FARMINGTON — A planned health insurance exchange program could bring coverage to about 430,000 previously uninsured New Mexicans.

The exchange is a key part of the Affordable Care Act, also known as Obamacare, and is intended to facilitate expansion of health insurance coverage to the nation's uninsured population. Each state exchange will feature an online marketplace where consumers can shop for a health care plan, compare benefits and prices and choose the coverage that's best for them.

The exchange itself, however, will not be the insurer. It is designed, rather, to promote transparency and accountability, increase enrollment and spread cost across a broader base.

Farmington City Councilman Jason Sandel is the health exchange board's vice president.

"The goal of the exchange is to insure more people across the state, and for those people to access health care," he said in a phone interview last week. "We hope they will be accessing medical services at a very basic level. That means doctors' offices, not clinics and emergency rooms."

Facilitating that thought process, however, could be a challenge.

"This is a large number of paying into the system could reduce costs for everyone," he said.

It is estimated that the system could have about 80,000 newly insured individuals in its first year, Sandel said.

"Anytime you have that many people, the system is going to be stressed," he said. "We're going to have to see how it all plays out."

New Mexico's road to the health exchange began after December 2012 when Gov. Susana Martinez declared her intent to establish the state-based program, said San Juan Regional Medical Center CEO Rick Wallace.

Wallace served on the governor-appointed health exchange task force that explored exchange options and structured how insurance options would be packaged for individual participation.

"Currently, approximately 21 percent of New Mexico's population is uninsured," Wallace said in an emailed statement. "That is nearly 430,000 people. ... It's safe to assume a fair number of that 21 percent reside in the Four Corners area of New Mexico."

Wallace hopes that the exchange program will result in a reduction to San Juan Regional Medical Center's no-pay or uninsured patients, which make up about 5 percent of its base.

"The Health Exchange will have a positive economic impact on both (the medical center) and the community medical providers," he said. "However, it will be dependent upon the eligible individuals to sign up for the health care benefits under the exchange service."

But the system may not be ready by the Oct. 1, 2013, deadline. Marjorie Petty, the regional director for U.S. Department of Health and Human Service, observed that New Mexico's Medicaid program could enroll individuals if the health exchange is not operating by the deadline, Wallace said.

A delayed launch date, however, could be the least of the exchange's problems.

"The exchange is going to be a lot more red tape from a business standpoint," said Rena Crochet, an insurance agent with Armstrong Coury Insurance in Farmington. "Although it's a good idea in theory, it's not going to be good business-wise."

Crochet said that paperwork has already quadrupled as a result of the Affordable Care Act.

"Commissions are already being reduced ... Some will say it's not worth the hassle, and I've already had clients who have called me in tears saying no insurance plan is available and if there are agents that aren't bothering with (the exchange), it will be even worse for those people," she said.

Overall, the program's flaws outweigh its benefits, Crochet said.

"We already had a good system, the NM Health Alliance," she said.

One local private practice physician is also worried about how the exchange could affect independent physicians and their patients

"One of the problems I see is that about 30 million more patients nationwide that haven't before had coverage could be entering the system," said Dr. Harold McFarling, a general practitioner in Farmington.

Some of those people rely on hospital emergency rooms and urgent care clinics, he said. There's also a portion who never see anybody, McFarling said.

"It could provide a tremendous influx of new patients, and we're having problems keeping up with patient load now," he said.

In addition to a potential system overload, the health exchange could lead to unsustainable payment rates to doctors, McFarling said.

The exchange sets payment levels at Medicare and Medicaid payment levels, he said.

This is not an issue for hospitals.

"They have to take Medicare to keep their doors open," he said.

Private physicians across the country are already not taking new Medicare patients, McFarling said.

"You can't keep the office doors open at those rates," he said.

The federal government is planning on balancing the deficit in the Medicare fund by cutting payment levels, McFarling said.

"Our expenses are going up, and those payments will be going down," he said. "I'm all for taking care of patients, but I also have to think about my business."

The influx of new patients could also slow down other patients seeking care at doctors' offices, McFarling said.

In addition, the payment model is shifting from the conventional fee-for-service model to a disease treatment model, he said.

In the fee-for-service model, payment is provided for each service a doctor or hospital administers.

The disease treatment model, which allocates a fixed amount of money per year for the treatment of a disease, will mark a drastic departure, McFarling said.

"You end up diluting the bulk of the money available," McFarling said. "It's also going to make it more difficult for us to integrate care."

And although the newly insured individuals entering the system as part of the exchange program will be very small, it could affect the system significantly.

"It's like a domino effect," McFarling said.

In the end, patients could suffer, he said.

"Those people are going to have a hard time getting into private doctors for appointments," McFarling said.

Greg Yee can be reached at gyee@daily-times.com; 505-564-4606. Follow him on Twitter @GYeeDT

 

Reporter Leigh Irvin contributed to this article.