The battle between the governor’s supporters and opponents for control of University Health Sciences at UNM has been over power and money, and left in its wake a legacy of bitterness unlikely to dissipate as long as Susana Martinez is governor.
But the most visible battlefield really cloaks other issues with stakes that are even higher:
- Should UNM build a new hospital with a price tag in excess of half a billion dollars?
- How would such a hospital be paid for?
- With the rapid growth of Medicaid, in a few years, a majority of New Mexicans will depend on it for everything from psychotherapy to heart surgery. More than 70 percent of that health care is paid for by federal dollars pouring into the state. What will happen if that flow is reduced by more than a third of a billion dollars?
- Will New Mexico have adequate hospital beds, clinics, doctors and nurses if the state cuts their income? How many would leave the state or refuse to take Medicaid patients?
- With health care the only sector of the state that has been regularly growing throughout the Great Recession and its miasmic aftermath, what will happen to the economy if hundreds of millions in federal health subsidies are deliberately sacrificed?
The resolution of these issues will shape the future of New Mexico for all of us.
DEEP AND DISTANT ROOTS
The current problem has deep and distant roots. It goes back to Martinez’s effort to solidify conservative support during her gubernatorial primary campaign in 2010 by promising never to raise taxes. Subsequently New Mexico was taken off guard when new technologies—fracking (in eastern New Mexico among other areas), shale deposits and Canadian tar sands—led to a huge upsurge in oil production at a time of reduced international demand. The result: oil prices plunged from $120 to $35 a barrel and destroyed the state budget, which in 2017 will be about the same as it was in 2008.
When income collapses, there are only two solutions: raise taxes or cut spending. (Actually in New Mexico’s case there is a unique third choice, use the state’s two multibillion dollar savings accounts, which the governor refuses to do.) Most state spending pays the salaries of bureaucrats, keeps the prisons full of minor drug offenders and employs overworked and underpaid teachers to provide a poor public education in overcrowded classrooms. Any serious cuts for those already underfunded purposes would create a political firestorm for a governor who has found herself on the defensive in her second term due to several political missteps and miscalculations.
So Martinez and her legislative allies moved earlier this year to cut the programs with the fewest defenders. At the top of the list were higher education and Medicaid. The details of these cuts are now working their way through the system.
The governor and friendly lawmakers sliced $86 million from state spending on Medicaid. But each state dollar is matched by three or four federal dollars, meaning that N.M. simply lost about $350 million in federal subsidies by refusing to cough up that $86 million. If somebody hadn’t already invented the metaphor of cutting off your nose to spite your face, it would be fitting to do so now.
When the governor looked at the result of her handiwork, it was hardly pleasing, and was attracting a lot of criticism. So the administration in Santa Fe had a bright idea: If they could force the University of New Mexico to give them $50 million, the Medicaid cuts wouldn’t have to be so steep and more federal money would flow to New Mexico in matching funds.
There was a hitch, however. That $50 million was part of a pot of about $200 million, according to an estimate given to me, that UNM has squirreled away to pay for a new hospital, which has a tentative price tag of between $500 million and $600 million. (I am told the new hospital is desperately needed; for example new equipment won’t even fit into old rooms.)
Although the majority of the cost would be paid by bonds, the university couldn’t borrow the full sum. And to borrow even part of the cost would require a substantial investment of its own resources.
So University Health Sciences administrators turned the governor down flatly. The Martinez administration has not evinced enthusiasm for the new hospital.
The governor has never been favorably inclined toward those opposing her major plans. So a couple of things happened. One was that when tentative Medicaid cuts to providers were recently announced, UNM would be harder hit than any other institution in the state, public or private. It had the appearance of retaliation. Hospitals and clinics complained that the provider cuts would mean that facilities would reject Medicaid patients or medical personnel would leave the state.
The other was that some of the Martinez appointees on the UNM Board of Regents suddenly came up with the idea of reorganizing Health Sciences. Again, the roots of the issue go back a ways.
In 2010, the regents felt they were having a hard time managing Health Sciences because the problems were both highly technical and quite different from the rest of the university. They looked at other institutions around the country, held hearings and accumulated data. The result was creation of a separate board to run Health Sciences. Its members were to be divided between regents and public representatives.
Last month, the president of the regents, Robert Dougherty III, came up with the idea of abolishing the Health Sciences board and replacing it with a subcommittee of three regents. There would be no public representatives. He apparently designed the new system in secret, disclosed it to at lest some of his fellow regents only on a Friday and scheduled a vote on it for the following Monday.
The regents consist of seven members, all appointed by the governor. Six serve staggered six-year terms, with the student representative named for two years. Most but not all of the regents are Republicans; at least one is an independent. When the regents met, there was, as you can imagine, a good bit of unhappiness. Some regents proposed delaying a vote for six months while the issue was studied. That proposal lost on a 3-3 tie, with two adult regents and the student representative voting for delay. The next vote was on whether to enact the change. The student joined the chairman and two other regents and the plan carried the day by a 4-2 vote. Later when journalists filed a public records request for his emails on the subject of the reorganization, the chairman said he had deleted every single one of them.
So what happens now? Applications for Medicaid—which in New Mexico is called Centennial Care—go through local offices of the state Human Sciences Department. In a hearing in federal court a few days ago, five HSD employees disclosed that the department was falsifying applications for Medicaid and food stamps.
They were raising the amount of income applicants put on their applications so as to prevent or delay them from receiving help they were entitled to by state and federal law. A group suing the state on behalf of the applicants is asking that the federal government take over running the department, or at least three of its branch offices. And the state auditor has announced an investigation of HSD.
About one-fourth of New Mexicans live below the poverty line and are eligible for food stamps. About one-half of New Mexicans will be enrolled in Medicaid within a few years. These are the most vulnerable New Mexicans, and they are going to have an even harder time surviving if the government continues to look for ways to deny them support.
The way the reorganization of University Health Sciences was handled—with its implausible rush, unjustified secrecy and bitter divisions among both the regents and the larger university community—has left a trail of anger and suspicion that is likely to endure until a new governor and a new board of regents take over in 2019.
Ultimately, such major decisions are the responsibility of elected political leaders—the governor and legislators. Their decisions affect everyone, but the poorer people are the more they are dependent on governmental good-will and integrity.
Alas, the poorer people are and the more they need government, the less likely are they to vote to elect those who govern. Politicians know the poor seldom vote, and even when they do, they are unlikely to vote for Republicans. The Republicans have just given them another reason for not doing so.