Impact of the Affordable Care Act in New Mexico
Thousands of New Mexicans have gained coverage, and hundreds of thousands more have had their coverage substantially improved
Today, the U.S. Department of Health and Human Services released an extensive compilation of state-level data illustrating the substantial improvements in health care for all Americans over the last six years. The data show that the uninsured rate in New Mexico has fallen by 44 percent since the Affordable Care Act (ACA) was enacted in 2010, translating into 178,000 New Mexicans gaining coverage. And, in addition to residents who would otherwise be uninsured, hundreds of thousands more New Mexicans with employer, Medicaid, individual market, or Medicare coverage have also benefited from new protections as a result of the law.
“As our nation debates changes to the health care system, it’s important to take stock of where we are today compared to where we were before the Affordable Care Act,” said Secretary Sylvia M. Burwell. “Whether New Mexicans get coverage through an employer, Medicaid, the individual market, or Medicare, they have better health coverage and care today as a result of the ACA. Millions of Americans with all types of coverage have a stake in the future of health reform. We need to build on our progress and continue to improve health care access, quality, and affordability, not move our system backward.”
Highlights of today’s data release include:
Employer Coverage: 884,000 people in New Mexico are covered through employer-sponsored health plans. Since the ACA was enacted in 2010, this group has seen:
- An end to annual and lifetime limits: Before the ACA, 555,000 New Mexicans with employer or individual market coverage had a lifetime limit on their insurance policy. That meant their coverage could end exactly when they needed it most. The ACA prohibits annual and lifetime limits on policies, so all New Mexicans with employer plans now have coverage that’s there when they need it.
- Young adults covered until age 26: An estimated 15,000 young adults in New Mexico have benefited from the ACA provision that allows kids to stay on their parents’ health insurance up to age 26.
- Free preventive care: Under the ACA, health plans must cover preventive services — like flu shots, cancer screenings, contraception, and mammograms – at no extra cost to consumers. This provision benefits 735,472 people in New Mexico, most of whom have employer coverage.
- Slower premium growth: The average premium for New Mexico families with employer coverage grew 4.3 percent per year from 2010-2015, compared with 8.5 percent over the previous decade. Assuming New Mexico premiums grew in line with the national average in 2016, family premiums in New Mexico are $5,100 lower today than if growth had matched the pre-ACA decade.
- Better value through the 80/20 rule: Because of the ACA, health insurance companies must spend at least 80 cents of each premium dollar on health care or care improvements, rather than administrative costs like salaries or marketing, or else give consumers a refund. New Mexicans with employer coverage have received $1,425,694 in insurance refunds since 2012.
Medicaid: 766,732 people in New Mexico are covered by Medicaid or the Children’s Health Insurance Program, including 358,107 children and 55,415 seniors and people with disabilities covered by both Medicaid and Medicare. The ACA expanded Medicaid eligibility and strengthened the program for those already eligible.
- 82,000 New Mexicans have gained coverage through Medicaid: An estimated 82,000 New Mexicans have health insurance today because New Mexico expanded Medicaid under the ACA. Coverage improves access to care, financial security, and health, resulting in an estimated 9,000 more New Mexicans getting all needed care, 11,700 fewer New Mexicans struggling to pay medical bills, and 100 avoided deaths each year.
- Thousands of New Mexicans with a mental illness or substance use disorder are getting care: Thanks to expansion and improved access to treatment, an estimated 8,000 fewer New Mexicans are experiencing symptoms of depression.
- New Mexico is saving millions in uncompensated care costs: Instead of spending $90 million on uncompensated care, which increases costs for everyone, New Mexico is getting $190 million in federal support to provide low-income adults with much needed coverage.
- Children, people with disabilities, and seniors can more easily access Medicaid coverage: The ACA streamlined Medicaid eligibility processes, eliminating hurdles so that vulnerable New Mexicans could more easily access and maintain coverage.
- New Mexico is improving care coordination: Building on Medicaid expansion, New Mexico is introducing delivery system reforms that will improve care and bring down costs by encouraging better coordination among providers and testing out new ways to pay providers for quality health care.
Individual market: 47,497 people in New Mexico have coverage through the Marketplace. Individual market coverage is dramatically better compared to before the ACA:
- No discrimination based on pre-existing conditions: Up to 861,621 people in New Mexico have a pre-existing health condition. Before the ACA, these New Mexicans could have been denied coverage or charged an exorbitant price if they needed individual market coverage. Now, health insurance companies cannot refuse coverage or charge people more because of pre-existing conditions.
- Tax credits available to help pay for coverage: Before the ACA, only those with employer coverage generally got tax benefits to help pay for health insurance. Now, 32,703 moderate- and middle-income New Mexicans receive tax credits averaging $212 per month to help them get covered through HealthCare.gov.
- Women pay the same as men: Before the ACA, women were often charged more than men just because of their gender. That is now illegal thanks to the ACA, protecting roughly half the people of New Mexico.
- Greater transparency and choice: Before the ACA, it was virtually impossible for consumers to effectively compare insurance plan prices and shop for the best value. Under the ACA, New Mexico has received $7 million in federal funding to provide a more transparent marketplace where consumers can easily compare plans, choosing among 20 plans on average.
Medicare: 385,918 people in New Mexico are covered by Medicare. The ACA strengthened the Medicare Trust Fund, extending its life by over a decade. In addition, Medicare enrollees have benefited from:
- Lower costs for prescription drugs: Because the ACA is closing the prescription drug donut hole, 23,642 New Mexico seniors are saving $24 million on drugs in 2015, an average of $1,006 per beneficiary.
- Free preventive services: The ACA added coverage of an annual wellness visit and eliminated cost-sharing for recommended preventive services such as cancer screenings. In 2015, 156,682 New Mexico seniors, or 63 percent of all New Mexico seniors enrolled in Medicare Part B, took advantage of at least one free preventive service.
- Fewer hospital mistakes: The ACA introduced new incentives for hospitals to avoid preventable patient harms and avoidable readmissions. Hospital readmissions for New Mexico Medicare beneficiaries dropped 3 percent between 2010 and 2015, which translates into 118 times New Mexico Medicare beneficiaries avoided an unnecessary return to the hospital in 2015.
- More coordinated care: The ACA encouraged groups of doctors, hospitals, and other health care providers to come together to provide coordinated high-quality care to the Medicare patients they serve. 3 Accountable Care Organizations (ACOs) in New Mexico now offer Medicare beneficiaries the opportunity to receive higher quality, more coordinated care.