2018-2023 Implementation Update
The health care transparency website is scheduled for completion by December 31, 2023.
In 2018, the Department of Health developed a trial model of the transparency website that included the average prices paid by Medicaid (which covers about 45% of all New Mexicans and pays for about 72% of births in the state) for nine common non-emergency procedures at each of the state’s 44 hospitals. (That trial website is no longer online.)
During the 2019 legislative session, Think New Mexico advocated for the next phase for the website: expanding the number of procedures listed on the site and adding the average prices paid by New Mexicans who are covered by individual or employer insurance policies.
We were very pleased that the legislature included $900,000 in the 2019-2020 budget and another $900,000 in the 2020-2021 to create an All-Payer Claims Database to collect information about average prices paid by New Mexicans who are covered by individual or employer-based insurance policies. Fifteen states have already created All-Payer Claims Databases (APCDs), including our neighbors in Colorado and Utah, and several other states are implementing them.
Once New Mexico’s APCD is complete, the health care transparency website will be able to include the average prices paid by New Mexicans with private insurance for many more medical procedures. This will allow New Mexicans with high deductibles to shop around for the highest quality, most affordable health care.
2015-2016 Legislative Update
During the 2015 legislative session, Senators Jerry Ortiz y Pino (D-Abq, Chair of the Senate Public Affairs Committee) and Sander Rue (R-Abq, father of the state’s Sunshine Portal) sponsored Senate Bill 474 to create a website where New Mexicans can easily find information on hospital prices and quality.
After extensive negotiations, the bill was merged with Senate Bill 323, sponsored by Senator Mark Moores (R-Abq) and supported by the New Mexico Department of Health and the New Mexico Hospital Association. The Senate Judiciary Substitute for Senate Bills 323 & 474 passed the Senate 26-0 and the House 52-0. It was signed into law by Governor Martinez on April 9, 2015. We are now working to ensure the successful implementation of the health care transparency website, and our Associate Director Kristina Fisher has been appointed to serve on the advisory committee to assist the Department of Health with the implementation process.
According to a 2014 study by the nonpartisan Commonwealth Fund, New Mexico ranks last in the nation for health care affordability and access. Employers and families are increasingly shifting to high-deductible insurance plans, and New Mexicans are paying more and more out of pocket for their health care. For example, the Bronze Plan policies available under the Affordable Care Act in New Mexico have deductibles averaging more than $5,000 for individuals and $10,000 for families.
Yet the lack of information on health care cost and quality makes it impossible for New Mexicans to shop around for the most affordable, highest quality care. (Naturally, shopping around only works for non-emergency care, but only about 10% of medical costs are incurred during emergencies.)
In 2014, Think New Mexico launched a new initiative focused on making health care more affordable by increasing transparency and ending price discrimination. Specifically, Think New Mexico recommended that the state create a user-friendly public website that would disclose hospital price and quality information for common medical procedures. (Much of this information is already being reported by hospitals to the New Mexico Department of Health, but it is not available to the public.) Fourteen other states, including Colorado, Arizona, and Utah, have already created health care transparency websites, and another five states are in the process of creating them.
In order to make price transparency possible, Think New Mexico proposes outlawing “gag clauses” in contracts between hospitals and insurers, which currently prohibit either party from revealing the prices they agree to. The state already prohibits insurance contracts from including gag clauses that would silence doctors from telling patients about treatment options that their insurance plans do not cover.
Finally, Think New Mexico recommends ending price discrimination, the situation in which patients at the same hospital receiving the same treatment from the same doctor are charged different prices depending on who is paying the bills. Medicare and Medicaid pay the lowest prices and private insurance companies each negotiate their own rate schedules. Perversely, uninsured patients who are least able to afford it often end up with the highest bills since they have the least negotiating power (although hospitals regularly end up marking down the final charges in charity cases).
Think New Mexico recommends that the state continue to allow hospitals to set their own prices, but require them to charge the same price to every patient for the same procedure, regardless of who is paying the bills. A similar system has successfully helped control health care costs in the state of Maryland since the 1970s.
These reforms have the potential to benefit all stakeholders, from patients and employers to doctors, hospitals, health insurers, and state taxpayers. Because hidden prices and price discrimination create unnecessary complexity, they result in enormous administrative waste in the health care system. About one out of every three dollars spent on health care in the U.S. goes to administration, and excess administrative costs burden consumers, insurers, and health care providers alike. Based on national studies, Think New Mexico estimates that the potential savings to New Mexicans from fully implementing its proposed reforms would be about $1.7 billion annually, or $868 per New Mexican per year.
All of Think New Mexico’s health care affordability reforms were endorsed by a 2012 article in the New England Journal of Medicine.
Watch a KRQE News 13 story about the need to improve health care price transparency • December 27, 2018 (2:49)
Read a guest editorial by Think New Mexico Associate Director Kristina G. Fisher explaining why New Mexico needs an All-Payer Claims Database to make health care pricing more transparent • September 12, 2018
Listen to Tom Trowbridge on KSFR 101.1 FM interview Think New Mexico Associate Director Kristina Fisher about the launch of the health care transparency website • January 9, 2018 (mp3, 7:46)
Read Grant County Beat post about the launch of the health care transparency website • January 8, 2018
Read Albuquerque Business First article about the launch of the health care transparency website • January 5, 2018
Read our opinion editorial making the case for health care transparency, which has been published in the Albuquerque Journal, the Carlsbad Current-Argus, the Gallup Independent, the Hobbs News-Sun, the Las Cruces Sun-News, the Las Vegas Optic, the Rio Rancho Observer, the Roswell Daily Record, the Ruidoso News, the Santa Fe New Mexican, the Silver City Sun-News, the Taos News, the Truth or Consequences Herald, the Union County Leader • December 2014-February 2015
Watch Larry Barker investigate the need for health care transparency on KRQE News 13! • February 24, 2015 (8:48)
Read a Santa Fe New Mexican editorial in support of Think New Mexico’s health care transparency legislation • February 15, 2015
Read a Las Cruces Sun-News editorial in support of Think New Mexico’s health care transparency legislation, which was also published in the Alamogordo Daily News, the Carlsbad Current-Argus, the Roswell Daily Record, the Ruidoso News, and the Silver City Sun-News • February 2015
Read a Las Vegas Optic editorial in support of Think New Mexico’s health care transparency legislation • January 21, 2015
Read a Hobbs News Sun editorial in support of Think New Mexico’s health care transparency legislation • January 18, 2015
Read a Rio Grande Sun editorial in support of Think New Mexico’s health care affordability initiative, which was also published in the Silver City Daily Press and the Union County Leader • November 12, 2014
Watch an Eye on New Mexico KOB Channel 4 interview with Fred Nathan about Think New Mexico’s health care affordability initiative • November 9, 2014 (18:56)
Listen to KRSN 1490 AM Los Alamos interview with Think New Mexico Executive Director Fred Nathan about our health care affordability initiative • October 28, 2014 (mp3, 18:52)
Read a column on Think New Mexico’s health care affordability initiative by syndicated columnist Tom McDonald, which has run in the Clovis News Journal, Las Vegas Optic, Portales News-Tribune, Roswell Daily Record, Silver City Daily Press, and Union County Leader • October 25, 2014
Read an Albuquerque Journal column by Dr. Barry Ramo on Think New Mexico’s health care affordability initiative • October 25, 2014
Listen to KSFR 101.1 FM interview with Think New Mexico Executive Director Fred Nathan about our health care affordability initiative • October 15, 2014 (mp3, 51:33)
Listen to KSVP 990 AM radio report on Think New Mexico’s new health care affordability initiative • October 10, 2014 (mp3, 18:30)
Read Santa Fe New Mexican article about Think New Mexico’s new health care affordability initiative • October 5, 2014
Listen to KSFR 101.1 FM radio report on the launch of Think New Mexico’s new health care affordability initiative • October 7, 2014 (mp3, 5:19)
Read an Associated Press article about Think New Mexico’s new health care affordability initiative, which has been published in the Albuquerque Journal, Artesia Daily Press, Deming Headlight, Farmington Daily Times, Gallup Independent, Hobbs News-Sun, Las Cruces Sun-News, and Las Vegas Optic • October 7, 2014