The March 11 gathering was not a typical town hall meeting for U.S. Rep. Steve Pearce, a Republican who represents a sprawling congressional district that includes 17 counties in Southern New Mexico.
The first question in his hometown of Hobbs was about the plan by U.S. House Speaker Paul Ryan and other Republican Party leaders to roll back some of the health insurance provisions of the Affordable Care Act, especially insurance coverage for the 200,000 New Mexico patients who have gained access to health care through the expansion of Medicaid eligibility rules.
“By some accounts, between 10 [million] and 20 million will be without medical coverage,” the woman said, referring to national estimates of those who might lose insurance coverage if the GOP’s American Health Care Act passes Congress and replaces the law best known as “Obamacare.”
“I got to tell you, this is a real concern for me,” the woman told Pearce. “I want you to explain to me if you are in agreement with that and why.”
Pearce, the state’s only Republican in Congress, who is said to be considering a run for governor in 2018, effectively dodged the woman’s question, saying he had read over the proposed bill on the airplane. “The idea that anyone under Medicaid will not be covered is not what I’m reading in the bill,” he said.
A subsequent congressional analysis of the legislation, however, indicated the woman at Pearce’s town hall was correct: Some 24 million Americans who now have insurance coverage through some aspect of the Affordable Care Act might have lost it within 10 years if the Republican plan had succeeded.
The American Health Care Act died Friday when Republican leaders in the U.S. House of Representatives pulled the bill from consideration on the floor ahead of a much-anticipated vote. With all Democrats promising to vote no on the act, Republican leaders said they lacked enough votes from their own members to gain passage.
For conservative Republicans like Pearce, the battle over the bill was a tug of war of sorts between promises to repeal and replace the federal health care law and constituents who now have better access to doctors and hospitals because of it. The internal struggle helps explain the bill’s demise Friday.
With lower-income residents and higher poverty rates, New Mexico has seen disproportionate gains in coverage under Obamacare, especially with the Medicaid expansion. About 275,000 more individuals in the state now have coverage, boosting total Medicaid enrollment to nearly 900,000 in a state with a population of just over 2 million. Pearce’s congressional district has seen more gains in health insurance coverage than anywhere else in the state, according to the U.S. Congressional Budget Office.
“That’s a lot of New Mexicans who can be affected by any change in the legislation,” said Brian Sanderoff, president of Research and Polling, an Albuquerque public-opinion research group. The individuals who now have insurance are paying close attention to the debate, he added. “That has to be front and center for any politician as they consider how to vote on this issue.”
According to an early analysis of the Republican legislation, 75,000 people represented by Pearce would have lost some insurance coverage under the bill. Of the Medicaid patients who might have lost coverage, 33,700 live in the Southern New Mexico counties represented by Pearce, almost 40 percent of the state total.
After Republican leaders pulled the legislation Friday, effectively killing for now the effort to replace Obamacare, Pearce released a statement continuing to criticize the Affordable Care Act.
“The failing Obamacare system has reduced choices and increased prices in the state of New Mexico,” he said. “More than anything, I wanted us to come to an agreement on a replacement plan that would protect the most vulnerable in New Mexico, while returning choice and affordability to middle class families and the working class.
“What happened today is not a victory for our nation’s health care,” he continued. “I promised to the people in New Mexico’s Second Congressional District that I would work in Congress to repeal and replace Obamacare, and I will continue to advocate for New Mexicans in my discussions with House Leadership and the Administration.”
When a new reform bill might emerge — and what it might look like — is anybody’s guess, but it is sure to raise many of the same concerns.
The current health law not only provides federal tax dollars to help states expand the Medicaid insurance program to low-income working adults, it also helps middle-income individuals purchase private insurance on internet portals called exchanges. The law mandates that most Americans have health insurance or pay a fine, and it regulates minimum levels of health coverage for routine examinations and procedures.
State Rep. Doreen Gallegos, a Democrat who represents rural areas in Doña Ana County, said there are many small, family-owned business in Southern New Mexico that can’t afford to provide health insurance. Under the Affordable Care Act, business owners with 50 or more employees must provide insurance. Smaller firms have no such mandate.
Gallegos said those workers in her district who don’t have coverage through the state “either work for small businesses or work for themselves,” and have benefited from Obamacare. If a replacement law results in less coverage, she said, the state will move backward, and “people will go back to getting emergency care,” showing up at the hospital when they are sick rather than a primary care provider or urgent care center.
The rate of New Mexicans without health insurance was once among the highest in the U.S. at 21 percent. In 2017, it is expected to be below 9 percent, a record low, according to an analysis released Friday by the New Mexico Office of the Superintendent of Insurance.
If the American Care Act had succeeded, the uninsured rate would have doubled to 18 percent by 2026, wiping out almost all the gains, said John Franchini, state insurance superintendent.
“If the American Health Care Act goes into effect as they have written it, the people in the state of New Mexico would be hurt severely, as would the doctors, the hospitals and businesses,” he said. “I’m glad it didn’t pass the way it was.”
Health Action New Mexico has been helping individuals enroll in insurance plans since the Affordable Care Act was launched in 2013. Colin Baillo, a consumer outreach worker for the organization, said the median income is lower in Southern New Mexico than in other parts of the state, and there are more agricultural and seasonal jobs there.
Any changes to the health law “will disproportionately impact that part of the state,” Baillo said. “The folks I talk with down there are receiving care more regularly than before, when they had to pay it all out of pocket. It’s a better coordinated system of care.”
Rep. Gallegos said she has encouraged people benefiting from Obamacare to call Pearce’s office. “Whether he likes the policy or not, he needs to know a lot of his constituents are benefiting from the law,” she said.
“We have received hundreds of calls about the health care bill with varying issues, and both sides represented,” said Keeley Christensen, a spokeswoman for Pearce. But the office did not make an official tally of the feedback.
Even with the death of the Republican health care proposal, political obstacles remain for the congressman in his bid for governor.
Sanderoff pointed out that Gov. Susana Martinez, unlike other Republican governors, campaigned by saying she would expand Medicaid and then followed through.
“Historically, Republicans that have had success statewide in New Mexico have campaigned as moderates,” he said. Among them: former Govs. Garrey Carruthers, Gary Johnson and Martinez, and former U.S. Sen. Pete Domenici.
A possible Pearce opponent in a general election for governor is U.S. Rep. Michelle Lujan Grisham, a Democrat from Albuquerque who supports the Affordable Care Act and has already announced her bid for the office.
Grisham, a former New Mexico Department of Health secretary, issued a statement Friday saying it’s time to focus on changes that can improve the law.
“It’s time to get to work because Republicans have played politics for the past seven years instead of putting consumers, patients and families first,” she said.
“The Affordable Care Act isn’t perfect,” she added, “but Republicans are responsible for not allowing us to negotiate prescription drug prices, not holding insurance companies accountable for high administrative costs, and not funding ACA provisions that pay for sicker patients.”
Contact Bruce Krasnow at email@example.com.