Even though the House Republican’s forced starvation of health care for the vulnerable, known as the American Health Care Act (AHCA), will undergo many changes in the coming weeks, and even though the U.S. Senate is bound to file off some of its most wicked burrs slashing away at almost everyone’s life line, the Republican “repeal and replace” dismantling of Obamacare has shaken New Mexico in a terrible way. It has shown us a future that we must avoid.
The New Mexico Center on Law and Poverty says that the Republican AHCA would have “devastating consequences for New Mexico.” Not only would it omit federal subsidies for purchasing health insurance, it would drastically reduce Medicaid funding. The numbers of victims would be staggering. Nearly half of New Mexico’s population – some 900,000 people – are enrolled in Medicaid. Without full federal funding for Medicaid New Mexico would have to fork up around $437 million a year to maintain the current level of healthcare coverage. “If it can’t or won’t” says the Center, “more than 250, 000 New Mexicans could lose their coverage and become uninsured.” That’s almost one-eighth of the state’s population! It’s also slightly less than the combined populations of Las Cruces, Rio Rancho, and Santa Fe, or a little under a half of the population of the City of Albuquerque.
Imagine, in one act of the most callous irresponsibility, the U.S. House of Representatives could wreck the lives of loved ones and acquaintances networked in someway throughout the state. As State Senator Martin Heinrich says, “Simply put, under Trumpcare New Mexican will be left paying more for less health coverage, our health care system will be thrown into chaos, and thousands across the state stand to lose their coverage all together. All so a hedge fund manager can get a six-figure tax break.”
Medicaid, and health care in general, would become a state’s rights issue. Some states would make up the reduction of Medicaid from its own tax base, others would not or could not even if they ‘d want to. America would become medically Balkanized. Federal law and funding is designed to create a “more perfect union” among the various regions and jurisdictions of the country. That’s, in part, what the Civil Rights Act, the Voting Rights Act, Social Security, banking regulations, the Environmental Protection Agency, Medicaid and Medicare are all about – extending “equal justice under law” to everyone in the country. An America without federal law and federal regulations would not be America, it would be a concoction, a confederacy, of political islands that could do as they please about any pressing issue even if their responses were blatantly discriminatory.
Arizona’s 2010 law, for instance, that allows police to stop vehicles on a “reasonable suspicion” of their occupants being illegally in the country has made many Hispanic New Mexicans refuse to even drive in Arizona or get a tank of gas. As the ACLU comments “…in America, everyone is supposed to be presumed innocent. This turns the presumption of innocence on its head. Because in most cases it is hard to conceive of any legitimate way law enforcement could develop a suspicion that someone is here unlawfully, the law clearly invites racial profiling by officers who are likely to rely on the way people look in forming any ‘suspicion’ that they are not in this country legally. The law invites discrimination.”
I don’t think we’re turning into a confederacy. But I do think the Republican AHCA takes us a long way down the road to Balkanization, an America composed of radically unequal states when it comes to basic social, health care and environmental justice. America could be made up of states known for having great health care and states known for having abysmal health care, just like we know that there are states in which Jim Crow remains a menace to African Americans and where Jim Crow has become marginalized in a major way. We could have states like California with pioneering air quality standards and states like Texas with substandard air quality, states with an affinity for the LGBT community and states that are openly hostile.
For culturally rich but financially impoverished New Mexico, having a reputation as a deadbeat health care state would be close to a deathblow to our whole economy. New Mexico would be no place for the medically vulnerable.
And we are all, of course, medically vulnerable. Everyone with a child, an older relative, an unwell spouse, a disabled family member, or an age-induced disability of their own, is vulnerable to America’s rapacious, price-gouging health care money vacuum that seems to suck the cash right out of our bank accounts.
As a free lance writer making a living in New Mexico for the last 55 years, I’m well aware of what it means to be medically indigent, without the back up of affordable health insurance. For years my family couldn’t be insured because a “pre-existing condition,” cancer, made us ineligible. Earlier, a burst appendix found us at the mercy of indigent care at UNM’s hospital, a godsend to be sure. Our income was next to nothing working at an alternative weekly. We got the best of care at UNM and were allowed to pay off our income-adjusted bill at a pace we could afford. The two cancer operations we suffered later were covered in large part by Hill-Burton grants because ironically we were “lucky” enough to be without work or savings at the time, and to have both surgeries take place in January before the annual grant money ran out. Hill-Burton is a Free and Reduced-Cost Health Care program offered since 1946 by hospitals built with federal subsidies and required to help those who can’t pay for procedures.
Even with Medicaid expansion under Obamacare cutting indigent healthcare in half at UNMH over the last two years, according to State Auditor Tim Keller the hospital still had to swallow last year some $64 million taking care of the uninsured and financially crippled. And if the drastic reductions proposed in the Republican AHCA are not mitigated or removed, UNMH will find itself in an ever deepening hole with spiraling costs and more and more impoverished New Mexicans to care for.
What would turn troubled New Mexico, with stripped down Medicaid, from a health care nightmare to a health care innovator? Would we follow the lead of Oregon and Texas and try to create patient-physician health cooperatives in rural parts of our state? What would the universities, the mainstream media, and insurance companies make of a state that set about to liberate itself from dangerous national trends that favor setting the dogs loose on the old and sick and unlucky, rather than creating a single-payer national system? What if a New Mexico medical co-op system were to try to negotiate prices with Big Pharma? Would New Mexico constitute a large enough pool to make a difference to an international corporation?
If New Mexican’s get stuck with some form of Tumpcare for even half a decade, we could be forced to actually innovate a healthcare system of our own, tax ourselves, and think our way out, somehow, of the mess the Republican party dumped on us in 2017. In a Balkanized America, a strong local healthcare system might be seen as the most important indicator of a business-friendly state.
*Nullius in verba: take nobody’s word for it
(Map image by Kevin Hutchinson)