Headshot of authorBy Derek Lin, MPH
November 10, 2020

Expanding access to health care is one of the most effective ways to promote a healthy future for New Mexico. The Affordable Care Act (ACA) has made significant progress on this front by helping cut New Mexico’s uninsured rate in half since it was signed into law 10 years ago. Given the public health and economic crises caused by the COVID-19 pandemic, it is more urgent than ever to build on this progress and protect access to high-quality health care. Despite strong evidence of the ACA’s public health benefits, Republicans in Congress have continuously worked to repeal the ACA and undermine its provisions. Even now, in the middle of a pandemic, the Supreme Court is hearing a case that could end the ACA, thereby endangering the well-being of more than 20 million Americans who have gained health insurance because of the program. The repeal or substantial weakening of the ACA would particularly harm people of color. In this two-part blog series, we will explore the public health benefits of the ACA (which includes reducing racial and ethnic health disparities), the current threats to it at the federal level, and what we can do as a state to secure a healthy future for New Mexicans.

In New Mexico, the ACA provision that allowed states to expand Medicaid has been particularly beneficial for equitable access to care. Since New Mexico enacted the Medicaid expansion in 2014, more than 270,000 previously uninsured adults who earn low incomes have gained access to health care. At the national level, we have already seen the substantial public health benefits of the Medicaid expansion in reduced rates of infant mortality and improved physical and mental health for new Medicaid enrollees. Medicaid helps families access important perinatal services such as home visiting, which is an evidence-based program for improving child and maternal health. Participation in New Mexico’s home visiting program is associated with dramatically reduced rates of premature and low-birthweight births. These gains in Medicaid coverage have been important for improving health equity by reducing racial and ethnic disparities in access to care for Black and Hispanic families. While the ACA reduced these disparities in all states, states like New Mexico that chose to expand Medicaid were much more effective at closing the racial and ethnic health care coverage gap.

For those who buy private insurance, the ACA helped make the cost of health coverage more equitable by prohibiting insurance companies from using discriminatory practices to determine premiums. Before the ACA, insurance companies used a practice called “gender rating” to charge women approximately $1 billion more per year in premiums than men. The ACA also protects people with pre-existing conditions, which occur at disproportionate rates in communities of color. More than 830,000 New Mexicans with pre-existing conditions, including 190,000 children, benefit from this protection.

Being uninsured, or having inadequate health insurance, is costly and medical expenses contribute to almost 60% of bankruptcies. The rising cost of health care often makes it impossible for the uninsured to seek treatment, and in 2017, one in five adults chose to go without medical care due to cost. This burden especially harms communities of color, which have disproportionately high uninsured rates. Prior to the pandemic, New Mexico’s uninsured rate among Native Americans was 25%, compared to 15% for Hispanics and 10% for non-Hispanic whites. These rates are likely higher now, due to the loss of employment. When people postpone necessary medical care, preventable diseases and manageable illnesses can progress into chronic conditions that often require expensive and time-consuming treatments, which can make it difficult to continue working. For families already struggling to make ends meet, losing wages adds to the cost of medical expenses, taking resources away from food, housing, and other basic needs.

The ACA has had enormous benefits for public health in New Mexico by making health insurance less discriminatory, more equitable, and more affordable, which dramatically lowered the uninsured rate and continues to bring in federal funds to support a stronger, more stable health workforce. The legal attacks on the ACA endanger the important progress being made to dismantle barriers for people of color and provide access to health care for all New Mexicans. Unfortunately, people of color, as well as families earning low incomes, are among those at the highest risk for losing coverage if the ACA is repealed. Given New Mexico’s high poverty rates and racial demographics, our state has more to lose than most.

In Part 2, we will cover the current threats to the ACA and the steps we can take as a state to protect access to health care and ensure a healthy future for all New Mexicans.

Derek Lin, MPH, is a research and policy analyst with New Mexico Voices for Children.