Ahead of the November 6 elections, CJR invited writers to spotlight stories that deserve closer scrutiny, in their states and beyond, before voters cast their ballots. Read other dispatches from “States of the Union” here.
About one-third of people in New Mexico are insured through the low-income health program Medicaid, the highest proportion of any state population. A huge number of them enrolled after the state expanded Medicaid in 2014 through the Affordable Care Act—under a Republican governor. As a result, New Mexico receives more federal subsidies for its Medicaid program than nearly every other state. (Last year’s threats from DC to swap Medicaid subsidies with block grants would have meant less money for the program in the long run—a disaster for poorer states.) Changes to the nation’s health system are quite literally a life-and-death matter for a plurality of people here.
In the wake of Republicans’ failure to formally repeal the Affordable Care Act, Democrats in state legislatures and Congress have proposed major changes to healthcare systems. Congressional Democrats have floated a range of proposals—from the near-total government replacement of insurance markets, à la Senator Bernie Sanders’s single-payer “Medicare for All” legislation, to arrangements that offer universal access to healthcare through Medicare or Medicaid but leave private insurance in place. Meanwhile, Democratic gubernatorial candidates in New York and Massachusetts have proposed state-level single-payer systems.
Many New Mexico journalists, including myself, have covered a campaign by grassroots groups to drum up support for a Medicaid buy-in program, which would permit anybody in the state to receive coverage through Medicaid regardless of income. This coalition’s main activity has been meeting with city and county officials and convincing them to support state legislation for the program. News coverage has generally highlighted the campaign’s major victories after-the-fact. For example, when the state’s largest county passed a resolution supporting the legislation last month (a mostly symbolic vote), the event received coverage in both the Albuquerque Journal as well as public radio station KUNM.
The coalition supporting Medicaid buy-in has close ties to Democrat Ben Ray Luján, one of the New Mexico’s three US House representatives and likely the only one who will keep his seat in November. Among several potential reforms Democrats in Congress have proposed, Luján has thrown his weight behind Medicaid buy-in. In a January op-ed in the Santa Fe New Mexican, Luján touted his support for the idea at the federal level, as well as his enthusiasm for state legislators investigating the same. Medicaid buy-in would position New Mexico as an “innovator” and “ground-breaker,” Luján argued, adding, “New Mexico’s Medicaid program is uniquely positioned to be the first state to take up this specific policy.”
Coverage of platforms such as Medicaid buy-in too often ignores the full scope of the healthcare-reform discussion. Voters need news outlets to analyze and arrange reform proposals on spectrums such as cost, inclusivity, complexity, and political feasibility.
Media in New Mexico has trailed the story, allowing Rep. Luján’s political ambitions to shape the narrative around healthcare expansion. It’s also let other Congressional candidates get away with uncertain or vague positions on healthcare reform, which makes it harder to hold them accountable if they win. Coverage of platforms such as Medicaid buy-in too often ignores the full scope of the healthcare-reform discussion. Voters need news outlets to analyze and arrange reform proposals on spectrums such as cost, inclusivity, complexity, and political feasibility. In general, reporters haven’t properly situated reform efforts like Medicaid buy-in—itself a jargon-y and inaccessible phrase—within a broader national context.
Medicaid buy-in builds on existing models to give more people basic healthcare; in almost all states, there’s already a Medicaid buy-in program for disabled people who work and would otherwise make too much money to qualify. The peer-reviewed Health Affairs journal noted just how much variation exists between state reform efforts that might broadly be categorized as either “single-payer” or “Medicaid buy-in.” In Nevada, for instance, lawmakers passed a bill last year to compel the state to use federal Medicaid reimbursement funds in order to contract with private insurers to offer a commercial insurance plan open to a larger swathe of the public. The governor vetoed it, but the policy effort was an example of how states might redirect federal subsidies made available through Medicaid in order to prop up new public health options.
“You can support healthcare for everyone in a variety of ways,” says Deb Haaland, a Democrat and the favored candidate for the House seat that will be vacated by US Rep. Michelle Lujan Grisham (who also introduced a Medicaid buy-in bill). Haaland, who is campaigning on a promise to support Medicare for All, tells CJR that she doesn’t see a contradiction between championing this more expansive idea while also supporting state and federal legislation for a Medicaid buy-in program, a refrain repeated by other candidates across the country. Asked whether she has investigated other healthcare reform proposals such as Medicare X, which would expand Medicare as an option to everybody by 2023 but would not create a path to single-payer, Haaland says she hasn’t, but would educate herself on such plans “by the time I get to Congress, if I am fortunate enough to win my election on November 6.” If Haaland wins, journalists should compare her actual voting record on healthcare with her campaign promise, and residents can use that information to act accordingly.
Reporters should press candidates, in New Mexico and beyond, to articulate clear positions on healthcare reform. In September, the National Republican Campaign Committee launched a misleading ad attacking Second Congressional District candidate Xochitl Torres Small, a Democrat, as a supporter of a Medicare for All plan. Similar NRCC ads targeted a number of Democratic congressional candidates; a fact-check by The Washington Post noted outstanding “questions and uncertainties” about Sanders’ Medicare for All plan, and observed that the ads “tar every Democrat with the Sanders brush if they so much as hinted at being open to the single-payer option.”
Small doesn’t support Medicare for All. However, she hasn’t made it clear what, if any, major health reform she does support. A statement from her campaign to the Post said that Small “is committed to fixing the ACA, lowering healthcare costs, improving accessibility for rural areas and protecting Medicare,” but that response leaves room for journalists to push for specifics to the benefit of New Mexico voters.
Clarity on candidate health-reform positions won’t necessarily prevent political opponents from characterizing their positions in bad faith. In an op-ed for USA Today, President Trump accused a majority of Democrats in the House and 15 in the Senate of wanting to “outlaw private insurance” and “end Medicare as we know it”—misleading attacks that resemble the ad against Small. With Trump in office, any bill to expand America’s health system likely won’t be signed by a sitting president until at least 2020. But people in New Mexico deserve robust access to all dimensions of the policy discussion now, regardless of how the political winds change.