Gov. Bill Richardson spent about one-third of his State of the State address on Tuesday talking about his health care plan, carefully outlining the reform he hopes to achieve this session.

As he did that, the governor subtly acknowledged the fact there will be opposition, questions and alternative plans proposed in the next 29 days.

"I believe my plan offers the fairest and most pragmatic approach," he said after referencing other proposals that lawmakers are likely to float to deal with New Mexico's high rate of uninsured.

Richardson knows this year's pitch isn't a slam dunk, as Democrats and Republicans are wondering just how they will overhaul New Mexico's health care system as the governor wants.

"With 360 million new dollars and about $5 billion worth of needs," Senate President Pro Tem Tim Jennings, D-Roswell, said, "I think it's going to be a tough road" for all of Richardson's health care proposals.

Richardson wants to require all New Mexicans to have health insurance by 2010. He also would mandate that insurance companies spend 85 percent of premiums on direct patient care as well as set up a Health Care Authority that would oversee the changes and help the state train and recruit health care professionals. In addition, Richardson wants to prohibit insurance companies from denying coverage to people with pre-existing conditions.

The governor wants all that in the next month — not to mention the other things on his agenda this year: ethics reform, domestic partnerships, a few crime bills and a state budget.

While many lawmakers support his health care reform ideas, they fret over the costs. "It's easy to talk about things, but financing all these plans is something the Legislature really has to look at real hard," said Senate Minority Leader Stuart Ingle, a Portales Republican.

"The New Mexico economy may not be as bad as others, but by the same token, the money and dollars have not come in like it has in the past two, three, four years," he said.

The administration says the plan will mean a spending increase in 2010 of about $30 million. The projected additional spending over five years would be about $72 million.

Ingle and others, however, have questioned those figures. "The estimates of the dollars are not estimable," Ingle said. "You can't tell me that anybody knows what this thing will cost."

The governor's plan would be phased in starting in 2010 — something some have suggested might have to be put off. "If the money is not there, we might have to take a slower approach," said John Heaton, a Carlsbad Democrat.

Richardson officials have spent weeks briefing lawmakers on the plan's details. They've lined up community and lawmaker support, but it remains to be seen whether the groundswell is there to make such sweeping changes. Already, the competing plans Richardson referenced are headed for the legislative bill hopper, set to be considered by lawmakers who spent Tuesday getting organized.

A key Richardson ally, House Speaker Ben Luján, says he thinks chances are good overall for the governor's proposal.

However, he expects the details on the Health Care Authority that Richardson wants would require "a lot of give and take" between the governor and the Legislature.

Under Richardson's plan, the governor would control who sits on the authority — an idea that's not sitting well with some lawmakers. "I don't believe that one governor should have his say over everything in health care," Ingle said. "Not this governor — I don't care if it's a Republican governor. No governor should have that kind of thing."

Jennings also has reservations about how Richardson wants to set up the committee. He'd rather have a permanent legislative committee that deals with health care. "I would be more in tune with a legislative committee that would call individuals from the affected areas," said Jennings, a Roswell Democrat.

Sen. Dede Feldman, an Albuquerque Democrat, has said she plans to push for a measure that would set up an independent authority not controlled by the governor.

More than 400,000 New Mexicans are without insurance, by the state's estimates. Lawmakers for years have grappled with how to get more people covered while trying to lower the rising cost of health care in the state.

As the state tries its most sweeping approach to the problem, Ingle wants to be sure that New Mexico doesn't enact so many regulations that it chases away the health care professionals it is struggling to keep. "If this is something they can't live with," he said, "we're going to have a worse problem than we have now."

And others say now might not be the best time to make giant changes in the state health care system. "If revenues weren't crashing and burning, I'd say the chances are high," said Sen. John Arthur Smith, a Deming Democrat who co-chairs the Senate Finance Committee. "But given the fact that everything is downturning, that won't be pushed very heavily."

"We're going to try and accommodate (health care changes)," he said, "but our constitutional charge is the budget."

Still, Jennings and others aren't totally pessimistic about the chances for reform this year. And there is common ground: Jennings in particular likes a push by the governor to make health records available electronically.

"Nobody around here always gets what they want," Jennings said. "It's a place of compromise, of different sides coming together and walking home with something for the people they represent."

Contact Kate Nash at 986-3036 or knash@sfnewmexican.com.


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