noted last week, New Mexico's new Democratic trifecta government has been on something of a tear in the first few months of 2019, either passing or advancing a number of positive healthcare policies, including:

In addition, there was one more important piece of legislation which looked like it was going to go through without too much fuss: HB 436, which would simply lock in protections for New Mexico residents with pre-existing conditions at the same level that the Affordable Care Act already does nationally:

I've posted so many "Great News!" updates out of New Mexico over the past month that I have a keyboard shortcut to select the NM icon graphic.

Here's the latest out of the Land of Enchantment:

HB 436 passed on the House floor by a vote of 40-24 on Thursday afternoon. The bill would bring New Mexico's state law dealing with pre-existing conditions into line with federal law. 

Rep. Liz Thomson, the bill's sponsor, says health insurance coverage for people with pre-existing conditions is already protected under the federal Affordable Care Act. She wants New Mexico's state law to do the same.

"Because before the Affordable Care Act came along, insurance companies could discriminate based on gender, they charge women more, and on pre-existing conditions," Thomson said. 

A couple of weeks ago, Louise Norris gave me a heads up that not only has the New Mexico Insurance Dept. restricted the sale of non-ACA compliant "short-term, limited duration" plans to be...you know...both short term and of limited duration via regulation...

In September 2018, the New Mexico Office of the Superintendent of Insurance (OSI) and Health Action NM (an advocacy group for universal access to health care) presented details about potential state actions to stabilize the individual market. OSI has the authority to regulate some aspects of the plans, including maximum duration, but they noted that legislation would be needed for other changes, including minimum loss ratios and benefit mandates.

New Mexico’s insurance regulations were amended, effective February 1, 2019, to define short-term plans as nonrenewable, and with terms of no more than three months. The regulations also prohibit insurers from selling a short-term plan to anyone who has had short-term coverage within the previous 12 months.

The contrast in how a completely Republican-held state government like Utah and a completely Democratic-held state government like New Mexico deal with Medicaid is pretty astonishing.

In Utah, just four months ago the public voted, clearly and unequivocally, to enact a full expansion of Medicaid to all adults earning up to 138% of the Federal Poverty Line...but the GOP state House, Senate and Governor decided to ignore the voters and override their will by cutting the expansion down to a 100% FPL cap, including work requirements, which will cover tens of thousands fewer people while costing the state $50 million more.

In New Mexico, meanwhile, a newly-enabled Democratic trifecta (I believe both houses of the state legislature were already held by Dems, but the Governorship flipped from Republican Susana Martinez to Democrat Michelle Lujan Grisham) has been on a tear in their first month and a half:

As always, Louise Norris has the skinny:

In September 2018, the New Mexico Office of the Superintendent of Insurance (OSI) and Health Action NM (an advocacy group for universal access to health care) presented details about potential state actions to stabilize the individual market. OSI has the authority to regulate some aspects of the plans, including maximum duration, but they noted that legislation would be needed for other changes, including minimum loss ratios and benefit mandates.

New Mexico’s insurance regulations were amended, effective February 1, 2019, to define short-term plans as nonrenewable, and with terms of no more than three months. The regulations also prohibit insurers from selling a short-term plan to anyone who has had short-term coverage within the previous 12 months.

Things have been happening so quickly of late that I'm getting farther and farther behind on some important healthcare policy developments, particularly at the state level. There are two extremely important Public Option announcements which could be game changers if they make it through the legislative process.

Since I don't have time to do full write-ups on either one right now, I'll just present these summaries:

My friend and colleague Colin Baillio, policy director of Health Action New Mexico, has been working on this for a long time, and it looks like this project has finally entered the legislative stage:

LUJÁN APPLAUDS INTRODUCTION OF MEDICAID BUY-IN LEGISLATION IN NEW MEXICO

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