Errors of Enchantment

It’s National School Choice Week across the United States. And, while New Mexico’s Legislature has not been particularly friendly to choice in recent years, the fact is that New Mexico DOES have some choice to celebrate (most notably charter schools), but it needs a lot more to improve the State’s poor educational performance.

A few bills are likely to come up for hearings in the New Mexico State Senate soon. Here is a link to the Senate Education Committee page with a list of members.

The VERY best bill is SB 109 put forth by Republican Craig Brandt, a Republican, which would create a system similar to that adopted in Arizona in 2022 which would create a program to allow the Public Education Department, in contract with parents of participating students, to pay for private school and other eligible expenses.

Another bill worthy of support is SB 113. This bill, introduced by Albuquerque Democrat Jerry Ortiz y Pino, would create a system of tax credits to be used for school choice. This is an idea the Rio Grande Foundation has been working on for more than a decade and Ortiz y Pino has supported the idea in the past. A brief (albeit old) discussion of how a school choice tax credit program might work can be found here.

We’ll keep track of other bills of interest and report on them in this space.

 

New Mexico has a shortage of medical providers across most practice areas (as discussed in Part 1 of this series). So, as the 2023 legislative session gets rolling, what can be done about it?

The Rio Grande Foundation has looked high and low throughout New Mexico laws impacting medical providers and has produced a series of recommendations laid out in an extensive policy paper.

1) While forward looking in nature, HB 75 passed in 2021 and was revised later on that same year makes New Mexico’s medical malpractice much more plaintiff and attorney friendly through the increase in damage award caps is  causing a great deal of concern among providers even though it will not be implemented until 2024;

2) Stop taxing medical providers via gross receipts tax. The State is one of the few states in the entire nation that levies the equivalent of a “sales” tax on certain medical services. In New Mexico’s largest city, Albuquerque, the rate of taxation is currently 7.75 percent. Rates tend to be even higher in outlying areas of New Mexico. This could be part of a broad reform or more targeted.

3) Reduce Medicaid dependency.  According to the American Hospital Association, Medicaid underpaid hospitals by $24.8 billion in 2020. For Medicaid, hospitals received payment of only 88 cents for every dollar spent by hospitals caring for Medicaid patients in 2020. In 2020, 62 percent of hospitals received Medicaid payments less than cost.

4) Expand scope of practice/telemedicine.

There are several additional ideas outlined in the report along with more detailed discussion of the ideas listed above. All of it can be found here.

The following appeared in the Las Cruces Sun News on Sunday, January 22nd, 2023.

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 10^th 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

Thanks to legal help from the Liberty Justice Center, a non-profit, public interest litigation center, the Rio Grande Foundation and its president Paul Gessing have filed a lawsuit against the City under New Mexico’s “anti-donation clause” over the City’s “donation” of $250,000 of our tax dollars to Planned Parenthood. You can read more about the case here.

“New Mexico’s constitution prevents politicians from using taxpayer funds like their own personal piggy banks,” says Daniel Suhr, managing attorney at the Liberty Justice Center. “Albuquerque’s grant to Planned Parenthood is pure politics, and the state constitution prevents that kind of abuse of taxpayer dollars.”  

“Taxpayers should not be compelled to subsidize Planned Parenthood or any other private group,” said Gessing, who is president of the free-market Rio Grande Foundation. “The anti-donation clause of New Mexico’s constitution is a bulwark for taxpayers against politically motivated earmarks just like this one.”  

Sadly, Albuquerque’s City Council seems to have ignored New Mexico law which clearly states that “Neither the state, nor any county, school district, or municipality … shall directly or indirectly lend or pledge its credit, or make any donation to or in aid of any person, association, or public or private corporation ….”

 

On this week’s interview Paul talks to his old friend Paul Teller. The two Paul’s go back 20 years when Teller was staff director at the Republican Study Caucus, a conservative coalition of House Republicans in Congress. They discuss how the conservative movement has evolved since then and some of the issues and battles that led us to the current moment.

Paul Teller is now Executive Director of Advancing American Freedom, a non-profit led by former VP Mike Pence. They discuss what the organization is doing to advance its goals which include “energy independence.” Teller is in New Mexico for a variety of meetings while Paul is hopeful for a visit/event with VP Pence.

After recording the show Paul Gessing took Paul Teller to one of New Mexico’s authentic restaurants.

Albuquerque residents who have been around more than a year or two probably remember the disastrous rollout of electric ART buses up and down Central Ave. As noted in numerous media reports:

The vehicles didn’t meet their promised battery charge, which meant they couldn’t manage a full day’s service. There were numerous durability and safety issues, including doors opening unexpectedly, malfunctioning brakes, faulty electric wiring, exposed wires, and overheating batteries.

On top of everything else, the charging system for the batteries was defective, and some buses simply could not be charged. Officials canceled the project within months, and the city ended up suing BYD.

Guess what? It’s happened again. This time, thankfully, we’re not talking about huge, expensive buses that are supposed to take people all over town. Instead, this electric vehicle fail involves the new “train” connecting the Zoo and Botanical Garden. Here’s the full story from KRQE Channel 13.

According to the story, “When they launched the shuttle during the River of Lights, it was hampered by electrical issues and needed a new charger.”

“If all goes well with the new charger, it should be within a matter of weeks. If that doesn’t work, we will actually bring the rep from the manufacturer out here to do some onsite diagnosis.”

Meanwhile Sen. Bill Soules (D-Las Cruces) wants to mandate that 75 percent of state vehicles be EV’s and US Senator Martin Heinrich successfully pushed for massive expansion of the Post Office fleet of electric vehicles.

NM’s legislative session begins at noon. We can talk broadly about what to look for in the upcoming session on a whole host of issues. MLG’s “more of the same” budget is built on extraordinary growth in oil production. Sadly it doesn’t seriously address tax reform.

Paul and Wally briefly discuss the latest in the gas stove “wars.”

New Mexico population loss is a long-term problem.

Left wing legislator introduces legislation to create high speed rail from Denver to Mexico (again). Paul has brand new Rail Runner data highlighting the taxpayer-financed train’s costly failure.

Albuquerque’s “free” bus fare program hasn’t moved the needle on bus ridership in the City either. 

Finally, Paul notes that the City’s community centers were closed not just for MLK Day, but also the Saturday and Sunday before. This highlights the City’s lack of concern for youth who have no inexpensive entertainment options when school is out and these centers are closed.

In a new policy brief which explores the shortage of medical providers in the State of New Mexico, the Rio Grande Foundation digs into an analysis of which areas of medical practice face the most acute shortages and compares New Mexico counties, New Mexico with its neighbors, and also looks at geographical trends regarding the availability of medical providers nationwide.

Forming part one of a two part series on the topic, the document titled, “The Existence and Extent of a Medical Provider Shortage in New Mexico” is an attempt to gain a foothold when it comes to the statistics behind the medical provider shortage.

Among the findings:

In a follow-up report Rio Grande Foundation will provide specific ideas on how policymakers, especially those here in New Mexico, can address the State’s medical provider shortage.

New Mexico Sen. Bill Soules, a Demorat from Las Cruces, plans to push for both a $500,000 study of high speed rail and to push his $1 billion plan to begin construction of the system. Supporters claim polls show support for such a proposal, but  as has been the case throughout the COVID 19 pandemic and beyond, mass transit has continued to lose ridership in New Mexico and around the nation.

The Rail Runner Express DID in fact see a slight rebound from the darkest days of COVID when the system was shut down for months at a time, but remains a far cry from recovering to pre-pandemic numbers and just over one-third of peak ridership back in 2010.

This, despite having been open for all of 2022 AND Gov. Lujan Grisham having reduced fares on the already-heavily-subsidized train by 75% to $2.75 cents for a round-trip to Santa Fe. This is shockingly low even by subsidized transit standards as two trips on the Washington, DC METRO subway system cost at least $4.00. 

On January 1, 2022 the City of Albuquerque began what it calls a “pilot program” offering “free” bus fares for all riders. The program cost an additional $3 million above and beyond the usual cost of the City’s bus system.

Not surprisingly (given national trends in transit ridership), the number of people riding Albuquerque buses remains well below pre-pandemic levels. In fact, even with “free” fares in place ridership was 33 percent lower than it was in 2019.

Ridership numbers were a bit higher than the pandemic years of 2020 and 2021, but the trend line remains negative for Albuquerque’s bus system regardless of the “new” ART system and zero-fares.