Nov. 22 -- The specter of a Donald Trump presidency loomed over the Legislative Health and Human Services Committee during a discussion Friday on a proposal that would greatly expand Medicaid across the state.

Proponents of the Medicaid Forward plan -- which would remove income caps for Medicaid eligibility in favor of a sliding scale system -- say the program would solve a host of health care-related headaches and help patients, the economy and the state.

But lawmakers expressed concerns Friday about what could happen if the incoming Republican president makes sweeping changes to the health care landscape -- a factor that wasn't contemplated while a study of the proposal was conducted over the past year. The study lays out a plan with heavy federal investments.

"Like Medicaid, the state will only contribute up to 28.32% of the costs for Medicaid Forward, with the federal government covering 71.68%," states an overview of the plan by New Mexico Together for Healthcare, a statewide coalition of groups with a goal of making health care in the state more affordable. "Upfront implementation costs will be offset by long-term savings from improved health outcomes and reduced emergency care needs."

"I love this concept, but like many of us, I'm really worried about what's happening in the federal government," said Rep. Elizabeth "Liz" Thomson, an Albuquerque Democrat.

"We have a nontraditional administration coming in who does nontraditional things," she said, adding, "I really want to be for this, but I'm terrified of what New Mexico can get stuck with if the nontraditional incoming administration takes a nontraditional route."

Thomson was one of several lawmakers on the committee who expressed concerns Friday about radically changing the way Medicaid is administered in New Mexico at a time when so much is uncertain at the national level.

Cost savings forecast

Under the terms of the proposed shift, New Mexico would adopt an option created by the federal Affordable Care Act that allows states to determine the income eligibility level for people under the age of 65 to be covered by Medicaid, federal health insurance historically offered only to people with very low incomes.

Currently, only those earning up to 138% of federal poverty level -- about $43,000 for a family of four -- are eligible in New Mexico. Under Medicaid Forward, which is being promoted by the coalition of health care providers and advocates, anyone could receive Medicaid coverage.

Those earning 200% or more of federal poverty levels would pay for a portion of their care, calculated on a sliding scale. The limited health care costs for patients would range from 2% to 5% of income, depending on a household's income level. Proponents say this would make health care more affordable and make it possible for patients to predict their annual costs for care.

"The uninsured rate will be cut in half and by even more in some parts of the state," said Arika Sanchez, health care director at the New Mexico Center on Law and Poverty and a member of New Mexico Together for Healthcare.

"New Mexicans will save a billion dollars on health care spending, businesses will save over $200 million and providers will see additional increases in Medicaid reimbursement rates, further narrowing the gaps between Medicaid and private insurance," Sanchez said.

There are still many details to solidify, she said in an interview after the hearing, but generally the plan would call for employers with more than 50 workers to continue offering a health insurance option. Studies indicate they could see cost savings, however, from no longer having to pay premiums for employees who choose to enroll in Medicaid, she added.

"The Medicaid Forward model also anticipates there will be some sort of new employer contribution or tax that would help offset costs to state but would be much less than they are currently paying," Sanchez said.

Rep. Reena Szczepanski, D-Santa Fe, told the committee a recent study shows the measure would be an "all around win" that would save money for the state, employers and families and prevent people from falling off the "Medicaid cliff" and losing their health coverage if their income slightly increases.

Szczepanski will carry a bill in the upcoming legislative session that would direct the New Mexico Health Care Authority to move forward with plans to implement the plan by January 2028.

Boosting quality of care

Medical providers who advocated for the program said the new way of doing things would also have a positive effect on the quality of health care in New Mexico.

Medicaid has built-in standards that must be met for reimbursement, they noted, and the expansion would allow patients to actually access care, which would reduce the "moral injury" driving providers to leave New Mexico due to feeling powerless to address their patients' needs.

"Moral injury ... is defined as the psychological response to an event that violates a person's deeply held values or morals, and we are losing health care providers from this state in good part because of burnout and moral injury," said Anjali Taneja a family physician and director of a nonprofit clinic in Albuquerque's South Valley who also works in an emergency room on the Navajo Nation.

Though the option for an expanded Medicaid system has been available for about 10 years, only Washington, D.C., has adopted it permanently, according to Sanchez. Oregon adopted it temporarily as a bridge to a different type of system.

The option makes more sense in New Mexico than in other places, Sanchez said, because so many people in the state already receive Medicaid and because the cost-sharing ratio between the federal government and the state already calls for the federal government to bear a larger percentage of the cost of Medicaid than it does in other states with residents who have higher incomes.

'There is a lot unknown'

It's that cost-sharing ratio where much of the uncertainty exists.

If the federal share were to change, lawmakers worried aloud Friday, the calculations that make the adoption of Medicaid Forward an attractive option now could look much different.

"There is a lot unknown," Sanchez acknowledged in an interview after the hearing. "We don't have any idea what could happen under a Trump administration."

However, she said, attempts to reduce access to Medicaid during Trump's previous administration "all met with strong opposition" and had little impact.

"We just know where we are today," she said. "We have health care needs that need to be addressed, and we're just going to continue pushing forward trying to increase that access."

Under current law, the state's executive has the authority to set up and implement the program, Sanchez said. "However, legislation is necessary for ensuring proper funding mechanisms are set up, and any other parameters or guidance the Legislature wants to put in place for implementation."