By Maggie Gunter / Albuquerque Medical Sociologist, N.M. Health Connections Board Member, and Dr. James Tryon / N.M. Health Connections Board Member
Monday, January 8th, 2018 at 12:02am
We are proud to serve on the New Mexico Health Connections (NMHC) board of directors, and are writing to dispel the inaccuracies and provide important clarifying information missing from the Jan. 2 Albuquerque Journal editorial.
NMHC is one of four surviving consumer-operated and oriented nonprofit health plans (CO-OPs) that were launched in conjunction with the Affordable Care Act (ACA) to help ensure healthy competition in the insurance exchanges to keep premiums reasonable. With the recent infusion of $10.25 million from Evolent Health and other significant revenue, NMHC is not only solvent, it is thriving and providing competitive health insurance rates for all New Mexicans.
The people of New Mexico deserve robust health insurance market competition. Competition keeps premium rates down. In three out of the five service areas in New Mexico, NMHC offers the lowest-cost plan on the exchange. In the other two areas, NMHC is the second-lowest-cost plan. As a result, we’ve seen a significant increase in new enrollees in the last quarter of 2017.
Another little-known fact: New Mexico is one of only two states with four plans available on the exchange in every county. The other state is Massachusetts. New Mexicans benefit in price and choice when health insurers compete to earn their business.
The Albuquerque Journal editorial board questioned if the cash infusion for NMHC from Evolent Health was the right prescription for New Mexico. We believe the answer is an emphatic yes.
What wasn’t clearly spelled out in the editorial and in the Journal’s previous coverage was why NMHC needed a cash infusion. The primary reason was the federal government’s failure to make ACA-mandated payments. For NMHC, this meant not receiving $46 million in promised payments. For a startup organization with less than $200 million in annual revenue, $46 million is very meaningful. Nationwide, the federal government’s failure to honor its financial commitments drove many smaller and startup health plans out of business. NMHC, despite hitting some rough spots, deserves great credit for surviving in the face of incredible odds when many other CO-OPs closed their doors.
NMHC has survived because its business model fundamentals are sound. By investing in keeping members as healthy as possible and out of the hospital for the right reasons, NMHC reduces costs. The savings NMHC gains through its highly effective medical management are passed on to members. This helps contain cost increases and keeps our competition on their toes, which is why NMHC’s presence in the health insurance marketplace is exactly the right prescription for New Mexico.
The editorial also referenced statements from Presbyterian and the University of New Mexico saying they have outstanding claims due from NMHC. Such differences between providers and payors are a normal part of business in our industry and are best resolved through negotiation or arbitration. In this case, however, their allegations bear little resemblance to reality.
When an insurance company is in financial distress, insurance regulators are responsible for taking necessary steps to get the company back on strong financial footing. New Mexico Insurance Superintendent John Franchini acted in accordance with New Mexico insurance law and regulations when he placed NMHC under financial supervision last summer. As a result of the cash infusion, when NMHC files its 2017 fourth-quarter financial statement, people will see a very successful turnaround.
As we start 2018, NMHC is financially a far stronger company than it has ever been in its four-year history. New Mexicans absolutely benefit from the effective market competition that NMHC provides. NMHC was established to challenge the stagnant status quo in health care. We will always maintain our commitment to improving the health of our members and elevating the health care system for New Mexicans.