New Mexico has always ranked high in health care — for the wrong reasons. The state is second for percentage of residents lacking health insurance.

When U.S. Sens. Jeff Bingaman and Tom Udall vote today on a massive health-insurance reform bill, and if it becomes law, they hope their biggest legacy may be more and better private insurance and increased access to primary-care doctors.

Bingaman claims that when all provisions are phased in, some 95 percent of New Mexico residents would have private or government health insurance. "There is a tremendous amount of good in this bill for our state," he said, "and the entire country."

For New Mexico, the biggest boost would be the proposed expansion of the Medicaid-eligible population. Bingaman estimates an additional 124,000 residents would qualify for the federal government's health insurance program for the poor or disabled. Most of those costs, he said, would be picked up entirely by the federal government, thanks to an amendment he drafted.

Those who have analyzed the bill say New Mexico's particular poverty situation means the state can potentially receive far more than Democratic leaders promised to Nebraska Sen. Bill Nelson in the deal he made to secure his vote and ensure Senate passage without any Republican support.

But to take advantage, the state would have to move quickly to enroll the newly eligible Medicaid residents, said Robert Otto Valdez, executive director of the Robert Wood Johnson Center for Health Policy at The University of New Mexico.

"We have so many uninsured people, New Mexico has a lot to gain," said Valdez. He added that the private health-insurance market "has not been functioning well" here, and the proposals would increase options and choices in the private market.

Once approved by the Senate, that bill and a separate one passed by the House of Representatives have to be reconciled into the one document. That would be done over the holiday recess by a conference committee of the House and Senate leadership.

The new bill would again have to pass both the House and the Senate before going to President Barack Obama to become law — which Bingaman hopes can happen before the State of the Union at the end of January.

The bills also include more restrictions on insurance companies, such as when companies can rescind coverage and specifics on covering patients with pre-existing medical conditions.

And there are mandates that a certain percent of insurance premiums be spent on patient care and that a dependent can stay on a parent's insurance to age 26. Many of the measures would be phased in over several years.

For those shopping for private insurance, there will be more transparency and disclosure and a new national nonprofit insurance exchange that offers coverage for those who can't get it elsewhere. There are provisions for tax rebates or credits so those below a certain income level can purchase private insurance. The exact amount for all these benefits depends on how the conference committee bill is written.

Valdez said New Mexico has had the steepest private insurance premium increase in the country, so any increased competition here will likely help hold down costs. Bingaman and Udall say Congressional Budget Office estimates confirm that premiums should go down with the measures, though both will continue to work for a public-insurance option for working-age adults.

Still, getting people health insurance and getting medical care are two different issues. But Bingaman insists the reforms go a long way toward changing the health care delivery system.

That's especially important to Dr. Nancy Wright, a pediatrician in Las Vegas, N.M., who has patients who travel 90 miles from Raton and others from Mora and Santa Rosa.

She has no hospital or after-hours coverage as doctors in Albuquerque do — and was one of the few physicians contacted by The New Mexican who was on duty Christmas week.

"As a rule, primary-care physicians are seen as working really hard and not making a lot of money. I work weekends once a month, I can get called at any time in the middle of the night," Wright said. "Doctors in Albuquerque don't have to take those calls" because they have other physicians or hospitals and urgent care centers that can provide those services.

She said young doctors would rather go into specialty fields and have more control over their lifestyle.

The bills do have some relief for primary-care doctors such as Wright — and with more insured patients than ever who will want appointments, that is important, Valdez said.

Bingaman said reimbursement rates for primary care would increase, and there are incentives for medical students to intern at community health centers. Udall emphasized there are more pilot programs in areas such as telemedicine so specialists in Albuquerque may be able to treat patients in Las Vegas without making the trip.

Valdez, of UNM, said the bills "would expand the infrastructure and expand opportunities for training in primary-care settings.

"There are lots of ideas captured," Valdez said. "There is no single vision of how you do quality improvement and control costs, but if there is a solution out there, it's likely to be found and there are little fixes for the private insurance market that work in a lot of different ways."

Contact Bruce Krasnow at brucek@sfnewmexican.com.