By Paul J. Gessing

In December the Legislative Finance Committee (LFC) published a report on New Mexico's Medicaid program. Whether by design or accident, the report happened to coincide with the 10th anniversary of New Mexico's Medicaid expansion. Then-Gov. Susana Martinez decided to accept the "ObamaCare" expansion dollars which, at the time, was 100% federally funded.

The LFC report is full of great information, but it doesn't attempt to assess whether Medicaid expansion was worthwhile. Unfortunately, when it comes to government programs (especially here in New Mexico) increased spending and good intentions are not often followed by thoughtful assessment of whether the spending has achieved stated goals. Even less common are analyses of whether the new program itself was cost-effective in achieving those goals.

The media covered the LFC's report which focused mostly on difficulties the Committee's "secret shoppers" had in making appointments with doctors for Medicaid patients. For example, the LFC found that only 15 percent were able to make an appointment with a primary care doctor. Other doctors were not accepting patients, failed to return phone calls, or were no longer at that phone number. These findings highlight an important problem with Medicaid: having "coverage" (especially from a government welfare program) doesn't mean you have access to medical care.

Less prominent in the news reports was the fact that the LFC reported that an astonishing 47 percent of all New Mexicans are on the program and a positively mind-blowing 77 percent of births are on Medicaid.

Ample reporting has been done about New Mexico's medical provider shortage. While there are many reasons for that shortage, our State's massive Medicaid population and the program's low reimbursement rates for providers are certainly factors. Any doctor will share their views on the challenges of serving large numbers of Medicaid patients.   

New Mexico's extraordinarily high number of Medicaid recipients is at least partially to blame for the State's low workforce participation rate. The LFC itself has noted that Medicaid and other government welfare programs, "can disincentivize work through either excessive benefits or reduction of benefits as recipient wages increase."   

Furthermore, the LFC report notes that Medicaid is the largest healthcare payer in New Mexico, and the state has the largest Medicaid program per capita in the country. Between FY19 and FY23, HSD projects total Medicaid spending to increase approximately 56 percent from $5.6 billion to $8.8 billion. In other words, by next fiscal year Medicaid alone will be spending more than New Mexico's current General Fund budget.

Sadly, the LFC did not take up a detailed discussion of health care outcomes and the impact (or lack thereof) of Medicaid expansion. The LFC did note that, "the state continues to face poor health outcomes overall." And, even more interestingly, while providing routine medical care for the poor was a stated goal of advocates for expansion, the LFC notes that "Emergency room visits for non-urgent reasons have increased, potentially leading to worse outcomes."

After a decade of massive federal and state spending growth on Medicaid the LFC does not point to significant positive health care outcomes from Medicaid expansion for New Mexico's population at large. Given the incredible impact this program has on state and federal budgets, it would be nice to know whether Medicaid expansion is having a positive impact or not. The LFC didn't even mention the lack of evidence on health outcomes much less call for such research or upbraid the legislature for failing to conduct it already.

The largest and most expensive expansion of the American welfare state in the last 50 years seems to have resulted in bigger government and more government dependency. However, here in New Mexico with the highest percentage of people on Medicaid, evidence of improved health outcomes remains elusive.

Paul Gessing is president of New Mexico's Rio Grande Foundation. The Rio Grande Foundation is an independent, nonpartisan, tax-exempt research and educational organization dedicated to promoting prosperity for New Mexico based on principles of limited government, economic freedom and individual responsibility