When Christina Armijo turned 19, she awoke to a new reality: life without health insurance.

During her childhood, Armijo was insured through Medicaid, but the state and federally funded program, which is predominantly for pregnant women and children, expired when she became an adult.

Over the past four years, Armijo has managed the best she could on meager income from her job as a home-health aide. But her own health problems worsened and she had to cut back to six hours a week.

Not quite 5 feet tall, Armijo weighs 270 pounds. With a body mass index of 56, she is considered morbidly obese. She uses oxygen at night and takes medication for swelling in her legs, high blood pressure and pain.

She rarely went to the doctor because of the cost.

But this year, Armijo's aunt told her about the State Coverage Insurance program, one of several state-sponsored health insurance initiatives. And she began seeing a doctor regularly again.

After a slow start, these new plans are starting to catch on with people who have lived for long periods of time without health insurance, often foregoing timely medical care.

'A cultural change'

New Mexico has the second highest rate of uninsured people in the nation. In 2004, Gov. Bill Richardson set out to increase the number of insured in the state. He established the Insure New Mexico Council, a group of problem-solvers from state government, the private insurance industry and business, and charged them with figuring out how to provide working adults with affordable health care coverage, and how to persuade small businesses and nonprofits to offer it.

Over a two-year period, the council lobbied for new insurance laws and designed products such as SCI for small employers and low-income U.S. citizens living in the state.

The cost of the new products is shared by the federal government, the state, the employer and the employee. But several factors kept them from being an overnight success.

People who never had health insurance do not always understand the value. Those who are busy don't want to fill out forms and stand in line at a government office every year to prove their qualifications. And people in the medical community accept patients without really understanding how the plans work.

Also, some of the products had to be fine-tuned before they could become attractive, and the state had to find effective ways to market them.

Now enrollment in SCI, the product Armijo uses, is growing steadily — in part because of a price cut the Legislature approved and in part because insurance agents have been trained to promote SCI to small businesses and are traveling around the state to explain it.

Both changes are new this year.

SCI is available to people who earn up to 200 percent of the federal poverty level. It covers preventive care as well as diagnostics, doctor visits, hospital visits, behavior health care and prescriptions.

Hundreds of new people are enrolling monthly. According to the New Mexico Human Services Department, 8,622 people are participating in SCI.

Armijo said she liked the price — $75 a month — and the choice of three insurance companies. In January, she signed up with Presbyterian Health Plan.

The deal got even sweeter in August, when the state lowered the cost for people with incomes less than 100 percent of the federal poverty level. Now Armijo pays no monthly fee. Prescriptions are just $3, and doctor office visits are free.

Enrollees can share the monthly cost with their employer — or apply for SCI benefits as an individual. Small employers, with 50 or fewer workers, pay a monthly premium up to $75 per worker; each worker pitches in up to $35 per month.

But there's more selling to be done. The Human Services Department estimates 84,000 adults would be eligible for the new premium discount — the bulk of them in the 18 to 34 age group. The challenge is to get them signed up.

"Granted, the system is not perfect yet because it is new," said Debbie Righter, an insurance agent based in Albuquerque. "It's just now getting what we would call take up, where people are actually enrolling. And they're beginning to use it and they like it, and they're telling their friends and neighbors and everybody about it. This is a cultural change, and it's starting to move."

Righter, who argues that SCI is even a better deal than depending on indigent funds, added, "Once you've had insurance and you've seen the benefit of it, you'll never go back to being without. But if you've never had something, you don't know what you're missing."

Promoting the program

Despite its wobbly beginnings, Insure New Mexico has its fans.

"Insure New Mexico is a strong program," said Barry Hatfield, an insurance agent in Santa Fe.

Some products date back to 1992, before the Insure New Mexico Council was created. But State Coverage Insurance is one of the newer products.

"They've just expanded it ... but there's pretty poor publicity about it," he said.

More people should know: A family of two with a gross income of less than $41,000 would qualify for SCI at a cost of $110 a month, he said.

"That's a large proportion of people in this town," Hatfield said.

Since January, Insure New Mexico has certified nearly 300 brokers to sell its products.

"The program itself is great. A lot of people can qualify for it; it's just doing the paperwork," said Cisco Rubio, an insurance agent in Las Vegas, N.M. "For a lot of employers, it's hard for them to believe they can get health insurance for employees for possibly $75 per person."

In May, he took the one-day broker training with Insure New Mexico even though the commission is only 2 percent, compared to 10 percent for standard commercial insurance plans.

"We decided to promote it to help the people in the area," Rubio said.

Righter, who owns an Albuquerque insurance company, said the result of the council's work could, in time, lessen New Mexico's uninsured burden. The products are good; the trick is to work out the bugs and make the products more synchronized with each other, she said.

Righter makes presentations to restaurants, day-care centers, nursing homes, doctor offices, construction contractors and hotels all over the state. By explaining the benefits to a captive audience at work and eliminating some of the unpleasantness of enrollment, she is succeeding.

One of her jobs is to differentiate SCI and other products from Medicaid. "This is insurance. You pick a doctor. You can change your doctor. You don't go and wait at a clinic to get in; you have appointments and you get seen," she said.

State-subsidized products do come with extra hassles: It can take months to process an application. But, Righter said, "Once it's done, they kiss the ground you walk on, they hug their employers. I wish I had a movie of what happens when we go out and do that."

Righter does her part to make Insure New Mexico a more workable solution. She hashes out shortcomings in the products with the Human Services Department. And this month, she gave a talk to the New Mexico Medical Society to help doctors understand how SCI works and how they get paid — at a higher rate than Medicaid.

She said doctors in rural areas accept the insurance plans quickly, whereas doctors in Santa Fe and Albuquerque are more reluctant.

In her outreach work with small businesses, Righter usually presents a package deal built around State Coverage Insurance to 10 groups at a time. Her insurance company adds, for about $1 a day, dental, vision and life insurance benefits.

"And the employees love that because you can't get a good dental package unless you're in a group," she said.

Righter said her agency is winning over 500 employees a month for State Coverage Insurance.

She hears reactions like: "Why hasn't anyone told us about this? Why would anyone walk away from this?"

In places such as Roswell and Las Cruces, she said, employers are getting 100 percent participation from workers who don't have other coverage. Many of them qualify at the zero premium, zero co-pay level, Righter said.

But employers in Santa Fe and Albuquerque are slow to catch on, she said.

In Santa Fe last month, Righter presented the deal to restaurants, hotel owners and other business owners but received little reaction. "Santa Fe is the most nonparticipating. And I hate to say that, but all the other cities are just like snapping it up," she said.

SCI has been around for two years, but not until January were some of the constraints lifted and insurance agents allowed to guide consumers through the first steps of enrollment.

"This is the first time in over a decade that I've seen this much activity," Righter said. "What we do is certify their citizenship and residency documents. And being agents, we explain their benefits."

She cites reasons people haven't signed up in the past: Either they don't read and write, or they've trained themselves to say no before they hear what it is because never before in their lives could they afford health insurance.

Others wonder if health insurance would fit with their lifestyle.

"They don't have checking accounts. They change their address every month or two. They change their phone numbers. The only thing stable in their lives is their work," Righter said.

But she tells them that if they leave their job, they can flip to an individual policy as long as they stay in New Mexico.

"So the broker is what's making the difference. We know how to present the benefits," she said.

Too much government involvement?

Last year, the Insure New Mexico Council was replaced by the Health Coverage for New Mexicans Committee, which this year explored the cost of three "universal health care" concepts. The Legislature is expected to consider bills to close the uninsured gap next January.

Meanwhile, the Human Services Department will fight during the session for higher levels of staffing for the Insure New Mexico Solutions Center. The center, a one-stop shop that opened in Santa Fe this year, is a place business owners and individuals can call to get an insurance eligibility screening and an information packet.

More outreach workers are on the wish list, too. These are people who can go to community events, such as high-school sporting activities, and enroll people in Medicaid or other programs on the spot.

Critics, meanwhile, worry that expanding government-assistance programs will drive up private health insurance costs. Hospitals and doctors make up for low reimbursement rates from Medicare, Medicaid and the State Children's Health Insurance Program by charging more for private insurance patients, according to the Rio Grande Foundation, a conservative think tank in Albuquerque.

Further, because of strict income guidelines tied to federally funded programs, people who improve their economic situation can suddenly lose their benefits.

The foundation also has concerns about the increasing level of government involvement in insurance. As programs expand, the foundation's Paul Gessing said, "It's getting to the point the middle class is now being put on welfare. That's what these programs are; we can't deny that fact. And there is a disincentive to earn more money and to strive to get out of that welfare situation. And we call this the low-wage trap."

His group thinks there is a need for some government action but believes the solution lies with the free market.

"I have family members who are being offered private insurance through their jobs," Gessing said, "but Medicaid is a more attractive deal for them — and that's not what we should be striving for in New Mexico."

Benefits and frustrations

Joe Natale, who owns a collection company of six employees in Rio Rancho, is satisfied with SCI so far. At age 46, he has no major health problems, but before he got insured, he had accumulated $4,000 in medical bills. With SCI, he can afford to get a physical and pay for his medications.

"I'm very thankful because for 10 years I didn't have (insurance)," Natale said.

But for Christina Armijo, SCI has been both a benefit and a frustration.

She said she's run into billing problems at doctor's offices, where people are confused about the program.

Most disappointing was Presbyterian's refusal to pay for weight-loss surgery recommended as "medically necessary" by her doctor, Dr. Caroline Kingston of Santa Fe.

Although an emergency-room doctor told Armijo she won't live to age 40 if she doesn't lose weight, the procedure is excluded under her state plan.

Armijo didn't learn this until she went through a battery of tests for the procedure last February, when both she and her provider believed she was fully covered. The confusion stemmed from the fact that Presbyterian's commercial plan often covers weight-loss surgery.

Armijo filed an appeal, but Presbyterian ruled to uphold the denial last week. She said she's now applying for disability benefits and thinking about not renewing her SCI policy next year.

A properly trained agent could have helped her avoid this disappointment, Righter said. "I would have walked her through the steps — work with your doctor, make sure you have the prior authorizations."

Contact Diana Del Mauro at 986-3066 or dianadm@sfnewmexican.com.

PROFILE OF THE UNINSURED IN NEW MEXICO

21 percent of residents don't have health insurance, the second highest rate in the nation.

41 percent of New Mexico employers do not provide health insurance.

26 percent of residents under age 65 who are not institutionalized are uninsured six months or more; 60 percent of those are eligible for Medicaid or State Coverage Insurance but not signed up.

16.3 percent of children are uninsured; more than half are eligible for Medicaid (New Mexikids) but not enrolled.

Source: New Mexico Human Services Department report to the Legislative Finance Committee, Oct. 4