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© 2024 NEW MEXICO NEWS SERVICES 12-9-24
We may improve access to health care, or not
By Merilee Dannemann
Triple Spaced Again
To review the obvious: Most of us could not afford the financial cost of serious illness or injury.
We never know who’s going to be the unlucky one to become ill or injured. Health insurance was developed to share the risk. When private health insurance was not enough, government joined in with Medicare and Medicaid. One principle underlying these policies is that when more of us have access to healthcare, we are all better off.
I find that principle persuasive. When more people have healthcare, fewer people spread infectious diseases. Fewer people take days off work, disrupting business and public services. Fewer children stay home from school, so they have a better chance of getting an education and elevating the economy for us all.
The United States has had a long-running argument between those who agree with that principle and those who think access to healthcare should be earned, giving preference to those who can afford to pay for the insurance or who contribute enough (however you measure that) to society. We may be approaching a clash between a New Mexico policy initiative designed to expand access to healthcare and a Trump administration policy intended to restrict it. We can’t tell now how this will play out.
The initiative is called Medicaid Forward. It has been under study for a couple of years, to expand Medicaid eligibility so that many more New Mexicans can get health coverage.
By New Mexico standards, this initiative is bold. Depending on which of several designs is adopted, it will increase enrollment in Medicaid between 93,000 and 326,000 new enrollees.
The in-depth analysis was prepared by Mercer Health and Benefits. You can read the full report on the New Mexico Health Care Authority website.
The expansion will include people who are now in the Medicaid gap, who earn a little too much money to qualify for Medicaid by today’s rules but can’t afford other coverage. It may include people who work for small businesses where employer-provided coverage is particularly expensive. It may also include some public employees, moving them from more expensive coverage and saving state and local governments some money.
The plan will attempt to adjust Medicaid reimbursements to providers so that they don’t lose by treating patients under Medicaid. This is a critical component. If it works, it potentially could reduce the incentive for doctors to leave New Mexico in favor of states where reimbursement is higher. But here’s the kick: The federal government pays roughly 70% of the cost of Medicaid. Do I even have to tell you what’s coming next?
The Medicaid Forward plan appears to presume that federal participation will remain stable. But we can’t count on that.
Project 2025, the Republican blueprint for transforming the federal government in the upcoming Trump administration, proposes adding work requirements for Medicaid and imposing lifetime caps on benefits (page 468 of the Project 2025 plan document). The American Public Health Association notes that this would “disproportionately affect… those with chronic conditions or disabilities.” Medicaid itself could also be affected by the Trump-proposed Department of Government Efficiency (DOGE). One of the proposed co-heads of this department, Vivek Ramaswamy, has been saying publicly that he will fire thousands of federal employees. But the Project 2025 work requirement would require a new bureaucracy to administer the program and determine who is eligible.
So there’s almost surely conflict ahead. I fear the plan for Medicaid Forward might turn out to be a wasted effort. And we may continue to be stuck with an overly complicated, confusing, expensive and inefficient system that fails to cover everybody, which might get a little bit worse.
Contact Merilee Dannemann through www.triplespacedagain.com.
© 2024 NEW MEXICO NEWS SERVICES 11-25-24
Culture war issues take time and understanding
By Merilee Dannemann
Triple Spaced Again
Some 30 years ago, around a Thanksgiving dinner table, a gentleman in my family stated this opinion: Gay people should not be allowed to be schoolteachers because they wanted to recruit children into their way of life.
The gentleman was then about 50-ish and had never had more than a superficial acquaintance with anyone he knew to be gay. I knew that accusation was a myth that had been debunked long before.
Then his sister dropped the family bombshell. She revealed to her brother that his nephew was gay. The nephew was a bright young lawyer in his father’s law firm. My relative had had a warm relationship with this nephew since he was a baby.
The family had chosen to keep this quiet because gay respectability was not yet fully integrated into our national culture. Gay people and their families had been pushing toward full equality but it wasn’t there yet.
“Gays in the military” was a hot-button issue in the 1992 presidential election. The argument was whether it would be acceptable to let gay men serve. Importantly, though, the controversy had been narrowed to that specific point – military service. It was no longer unthinkable for gays to be openly themselves in society.
In 1994 the Clinton administration developed a policy for the military called, “Don’t Ask, Don’t Tell.” It was a way of letting LGBTQ+ people (a term that did not yet exist) serve as long as they were discreet and did nothing to arouse suspicion. The policy lasted only a few years.
This family conversation took place during that period. It was a moment in a transition that had been building for more than a generation.
The transition for my relative was not gradual at all. He realized quickly that his opinion was outdated and uninformed, and he promptly caught up.
I mention this now because we are in a comparable moment in the debate about transgender identity and especially participation in women’s sports.
During the recent election, one TV commercial on this topic got saturation exposure in New Mexico. The commercial showed a broad-shouldered person who could have been male in a woman’s swimsuit. The commercial claimed it’s not fair for biological males to compete in women’s sports. It went on to state that this threatens to destroy all the rights women have gained over the last 50 years.
I understood the argument about sports, but it seemed conservatives were trying to expand that narrow issue into a threat to all women’s rights, and I didn’t see the logic in that.
There have been incidents here in New Mexico involving transgender athletes playing in women’s sport events, including one where the transgender person reportedly knocked another player to the ground.
The legal question about sports is currently in courts and state legislatures. More than 20 states have passed laws requiring that women’s sports be limited to women who are biological from birth. New Mexico has no law on the topic, so the default is that transgender athletes are allowed to play. The dispute also involves proposals to amend definitions within Title IX, the 50-year-old federal law that led to the movement to provide equal funding for women’s school sports.
Policy regarding transgender athletes might be resolved quickly by the new Republican majority in Congress. But debate about what’s right may continue for some time, and it may lead to a conclusion that has not been found yet. LGBTQ+ individuals did not invent their unconventional identities as a way for liberals to offend conservatives or vice versa.
The issue arose because some people who didn’t fit in our usual categories made an earnest search for their own truth, and they have the right to continue that search. Contact Merilee Dannemann through www.triplespacedagain.com.
© 2024 © 2024 NEW MEXICO NEWS SERVICES 11-11-24
The illogic of asylum seeker detention
By Merilee Dannemann
Triple Spaced Again
About once a month, several volunteers from Albuquerque and Santa Fe travel to one of New Mexico’s immigrant detention prisons.
They are from VIDA, Volunteers for Immigrants in Detention Albuquerque (abqvida.org). They go to provide comfort and solace for incarcerated asylum seekers who are mostly abandoned in a prison where conditions are miserable. They are not lawyers and don’t provide legal services.
The VIDA members are part of a coalition seeking to end immigrant detention in New Mexico. There will probably be a bill in the upcoming legislative session, similar to legislation previously introduced. In 2024 it was Senate Bill 145.
Two things are seriously wrong with immigrant detention centers.
First: The detainees are not criminals, have not committed a crime and are not held under criminal law. They are there under a civil detention that immigration authorities have the legal power to impose, with no clear conclusion or termination. The detainees have no way of knowing when or under what conditions they will be released.
Second: The prisons are private for-profit prisons, so it’s almost a foregone conclusion that inmates will be kept in inhumane conditions to save money so the owners can profit. Observers have seen and reported on those conditions.
Three private prisons in New Mexico keep immigrant detainees: Cibola County Correctional Center (CCCC), Otero County Processing Center (OCPC), and Torrance County Detention Facility (TCDF). These facilities also contain other non-immigration inmates.
Statistics from June 2023 show 1,110 people held in ICE custody in New Mexico. Nationally, according to Transactional Records Access Clearinghouse, there were 37,395 in ICE detention as of Sept. 8, and 60% of them had no criminal record.
I’ve been reading about these detention centers for several years. Recently I had the chance to ask someone knowledgeable why some immigrants seeking asylum are imprisoned while others have the chance to enter the country while waiting for their asylum hearing.
The very disturbing answer I received is that there does not appear to be a logical reason. Asylum seekers in immigrant detention have done nothing substantially different from what other asylum seekers have done: that is, they followed the legal process in approaching agents at the border asking for asylum.
According to Sophia Genovese, managing attorney at the New Mexico Immigrant Law Center, the number of immigrants held in detention is related to the availability of space to hold them, so if New Mexico were to stop permitting immigrant detention, there would be fewer immigrants nationally in this inhumane condition.
State law cannot directly outlaw federal immigrant detention. But the existing facilities have entered into intergovernmental service agreements with their local county governments. The proposed legislation would prohibit the county governments from entering into these agreements with respect to civil immigration custody.
That would effectively prohibit these prisons from continuing to incarcerate asylum seekers, and, according to Genovese, if there are fewer spaces to house them, fewer of them will be detained. Probably more of them would be admitted temporarily into the USunder what is called humanitarian parole authority while awaiting hearings.
This is a controversial approach. Reportedly, it has been tried in other states and appealed to federal courts, with different results in different jurisdictions. The legislative intervention succeeded in some places and failed in others. Perhaps the 2025 version will have technical changes that might overcome the objections.
The election is over and it’s time for Congress to act on passing a comprehensive immigration law. Regardless of what that is, and maybe it’s sending those individuals back to the countries they tried to escape from, it should not include the deep immorality of private prisons continuing to profit from the misery of the innocent incarcerated.
Contact Merilee Dannemann through www.triplespacedagain.com.
