San Juan County lags in health coverage

Brett Berntsen
Amy Dowd, chief executive officer of BeWellNM, says a lack of affordability is the reason most residents cite for not enrolling for coverage under the state's health insurance exchange.

FARMINGTON — Despite the presence of billboards and various advertisements in San Juan County promoting the benefits of the New Mexico’s marketplace for health insurance under the Affordable Care Act, commonly called Obamacare, local enrollment rates remain lower than state and national averages.

Nearly 30 percent of county residents currently don’t have health insurance, according to figures from the New Mexico Health Insurance Exchange, or NMHIX. That rate is about twice as high as state and national levels, highlighting several challenges to implementing health care reform in the region.

“The No. 1 issue we hear from people is still affordability,” NMHIX Chief Executive Officer Amy Dowd said.

Dowd said medical costs continue to rise each year, driving up insurance premiums. In San Juan County, where on ongoing downturn in the oil and gas industry has resulted in layoffs and economic hardships, price factors may loom especially large. The exchange, however, was created specifically to provide an affordable option for people in such situations. And with 96 percent of uninsured county residents eligible for subsidized coverage under the exchange or through Medicaid, other factors may be at play.

“I think some of the misinformation around the program does make an additional barrier for us,” Dowd said.

Critics of the Affordable Care Act have launched national media campaigns claiming the policy hurts small businesses and damages the economy.

Cody and Amy Martin sign up for health insurance on Friday at the New Mexico Health Insurance Exchange office in Farmington.

State lawmakers have also criticized New Mexico’s implementation of the ACA. An October 2015 report from the Legislative Finance Committee blasted the exchange for spending $78 million with “little benefits to tax payers.” The report states that marketing efforts have produced questionable results, noting a 10.2-percent advertising effectiveness rating for San Juan County — the third lowest out of 23 major counties studied.

Committee Member Sen. Steve Neville, R-Aztec, said the local situation demonstrates underlying flaws in the ACA as a whole.

“It’s just a reflection of the whole program,” he said. “It’s prohibitively expensive.”

In their response to the report, NMHIX officials have acknowledged the exchange has challenges to overcome, but they say some elements are out of their hands. Dowd wrote in the response that legislation creating the exchange was passed just 187 days before the first enrollment period began on March 28, 2013.

“Certainly, we would have appreciated the luxury of two and a half years that (other states) had to get ready to open their doors for the first time,” she wrote.

NMHIX's response also points out that during the exchange’s first year, New Mexico’s uninsured rate fell 4.1 percent, and most of the uninsured people are not the program’s “target” audience — those who qualify for a tax credit for having health coverage. The credit applies to individuals who earn between $11,770 and $47,080 per year.

Dowd said that the exchange, under its BeWellNM brand, is continuing to gain attention through a vigorous marketing campaign, including billboards, television, radio and social media ads.

But despite tech-savvy outreach efforts, the task of informing certain demographics still presents a challenge.

Native Americans comprise 2 percent of the population covered under the state's exchange.

Monica Marthell, NMHIX’s Native American outreach coordinator, said that although many tribal members receive federal health benefits from Indian Health Services, the exchange can also play an important role in filling coverage gaps. Marthell said NMHIX employs bilingual staff members to promote its services, but some cultural barrier exist.

“There’s not a specific word in many languages to say deductible or co-pay,” she said. "We have to get creative."

Marthell said in-person meetings have proven the most effective way of enrolling Native Americans.

Amy Dowd, chief executive officer of BeWellNM, talks about the organization's mission on Friday at the New Mexico Health Insurance Exchange office in Farmington.

As the open enrollment period beginning Nov. 1 draws near, Dowd said the exchange plans to ramp up such efforts. Dowd said San Juan County residents can also take advantage of the enrollment center in Farmington, where customers shopping for insurance can sit down with an expert and discuss coverage options. She said the opportunity to meet one on one with a councilor can provide the extra incentive needed for people to join the exchange.

Another motivating factor for the 33,583 uninsured county residents could be the annual fee taken out during tax season. The fine for not having coverage during 2016 is $695, depending on income level.

“It's not meant to be a punishment," Dowd said. "But the fact is, if you don’t have coverage, you face a penalty."

Brett Berntsen covers government for The Daily Times. He can be reached at 505-564-4606.