I am writing this column from another state where I am currently undergoing a course of
medical treatment. When this medical issue arose earlier this summer, I was told flat out
by my Albuquerque primary care provider that getting a consult to this particular
specialty in New Mexico’s largest city would take a year. So here I am in Minnesota.
We have all felt the pinch as health care providers have left our state. Think New
Mexico, the state’s leading non-partisan think tank, just released a new report on the
issue. According to the report, more than one in three New Mexico counties no longer
have hospital-based maternity care, meaning expectant mothers must take to the open
highways to deliver their babies safely in a hospital.
The report cites more disturbing statistics. Our healthcare provider shortfalls are
profound: we come up 30% short for nurses, almost 19% for primary care physicians,
25% short for OB-GYNs, 35% short for psychiatrists. One number is shocking: we have
a 73% shortfall statewide for EMTs.
These shortages are compounded by many factors, including the age of our physician
population (roughly 40% of our doctors are expected to retire by 2030), the dispersion of
our healthcare providers across the state (every county except Los Alamos County has
a provider shortage), and the age and comparatively poor health of New Mexicans (one
in four New Mexicans will be 65 or older by 2040).
There is a cure for some of these ills.
Think New Mexico is really good at solving statewide problems. Think New Mexico is in
its 25 th year and counts among its dozens of positive policy results the repeal of the
state tax on food; enhancing the training and transparency of local school boards;
reforming title insurance to lower closing costs for homebuyers; making the state’s
infrastructure spending transparent by naming the legislative sponsors of every capital
project; and repealing the state tax on Social Security for middle and lower income New
Mexicans.
Think New Mexico has several common-sense solutions to address our healthcare
provider shortage. They involve making it easier and more cost-effective to be a
healthcare provider in New Mexico; growing of our own healthcare workers here in New
Mexico; bringing in more international physicians; and creating a permanent fund to pay
for these reforms while the state is flush with cash.
Perhaps the area in greatest need of reform is New Mexico’s Medical Malpractice Act.
Simply put, New Mexico’s malpractice premiums are among the highest in the nation
and rising at rates approaching 150% over the last three years. New Mexico’s Medical
Malpractice Act, badly needing reform, represents a perfect storm of loopholes that
make New Mexico a great place to file a lawsuit and a lousy place to open a medical
practice.
Think New Mexico recommends six reforms to bring our Medical Malpractice Act into
best practices as evinced by other states. First, it recommends a reasonable cap on
attorney’s fees. Next, end lump-sum payouts from the Patients’ Compensation Fund (up
to 40% of which comes off the top to the lawyers) and instead make payouts as costs
are incurred by the patient.
The next recommendation is to stop venue shopping; as an example, a $68 million
verdict against a Gallup hospital was not filed in the county was located, but in the First
Judicial District in Santa Fe, which is known for being more generous to plaintiffs. A
local jury might not have made an award that was so likely to close their local hospital.
The remaining malpractice reforms involve changing the standards of proof for punitive
damages, prohibiting multiple lawsuits over a single malpractice incident, and requiring
that damages awarded for future medical costs reflect the actual cost of care. These
reforms are all intended to reduce the malpractice insurance loss ratio in the state – the
amount of money malpractice insurers pay out in claims that exceeds the amount they
are receiving in premiums.
The next major area for reform involves making it easier to work in New Mexico. There
are ten major interstate agreements for healthcare licensure; New Mexico only belongs
to one. Colorado belongs to all ten. Only four other states belong to two or less of these
agreements, or compacts. Healthcare workers moving to states belonging to these
compacts do not have to reapply to be licensed in their new state.
The last legislative effort to bring New Mexico into these compacts in 2023 ended when
the bill failed to receive a hearing from the House Judiciary Committee. Opponents of
the interstate credentialing proposal argue that adopting them would allow other states
to decide who gets to practice medicine and therefore harm state sovereignty. Phooey.
Think New Mexico also recommends establishing a centralized credentialing system to
be used by all insurers and healthcare delivery systems; expansion of the Health
Professional Student Loan Program; a permanent repeal of GRT on medical services;
and expansion of the Rural Health Care Practitioner Tax Credit.
The next reform is challenging: Medicaid reimbursement. More than four out of ten New
Mexicans is on Medicaid. Medicaid is a federal-state partnership, and the state
determines the rate of reimbursement to providers for Medicaid patients, even though
New Mexico only provides 20% of Medicaid funding (the federal government pays the
remaining 80%). Generally, Medicaid reimbursement is benchmarked against Medicare
reimbursement rates, and some proposals recommend taking Medicaid reimbursement
as high as 250% of Medicare reimbursement rates.
This will be expensive for the state and the nation in the long term, but with more than
40% of our population enrolled it seems crucial to increase reimbursement rates to a
certain level to retain the medical providers required to care for them.
Think New Mexico notes in its report that the best way to retain healthcare workers is to
“grow our own.” It recommends increasing Career and Technical Education programs in
public schools and incentivizing hospitals and medical centers that support these
programs by offering liability protections, with the goal to creating more employment
certifications, particularly EMT certifications, out of our high schools.
Think New Mexico has also noted a significant salary gap between the physicians and
nurses who serve as medical and nursing school faculty in New Mexico and doctors and
nurses in private practices. It recommends closing this pay gap and also providing a tax
credit for the fully trained professionals who donate their time to provide on-the-job
training to healthcare students. More common sense.
Think New Mexico recommends the Legislature consider permitting internationally-
trained physicians to apply for a provisional license without completing a residency in
the U.S. These physicians would practice under the supervision of a New Mexico
physician and upon successful completion of the provisional period be eligible to apply
for a permanent license. Tennessee, Florida, Illinois and Virginia have all enacted such
legislation and similar bills have been introduced in seven other states.
The final recommendation is the establishment of a $2 billion permanent fund out of
budget surplus to cover the cost of these reforms in perpetuity.
Unlike this columnist, Think New Mexico does more than write about New Mexico’s
hardest problems; it develops sensible fixes for them. You can download the report I
have referenced in this piece and learn about their other work at
www.thinknewmexico.org. You can also make a tax-deductible donation. Your donation
can be assured to go toward thoughtful policymaking, a refreshing change in today’s
polarized times.
Merritt Hamilton Allen is a PR executive and former Navy officer. She appeared
regularly as a panelist on NM PBS and is a frequent guest on News Radio KKOB. A
Republican for 36 years, she became an independent upon reading the 2024
Republican platform. She lives amicably with her Democratic husband north of I-40
where they run one head of dog, and two of cat. She can be reached at
news.ind.merritt@gmail.com.
Leave a comment