The laboratory of the states

has a clean-up on Aisle 9, from the experiment in health care coverage. What a mess this is. Remains to be seen whether it's better than nothing.

Here's the plan from New Mexico's executive branch. The summary of comments from Human Services Secretary Pamela Hyde:

This document is the result of 5 years of work, and everyone hates it; so it’s a compromise. 

Having stated that all stakeholders are dissatisfied, and keeping in mind that the chronically ill, poor kids and employees with three part-time jobs are not considered stakeholders in that analysis, it probably is a compromise that represents the best viable solution set.

There are four areas of reform specified.

-Insurance reform: We’re imposing some upper limits on margins and premium increases; adds options for providers and insurance brokers to make money from new enrollment paid through consumer, state and federal dollars
-Coverage mechanisms and participation requirements (employers, individuals, new residents): Mandate purchase of a policy for uninsured New Mexicans. Healthy NM Workforce Fund will be paid for by a fee of less than $500 per employee per year. The math is simple: Pay up, and if you’re offering coverage now subtract that cost from your liability to support the Fund.
-Creation of a health coverage authority, for a single point of accountability across PRC, DOH, licensing boards, etc. Notably, no system-wide ombudsman's office seems to be called for.
-EMR-electronic records will get its own bill because of the many statutes it touches.

Predictably, the employers find it outrageous to have a cost added, but only a few of them were willing to take a whack at the pinata by complaining about it. The preview on the upcoming legislative session was offered by a couple of lobbyists, one from the chile packing area chamber and the former Lt. Gov, Walter Bradley. It appears that they're going to push back against any form of reform by objecting to the costs and burden on employers, which is no surprise. Privacy concerns were also raised.

One did an unexpected bit of bashing on the fat, by suggesting that the 'unhealthy habits' some of her employees engage in shouldn't be the problem of the public. She's outraged, outraged I tell you, that the state is going to make those drinking, smoking and overeating among us get insurance, because that could cost real money.

The issue that seems most pressing to me, as a self-employed person, is the lack of coordination between the mandates and the fixes. BCBS has nothing to complain about here, as they get a huge new group of enrollees. The insurers have a lot to gain, despite the requirement that they spend 85% of premiums on care. But if they will only sell me a crappy HSA plan that has no required benefits, and they aren't immediately required to set my premium by community rather than my height-weight proportion, that's no help.

Further, we aren't covering 50,000 kids who are eligible for Medicaid today. We're spending enough to cover 96% of our residents and yet have 40% without access to insurance, which is the gateway to primary care, which is the door behind which savings will be found.