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The State of Health in New Mexico 2018

15. Access to Health Care

Access to Care is Key to Reducing Disease Severity

In 1978, nearly all nations of the world signed the World Health Organization Declaration of Alma Ata, proclaiming the right of all people to primary care. Primary care is defined as basic or general health care focused on the access point where a patient ideally first seeks assistance from the medical care system. All or parts of 32 of New Mexico's 33 counties have been designated "primary care health professional shortage areas" by the U.S. Health Resources and Services Administration - indicating inadequate supplies of primary care providers considering the population size.

Important health maintenance information and tools and access to clinical preventive services (CPS) such as mammograms, PAP tests, measurements of blood cholesterol, and many others, are only available through health care providers. For most individuals and families, the high cost associated with accessing health care can only be managed through some form of health care plan, be it private health insurance, employer-provided insurance, or some form of public-sponsored coverage such as Medicare.

Individuals without health care coverage are much less likely than those with coverage to receive recommended CPS, are less likely to have access to regular care by a personal physician, and are less able to obtain needed medication or health care services. Consequently, the uninsured are more likely to develop preventable illnesses, more likely to suffer complications from those illnesses, and are more likely to die prematurely.,

The New Mexico Department of Health routinely monitors health care coverage. Over the past 6 years, the health care coverage gap between New Mexico and the rest of the county has narrowed significantly. Among adults aged 18-64 years, 26.1% in New Mexico lacked health care coverage compared to 21.3% in the United States (Figure 1). In 2016, the gap had virtually disappeared (12.0% New Mexico, 12.4% U.S.). Among children under the age of 18, the gap was similarly narrow: 6.1% of New Mexico children and 6.0% of U.S. children were without any form of health care coverage in 2016. Most adults aged 65 years or more qualify for federally sponsored Medicare, and predictably, nearly all (98.1%) New Mexicans in that age group had health care coverage in 2016.

The percentage of adults who had received selected preventive health services varied by health care coverage status. Adults who were covered by a health plan were significantly more likely to have received each form of potentially life-saving service by the recommended age and within the recommended time frame than those without coverage (Figure 2). In 2015-2016, 73.2% of adults aged 65 or older who had coverage had received the recommended pneumococcal vaccination while only 42.5% of those without coverage had. In 2016, 37.8% of adults without coverage experienced a time in the previous 12 months when they needed medical care but could not get it because of the cost, while cost prevented only 10.1% of adults with coverage from obtaining needed medical care.

Community-Based Primary Care

The community-based primary care sector in New Mexico is a major public health success story. Few other states have such a widespread system caring for such a large percentage of the state's underserved population. Primary care centers are serving a significant portion of the unmet need in New Mexico. Under the Federal Primary Care Cooperative Agreement, the Office of Primary Care & Rural Health (OPCRH) of the NMDOH works to facilitate the expansion of primary care centers by providing support to the New Mexico Primary Care Association and individual community groups and primary care centers seeking to initiate or expand community-based primary care centers in underserved parts of the state. The OPCRH will develop and disseminate information about areas of highest need and will promote coordinated planning to meet local needs, including coordination between primary care centers, rural hospitals, local health councils and public health offices.

The Rural Primary Health Care Act (RPHCA) program provides financial support for the operations of 100 community-based primary health clinics throughout the state ensuring the provision of basic health care. The RPHCA Program documented more than 330,000 patients and over 1,000,000 primary care encounters in state fiscal year 2016. Primary Care Provider Recruitment and Retention supports a clearinghouse for recruitment and retention of primary care providers for underserved and rural areas of the State: 62 health professionals have been placed in 19 counties in 26 different communities for state fiscal year 2016. The Primary Care Capital Fund, in cooperation with the New Mexico Finance Authority, offers low-interest rate loans to community-based primary care centers and hospices. There are 10 active loans for primary care center facilities state fiscal year 2016. The Primary Care Cooperative Agreement (PCO) supports the coordination of state primary care center program activities with those of the Federal Health Resources and Services Administration (HRSA). The PCO works to foster collaboration, provide technical assistance, assess needs, develop workforce for National Health Service Corps (NHSC) and safety net programs, coordinate Health Professional Shortage Area (HPSA), there are 187 NHSC clinicians serving at 100 sites in the state of New Mexico for fiscal year 2016.

While the focus of these centers is on medical services, there is an increased emphasis on expansion of dental services in the primary care setting. Fewer than half of primary care clinic sites have dental service capacity. But even with this limited capacity, primary care centers provide more than 21% of all Medicaid dental services in New Mexico.

Affordable Care Act

The implementation of the Affordable Care Act (ACA) in 2014 expanded insurance coverage in New Mexico, most notably by expanding eligibility for New Mexico Medicaid programs. Medicaid enrollment increased significantly after the implementation of the ACA with an increase of 24 percent in 2014 among all age groups. Among adults 18-64 who say Medicaid is a source of coverage, the percentage increased by 97.1% going from 10.5% in 2013 to 20.3% in 2016. The percentage of New Mexico adults without healthcare coverage dropped by over 54% between 2011 (26.2%) and 2016 (12.0%). The percentage of adults who say they are unable to get needed medical care due to cost dropped significantly as well, going from 22.0% in 2011 to 14.4% in 2016.

The Affordable Care Act (ACA) has provided some important benefits for residents of New Mexico. ACA includes a small business tax credit designed to support small businesses in providing health care coverage to employees providing health care coverage to employees. As of September 2017, New Mexico was one of five states with a state-based health insurance exchange that used the federal web platform. Enrollment in plans offered on the exchange amounted to about 45,000 in 2017. Of individuals enrolled, 73 percent were eligible for premium tax credits, which averaged $283 per month. In addition, 47 percent were eligible for reductions in their cost-sharing responsibilities. Frequently, adults who retire early will lose employer-provided coverage but will be too young to receive coverage through Medicare. Through ACA, the Early Retiree Reinsurance Program provides support to employers to ensure continuation of coverage of employees who retire early. ACA allows children to be covered through their parent's plan through age 26. ACA made available to New Mexico $37.5 million to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool. Additionally, the ACA includes many consumer protections, including: eliminating lifetime limits on coverage; restrictions against denial of coverage based on pre-existing conditions; regulation of use of annual limits to coverage; requirement of appeals processes to ensure pathways to dispute denial of medical claims; and, increased flexibility in choice of physician.

Contributing Factors

Risk and Resiliency Factors

A major risk factor is limited access to healthcare in New Mexico, which is related to primary care provider shortages and lack of awareness of insurance availability. Another risk factor is that the rurality of New Mexico creates long travel distances to primary health clinics and hospitals. Healthcare affordability in New Mexico remains a risk factor although the implementation of the ACA has made healthcare more accessible to those who couldn't previously afford insurance.

Health Disparities

Ideally, all individuals would have effective access to health care. However, health insurance coverage varies by gender, race/ethnicity, education level, annual household income, employment status, and region of residence. In 2016, adult men were slightly less likely than adult women to have health care coverage (88.6% vs. 91.8%). Asian or Native Hawaiian/Pacific Islander (100.0%) and White (94.8%) adults were more likely than American Indian (92.5%), Black or African American (88.4%), and Hispanic (85.3%) adults to have health care coverage. Hispanic adults were least likely of all racial/ethnic groups to have health care coverage. However, cost was more likely to have prevented Asian or Native Hawaiian/Pacific Islander adults from getting care when needed compared to White adults (16.2% vs 8.6%).

Adults with more education were significantly more likely to have health care coverage. At each level of completed education, the prevalence of health care coverage was significantly higher. Adults with a household income of $15,000 to $24,999 had significantly lower coverage than those with incomes over $25,000 and slightly lower than adults with incomes less than $15,000. Adults who were employed were significantly more likely to have coverage than adults who were unemployed (96.7% vs. 83.3%). Retired adults were most likely to have coverage (98.2%). Of course, most retired adults are 65 or older and qualify for Medicare. Adults living in the Southeast region of New Mexico (86.1%) were less likely to have coverage than adults living in other regions. Adults living in New Mexico's Metro Region had the highest coverage (91.4%) of any region.

New Mexico adults living in Los Alamos County were the most likely to report having a usual primary care provider (83.7%), while those living in McKinley (53.6), Luna (60.0%) and Lea (60.6%) counties were least likely to report having a primary care provider (Figure 3). Having a usual primary care provider depends on affordability (e.g., income, health care coverage and the quality of health care benefits provided by the health plan) as well as physical proximity to an appropriate provider.

Assets and Resources

New Mexico's health insurance exchange is a marketplace where New Mexicans can learn about health insurance, compare plans and get ready to enroll.

The New Mexico Primary Care Association (NMPCA) is a non-profit 501 (c) 3 corporation, representing 19 member organizations that operate over 160 primary care, dental, school-based and behavioral health clinics, throughout New Mexico. Many NMPCA members are among the dozens of Federally-qualified Health Centers (FQHCs) located throughout the state. FQHCs receive federal support to provide comprehensive primary care and preventive care to persons of all ages, regardless of their health insurance status or ability to pay.


Factors limiting access to healthcare in New Mexico are availability, accessibility, and utilization of health insurance. Limited access is a major factor due to primary care provider shortages and rural areas in New Mexico. New Mexico has seen a sharp decrease in the percentage of the population lacking healthcare coverage due to the implementation of the Affordable Care Act. References

Figure 1. Lack of Healthcare Coverage by Year, Age 18-64 and 65+, New Mexico and U.S., 2011-2016 Lack of Healthcare Coverage Age 18-64 and 65+, NM and US, 2011-2016 Source: NMDOH BRFSS Figure 2. Access to Important Preventive Health Care by Health Care Coverage Status, New Mexico, 2015-2016 Access to Important Preventive Health Care by Health Care Coverage Status, NM, 2015-2016 Source: NMDOH BRFSS Figure 3. Percentage of Adults Aged 18+ Years With a Usual Primary Care Provider by County, New Mexico, 2012-2016 Percentage of Persons With No Primary Medical Provider by County, New Mexico, 2012-2016 Source: NMDOH BRFSS

What is Being Done?

  • $1.38 million from U.S. Department of Health & Human Services was provided to the New Mexico Medical Insurance Pool to support coverage of those who have been denied coverage due to pre-existing conditions
  • Analysis of the New Mexico Behavioral Risk Factor Surveillance System healthcare access supplemental questions to assess the impact of the Affordable Care Act.
  • Planning assistance and low-interest loans are being given to community groups and agencies developing or expanding community-based primary care centers.
  • Tax incentives and education loan repayment programs encourage medical professionals to settle and work in under served areas.

What Needs to be Done?

  • Careful study of and integration of New Mexico primary care and other medical resources with the federal Affordable Care Act.
  • Monitor distribution of medical professionals and services across the state to identify geographic areas of need.
  • Expansion of primary care centers to meet the needs of more underserved people.
  • Expansion of services provided by primary care centers to include dental services, behavioral health services, health promotion and disease prevention services, and chronic disease management.
  • Continue, and expand, monitoring of access to and utilization of health care across the entire population of New Mexico.
The information provided above is from the New Mexico Department of Health's NM-IBIS web site ( The information published on this website may be reproduced without permission. Please use the following citation: "Retrieved Tue, 26 October 2021 from New Mexico Department of Health, Indicator-Based Information System for Public Health Web site:".

Content updated: Tue, 20 Mar 2018 15:16:58 MDT