Report from Santa Fe; John Heaton and Clint Harden

music made by architect song music Report from Santa Fe is made possible in part by grants from New Mexico Tech on the Frontier of Science and Engineering Education. For bachelors, masters and PhD degrees, New Mexico Tech is the college you've been looking for, 1-800-428-TECH. I'm Lorraine Mills. I'd like to welcome you to this week's report from Santa Fe. Today we'll be featuring two guests. The first is Representative John Heaton, a Democrat from Curlsbad. The second will be Senator Clint Hardin, Republican from the Clovis area. And now I'm so happy to welcome John Heaton, Representative Heaton.

Lorraine, thank you very much for having me on your program. It's always a pleasure. It's always a pleasure having you too. And in a way, you're our finger on the pulse of healthcare issues for this session. And because tell us a little about your background and what gives you that unique perspective that no one else has on health issues. Lorraine, I'm a pharmacist by profession. And even though I've been retired for the last five or six years, I do do some relief work. But I was in practice for about 35 years. So while you're doing that, you learn the ins and outs of the Medicaid program, the Medicare program, and insurance plans that are available on the state. So you do have a unique perspective. We see pharmacists see a patient seven more times than a physician typically sees a patient. So we're really on the ground in touch with people. Yes. And on the ground in touch with these incredibly complex issues of Medicaid, Medicare, all the insurance programs. So in addition to the whole pharmacological knowledge, there's

also all the insurance knowledge. And then the interpersonal contacts, what people really need and their drug interactions. So first, I need to ask you, what's happening with healthcare issues this session? What do people need to know? It is a huge issue this session as it is usually every session. And the two competing areas are usually education and healthcare for the dollars that we have. And the Medicaid program continues to grow as we add people. And I think it's important to understand that the program grows in cost because we're adding people, not necessarily because of the cost of the services that are delivered to them. In fact, you could probably go back and look at the average cost in 1990. It'd probably be $4,000 a person you look at it today. And it's the same price. So it's the volume of people that we are adding. And one of the

issues that we have to deal with is that we have 400,000 people, a little over that, that are uninsured in New Mexico. And so those costs get transferred over to the people that are buying insurance. In fact, when we look at economic development issues for the state in New Mexico, the high cost of health insurance is becomes a deterrent to us recruiting business into the state. So we have to find out, find a way to get this 400,000 people insured in some way or another. And I think that I have a memorial in this time to ask the Department of the Health and the Human Services Department and the Health Policy Commission as well as the interim legislative committees to look at that issue. We try to do some things to create economies. But if we don't cover that 400,000 people, those are the people that ultimately transfer over to Medicaid. So we have to find a way to get them insured. So not a single

pair plan, but universal coverage, if you will, in the state. And I think there are ways to do that. We have what's called state coverage initiative, which is a waiver that was given to us and probably one of the few last waivers that have been given out by the President Washington administration. And it gives us the opportunity to take adults up to 200 percent of the poverty level and cover them under our children's health care initiative, which means we get an 80-20 match. The federal government matches 80 percent with our 20 percent. The issue is that we don't have the 20 percent in our coffers. So we need to figure out a way that we get money in from the private sector, if you will, to match that money. And there are ways to do it, I believe, that are indeed legal.

What does that 20 percent come to in approximate dollars? Is it 200 million? Is it 20 million? If we looked at the whole 400,000 population, and we insured them, and we put them under a state plan that's equivalent to what our state employees have, the insurance companies would receive approximately $1.2 billion. If you did it on a per person average of $240 a month kind of payment schedule, that would translate into about $1.2 billion. Right now, all of those 400,000 are being taken care of. They're not maybe being taken care of at the same level that they would be if they had insurance, but they are going into the hospitals, they're going into physicians offices, they're going into pharmacies, and they're indeed getting services. The hospitals tell us that they lose $300 million in uncompensated care, people that don't pay their bills. And it's probably a like number within the physician

community, the pharmacy community, the other services. So that money, because we would be covering people under some plan, would no longer exist. So if we received some of that money back, then we could use it for matching. It was going out to pay the insurance companies, then we could help match that, and we could also control rates and premiums. People could buy an adult buy insurance if they're under 300% of the poverty level. That's generally where they begin to buy it and when they quit buying it. So we need, we could work the 20% with the state coverage initiative, and then the two to 300%. We help employees and employers cover that group of people. We subsidize them to some degree, and then over that level, we ask employers and employees to participate in insurance plans. And I think we can get

it done. That's a very well thought out plan. I'm very impressed with it, and we'll have to do some follow-up and see how it does during the session, because you've found a way to replace that money. I just think it's brilliant. So I know I'm going to ask you some other very hard things about what's happening. There's a movement to remove doctors and health care providers from paying the grocery receipts to the tax. I mean to the tax and rev department, but there's also a move in the list of Medicaid cuts that will go into in a minute to reduce the reimbursement rate for health care providers. So here's somebody is trying to give them a break by not having them pay grocery receipts taxes, but here's somebody else trying to impose more penalties on them by reducing the amount of reimbursement they get. All of these tugs of war that go back and forth make people like us legislators a little bit schizophrenic, if you will, because we don't, you can't take it away with one hand and give it with the other. We need to

have some equity and also some consistency in what we try to do. I have the physician issue is a very real issue. It's difficult for us to recruit some of the specialty areas and especially in rural areas, we're having a very difficult time recruiting physicians and especially specialists. If it weren't for New Mexico resources, which really helps us recruit and the J1 visa program, we wouldn't have physicians in rural areas to any extent at all. We would be grossly underserved. So we need to help in this issue because it is a deterrent to us bringing physicians one of the things that there are two ways to skin this cat. You either eliminate the gross receipts tax, if you will, like has been proposed, but it's a $40 million hit on the general fund and we don't simply have the money. Is it $40 million? Isn't that also for food and doctor services or just for

medical services? That's just for doctors. Medical services all together would come to about $120 million, food by itself is about $110 million. So those are big numbers. Those are very big numbers. And the local governments are very worried that they depend on it so much for there. It's a huge part of their revenues. Cities depend about 85 percent on gross receipts tax for their survival. Counties are not nearly as dependent. They're dependent about 17 percent. So it's important that we keep cities whole in this or they're not going to be able to provide the services they have. But back to skinning the cat here, you can either eliminate the taxes, which is the $40 million, or you go to the health plans and say that they no longer can include gross receipts tax in their fee schedules. So that those fee schedules then reflect what the doctor's getting, then he and turn can charge or she, the gross receipts tax. So it's not lost to them out of the fees

they get from the health plans. And so that is a way to solve the problem just as easily as removing it. You allow them to charge it. And anybody that has to pay gross receipts in New Mexico is indeed allowed to charge it, but we are not allowing the physician community to do it. So this little fix would indeed allow physicians to charge the gross receipts tax. And I think it's a way to get it done and take the issue off the table and help us recruit doctors. Okay, we're running out of time. So I'm just going to throw a real huge elephant to skin because it's the issue of Medicaid cuts. We've done a show with Cabinet Secretary Pam Hyde and she listed all the things they didn't cut and that these were the cuts they had left having copays for office visits, reducing the quality of some of the machines, wheelchairs and things that people get. What is your idea? What's going on in?

Well, I think a lot of those cuts are very legitimate and an issue we call medical necessity. What you can get and what you can't get based on your condition or your diagnosis are all important issues to address. And we're probably allow a little too much to be available to people in New Mexico and those need to be cut back somewhat. But there are issues for instance with providers. If you're going to do a provider cut and you're going to do three and a half percent or whatever that number is, it ought to apply to all providers not just some of them as an example. The HMOs are on schedule to get a 7 percent increase. All other providers are being held at parity and being asked to suffer a three and a half percent reduction. And there are some classes I can tell you in my profession, they're asking pharmacists to go to take about a 48 percent reduction in their fee.

I'm sorry. Almost 50 percent. Almost 50 percent. And they're also asking them to extend the number of days that they give a prescription for, which is equivalent to a 66 and 2 thirds percent reduction. And then at the same time, if you reduce a gross profit down to $2 and then you ask a pharmacy to collect a $3 copay and they don't get the copay, they lose a dollar on the prescription and be the same way with the physicians. If you're allowing them a fee and then you ask them to sacrifice the copay, which we know by experience, we don't collect. I think that you're doing a double penalty. The physicians will end up with close to 9 or 10 percent. And then when you get in the dental community, we have worked very diligently to try to improve the number of dentists in this state and then to turn around and cut the fee and cut some of those services, detract from this, all of this extra money we've

put into trying to recruit dentists. We're desperate for dentists in New Mexico. So you get a little bit concerned about the incongruity of some of the approaches. But we're almost out of time. So I have to thank you. You have presented some wonderful, wonderful solutions to some things that have been really troubling me. We'll watch these bills and these issues as they go through the House and the Senate and we'll see what happens. It's an exciting time. It is. I'd like to thank you, Representative John Heaton, Democrat from the Carlsbad area. Thank you so much for being with us. Thank you very much. We're back with Senator Clint Hardin, who is a Republican from the Clovis area. Tell us what counties you represent. How long do you have? Oh, you've got that monster district. That's right, yes. Yes, yes. I'm really pleased to represent the counties I do. I have parts of Curry, all of Kwe, all of Hardin, all of Union, all of COFACs, parts of San Miguel, and we'll pick up parts of

the House. Wow. How do you cover it? That's just a challenge. You're just getting your pick up and go is really what you're doing. And it's challenging, but what a great part of the state to drive. It's a fabulous part of the state to represent and I think they're very lucky to have you. Because as we were speaking earlier, I was very interested in your small business background, but also you were a cabinet secretary of labor under Governor Johnson for eight years and you did a fabulous job. Well, I appreciate that. Yeah, I think it gave me kind of an interesting perspective on the Senate job. You know, I've been in Santa Fe or associated with the process now for a decade. So, a little bit of experience. I like to tell people that, you know, working for a governor in the executive side branch is kind of like maybe playing for the Dallas Cowboys and then being traded to the New England Patriots. They won the Super Bowl. So, you play for the team and it's kind of a different offense, a different defense. I like to think whether it's the executive or the legislature

that they're working for the best interest of New Mexico and its citizens and its constituents. It's just a different way of working towards that end result. So, it's been interesting last couple of years as a senator. Well, I'm very interested to know what your pet issues are. What are issues of concern for you this session? We're part way through it, most of the way through it and things are coming hot and heavy. So, tell me what your concerns are and what issues you're following. First of all, my main issue is local control. You know, I believe that they want the problems with Santa Fe as you can't get to it from a tractor, you know, from San Home. It's just difficult. So, local control is always one of my big issues. My big concern is something I try to watch. I think the other thing, and just the most difficult aspect of the job is representing the people, is trying to sort through all of the mail and listen to the lobbyist and then apply your own knowledge. And after everything's said and done, recognize

that the vote you cast is for the constituents. And I think especially in regions or districts like District 7, that becomes really difficult. First of all, it's, you know, from the middle of the state, on the east side, all the way to the Colorado border. There are so many varied interests. You have fairly large cities and clovus, too, com carry, rat town. And those desires and needs are just a little bit different than those in Roy or Muscaro. And then you get the tourist side, which is the Marino Valley where he goes next. And so whether it's water issues or whether it's, it's lodgers tax, grocery seats tax, that's a huge multi-eclectic district to try to really represent all of those various viewpoints. And that's hard, I think, when you're trying to cover that much territory, to recognize that, you know, it's a very pluralistic, pluralistic district. But each one of those voices needs

my representation and deserves it. So that's really challenging. Something that I have to watch. And it's not an easy job to do. No, an idea. It's fine, but it's not easy. Yes, but I don't know if your constituents know how, what an all-consuming job it is when you're here. I mean, you have four sessions that go into the night and then committees and all this, but it does become a passion. It does. And I'd like to know a little more about some of the water issues because we have all these new statewide water plans. Do we have a one-vision at last for water in the state and on the east side? I don't really think so. That's my opinion. And I think what I guess what concerns me about water issues is they're going to be very hard decisions. And no matter what bill comes before the Senate or the House or what decision is made, there's going to be an opposing viewpoint

to that. In other words, there's going to be some basis. You know, this is a good bill for those guys, but not for me. So don't pass that. Don't deal with that. And it just, it's going to be very hard decisions. But water is so important. I mean, if we all agreed on what was going to occur or what was right, what have already done it? So it's going to be pros and cons. There's always going to be that. And I think that's the big concern, especially if you're in a district, any district, where you have a very predominant rural population as well as an urban population. But then if you back up and looked at those needs may be totally different than the agri community. So these are hard decisions to make. Challenging, but it's the right public policy. I mean, this is an issue that's very important. What are some other issues that are following? You're following very closely. I'm, I like, I'm following the issue of county funding. I think that some of the mandated

laws, some of our new tougher penalties on pick a lot of them have made it difficult on county budgets. Because the enforcement of some of the things we do in Santa Fe is actually driven to the county level. For example, housing state prisoners that end up back in the county on parole appropriation, they're picked up and put back into county detention center. Well, the counties bear the cost to house those people once they violated parole appropriation and it's expensive for our counties. Same way with transporting prisoners from rural parts of the state. If you got to move, move a prisoner from Clayton to Los Cruces or Albuquerque, it's going to be expensive for that, for that sheriff's department. Well, there's no provisions for the state to pay for that. So Clayton has to bear the burden. So another issue that I, that's important to me. Yeah, the unfunded mandates that everyone struggles with. And then of course, finally, and this is the session for it. Right now is the budget

session and the capital outlay needs for so many communities. And I'm not talking about tennis courts and swimming pools. We're talking about senior centers, heating and air conditioning unit for courthouses, roads and counties that are beginning to move products and goods and services around that may be just dirt. What are you doing? It snows and you've got a truck full of milk that you try to get to market some places. So are water issues that are so huge in communities that, you know, are not, not part of the Rio Grand Corridor. And I'm not saying that the Bernalillo, the metropolitan areas don't have just as significant needs. I guess what I'm saying is I'm representing the folks in the real part of the state and that's who I'm fighting for. So also it seems to me like Bernalillo, Santa Fe and the Rio Grand Corridor do seem to get a little more. And that's another issue I'd love to talk with you about. The governor

in his state of the state proposed a new way of dividing the capital outlay money. In other words, instead of a third to the governor, third to the house and third to the center, he would like control over half. How did that sit with the lawmakers? I think that the closer you can get to the people, those are the individuals that understand the needs of the people. I don't think the governor lives in my district. He travels through it and he was a congressman that represented the district, but he's not driving those roads and not talking to those people. The closest representation to the person is the best to make an assessment of what that community's needs are. Well, he did say that he would, that the lawmakers knew better. He did at least acknowledge that, but I just got a sense of competition there because, you know, your constituents will go to you first before they'll write a letter to the governor or you may visit a community center and be appalled. They really need, like the roof is leaking or something

like that. I don't know where their competition is the right word, but certainly credit is in there. But the main thing is not who gets the credit, I don't think. It's what gets done. What's right? What's the best public policy? And I think the people that are the lowest, more local level of government always have a better feel for what the people want. And you travel your district? You couldn't certainly in the winter with, you know, the storms and everything, but you really try to get out to all of them. Well, basically, I spend one day a week from my day job, one of the Monday through Friday days to try to do nothing but Senate business. And then I try to be out in the district at least three days a month. But those three days, nearly always are an overnight or so. That takes a day coming. We're going to save you a trip because this

is an opportunity for you to address your constituents without getting in your pickup truck. And what would you like them to know about how the session is going and just what is your message to your constituents? It's going to be okay. Well, that's a very important message. We're going to get a budget. And it always works out. I've watched 10 of these sessions, eight from the executive standpoint, now two plus a special. And after the bell rings and everybody goes home, they're all different, but it works out. And the two main issues of health care and education will be properly funded, do you think? Certainly. Yes, I know. I don't think we can ever get enough money to take care of. Well, that's true. I don't know if we can. And I'm not one that just once says the answers throw more money. But will teachers ever have enough money? Probably not. Neither will principals, but the neither will janitors. Will stadium employees ever get enough money to do the job? Probably not. But then neither do the cooks that work in my drive-in or

the people that wait for you in the grocery stores. That's always going to be an issue. But I think that whenever things, the dust is settled, we will have a budget. We'll have capital outlay projects that are absolutely the best that this legislature and this governor can come up with for this year. Well, that's saying a lot. That gives me a lot of confidence because I know there's a lot of idealism at work here and trying to make the most good for the most people. We're a great state. We are. We are. We have lots to be proud of. And we have great leadership. I thank you for being proud of our process. Yes, yes. I'd like to thank you, Clint Harden, Republican from the Clovis area and all those wonderful East Side counties. Northeastern New Mexico. Northeastern New Mexico. Thank you for being with us. Thank you. And I'd like to thank you, our viewers, as well as our first guest, Representative John Heaton from Carl's Band and Senator Clint Harden. And thank you for being with us today on report from Santa Fe.

Report from Santa Fe is made possible in part by grants from New Mexico Tech on the frontier of science and engineering education. For bachelors, masters, and PhD degrees, New Mexico Tech is the college you've been looking for. 1-800-428-TECH. Thank you.