The Affordable Care Act signals a culture shift, but will it be swift?

January 2014 will mark a new beginning in our country. On that day we will wake up to a new way of thinking about health care.

Currently, if you are rich enough, poor enough, old or young enough, or lucky enough to have a good employer, you get health care. If not, you’re on your own and likely to either go bankrupt or not get the care you need if you get really sick or have an accident.

Beginning in 2014, it will no longer be a question of IF you have health care coverage, but HOW you get your coverage. In spite of all the foot dragging, complaining, talk of repealing, and website glitches, health care will soon be available to all citizens of the United States.

This paradigm shift will take longer in states that are not immediately expanding Medicaid, and some of their most vulnerable residents will continue to be left without coverage. But in New Mexico, access to coverage will be immediate—and so should the cultural shift in attitudes about health insurance.

For years, and especially under the Governor Martinez administration, the leadership at the Human Services Department (HSD) has seen its role as that of gatekeeper. In other words, even though HSD runs the state Medicaid program, they believe it’s their job to keep people from easily accessing it. They’ve done this by instituting policies that make it difficult to apply for and stay enrolled in Medicaid, which explains why thousands fewer children have health care coverage today than when Martinez took office three years ago. They also refuse to cross-match Medicaid and food stamp applications to see if recipients of one program are eligible and could benefit from enrollment in the other. If we are to improve child well-being in our state, we need to lift these kinds of barriers to programs that can help kids and families succeed.

Come January, Medicaid in New Mexico will no longer be the program that just covers certain members of the low-income population. It will become another piece of a national insurance puzzle that draws everyone in under an umbrella of universal coverage. The state’s HSD workers who currently enroll New Mexicans in Medicaid will still determine whether applicants are eligible—but they will have one important new job. According to the law, they will direct applicants who are low-income but not eligible for Medicaid to the Health Insurance Exchange where tax credits will help make coverage affordable. In other words, their role should shift from gatekeeper to facilitator. Just as the Exchange should steer those who don’t earn enough money to purchase insurance (even with tax credits) to the Medicaid program. It’s called the ‘no wrong door’ policy and it is an important part of health care reform.

The Martinez administration has already failed the first test in the no-wrong-door policy by refusing to set up a new computer system so Medicaid and the federal Exchange can talk to one another. Since this is required by law, we now have to spend an additional $18 million to connect the two computer systems even as the deadline fast approaches. Of course, New Mexico would have its own health insurance exchange if Martinez had not vetoed the bipartisan legislation in 2011 that would have created it. This means New Mexicans have to go through the federal Exchange, which had technical problems in its first month of operation.

If the transition from gatekeeper to facilitator is ultimately successful, New Mexicans will be healthier and financially more secure. If that paradigm shift is slow to take hold, our children and families will continue to struggle. Let’s hope the Governor’s commitment to implementation of the Affordable Care Act is deep enough to reach down into the bureaucracy of the Human Services Department… and swiftly!

Bill Jordan is Senior Policy Advisor/Governmental Relations for NM Voices.

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