This fall, a 65-page report authorized by the Legislature was released by Mercer Health and Benefits, a New York-based consulting firm, providing an overview of the impact a single payer healthcare system, Medicaid Forward, would have on New Mexico.
There were a lot of tables in the report, and a lot of references to “stakeholder input.” What the report was silent on was the central question: should New Mexico be the first state in the nation to adopt a single payer healthcare system?
Medicaid Forward is being promoted as a mechanism to cut the state’s uninsured population in half. Mercer used 2022 numbers for its statistics, listing about 29% of the state enrolled in Medicaid, and 8% uninsured. The Kaiser Family Foundation uses 2023 numbers, showing 33% of New Mexicans covered by Medicaid and 10% of New Mexicans uninsured. It’s unclear why Mercer went with older numbers.
Regardless, Medicaid Forward purports to bring roughly 80,000-85,000 New Mexicans into medical coverage. If we split the difference between Mercer’s and KFF’s numbers, it looks like on its face, Medicaid Forward would increase Medicaid enrollment by about 13%.
However, it’s very likely that Medicaid enrollment would increase by far more than that, as the proposal would eliminate income caps for enrollment, meaning anyone could enroll in Medicaid. A sliding scale would be implemented, so those earning a certain amount over the federal poverty level would have a co-pay. However, the cost would still be far less than private insurance.
But wait, there’s more. The proposal would also increase reimbursement rates for healthcare providers. That is necessary to keep our providers from leaving the state – an ongoing crisis we currently are enduring – but, that also adds significant cost to the program.
According to the Mercer report, a family of four with an income of 600% the federal poverty level, or $187,000, would pay roughly $23,000/year in premiums and out-of-pocket maximums on a plan from the BeWell state health insurance exchange. Under Medicaid Forward? Just over $9,000. That’s a tempting cost savings – 60 percent - especially with the knowledge more providers will be participating because of better reimbursement rates.
And then there’s the gamble. New Mexico only pays 28% of Medicaid costs, and the federal government kicks in 72%. It’s a fair bet that New Mexico could see Medicaid enrollment quickly go from roughly a third of New Mexicans to more than half under Medicaid Forward (Mercer estimates 48%). Perhaps the state could cover its 28% with the establishment of a permanent investment fund. Can New Mexico count on the federal 72% in perpetuity?
Or after January 20? All tweets from the DOGE-in-chief and corresponding Truth Social posts indicate this is a bet with very long odds.
Now, New Mexico is unique, in that unlike other states trying to implement a single payer system, Medicaid Forward is almost voluntary. No one has to give up private insurance directly. Medicaid Forward simply utilizes an Affordable Healthcare Act provision allowing states to remove income caps for Medicaid. A third of the state is already in Medicaid – what’s a few hundred thousand more?
Sounds like a no-brainer, right? It’s that “almost” voluntary that’s the rub. Employers of enrollees will be required to contribute a cost share. Proponents maintain that this would offset the additional costs to the state (estimated by Mercer to be anywhere from $225 million to $1.2 billion).
As an employer who pays 100% of employee health premiums and 50% of their families. I know something about private health insurance costs. And I can tell you that $9,000 a year for a family of four is pretty sweet. So employers are absolutely going to be encouraging their workers to dump private insurance and go get on that Medicaid – because even with a mandatory cost share, it will probably be cheaper than private insurance. Which will be eliminating a lot of choice for a lot of privately insured New Mexicans.
Which sounds a lot like a regular old single-payer system.
California and New York have both tried without success to implement single-payer systems that eliminate all consumer choice. Both have price tags in the hundreds of billions that will be passed on to taxpayers. A much smaller state, Vermont, with less than 700,000 people, passed a single-payer bill a decade ago and has yet to implement it. Colorado tried to implement a single-payer system recently but 79% of voters voted against it.
Perhaps I should call New Mexico’s plan Single-Payer Lite.
The assassination of the United HealthCare CEO earlier this month brought patient dissatisfaction with corporate oversight of our health into a terrible limelight. It’s not clear that government oversight is the answer. Going it alone – no insurance – in this country is truly a scary proposition, and the goal of eliminating that status is laudable.
Unfortunately, Medicaid Forward is not the miracle drug for New Mexico’s ills in 2025. While we may want to insure another 80,000 New Mexicans, that number could easily become 400,000. And 72% of their coverage could be swiped away like Lucy pulling the football away from Charlie Brown.
Merritt Hamilton Allen is a PR executive and former Navy officer. She appeared regularly as a panelist on NM PBS and is a frequent guest on News Radio KKOB. A Republican for 36 years, she became an independent upon reading the 2024 Republican platform. She lives amicably with her Democratic husband north of I-40 where they run one head of dog, and one of cat. She can be reached at
