Pork Politics Versus Health Care In New Mexico

Government is an unreliable refuge for victims of catastophic illness

NM Gov. Bill Richardson plays Washington-class hardball, and so the Roundhouse fans must have enjoyed the way he vetoed the brain-injury bill, especially because the sponsor was known to have personal feelings about it. But the sponsor, Sen. John Arthur Smith, D-Deming, doesn’t see it as a case of payback politics.

True, he had led the unsuccessful fight against the governor’s grocery tax repeal bill and this individualism did not please the governor or his people. Smith, in fact, recalls how they hot-boxed him at one point during the 2004 legislative session — Richardson and three of his lieutenants (David Harris, Jan Goodwin, David Contarino) were in the room. “They were trying to arm-twist, but I wouldn’t have my arm twisted,” Smith told me.

And next Richardson tried pork. “He called me and thanked me for being honest and truthful on the food tax,” Smith said. “There was something said, like, ‘Would more capital outlay for your area encourage you?'” The 15-year senator, a real estate appraiser by profession, said no.

So Smith fought Richardson on the repeal of sales taxes at the grocery checkout counter, and the governor vetoed Smith’s Senate Bill 113. The bill and identical legislation by Rep. Gail Beam, D-Albuquerque, would have authorized an $8 million a year federal program – at a cost of $2 million to New Mexico taxpayers – to pay for long-term rehabilitation after traumatic brain injury.

Viewed from the Roundhouse grandstand, the political pieces did seem to fit together. But for Smith, who ought to know, retribution is not the story here. It wasn’t that simple.

He accepts, at least for now, the explanation by Human Services Secretary Pamela Hyde. “The governor believes, and I agree, that adding a new, multimillion-dollar Medicaid program before the comprehensive performance review of the current system is completed, would be irresponsible and costly,” she said in an op-ed piece.

Explanation: Hyde was talking about something known in the legislature as “recurring” expenditures. In other words, if you appropriate $2 million this year you probably will be expected to appropriate $2 million or more next year. This, in the legislature, is regarded as money of a different kind than capital outlay, which although it too comes from taxes is paid by bonding. This distinction is what allowed the legislature and the governor to deal out $475 million from the pork barrel this year while arguing that the state can not afford $2 million more for health care.

Another note: Longterm therapy for traumatic brain injury is no poverty program. Families with health insurance are as much at risk as the uninsured because insurance and health maintenance organizations will not cover longterm brain injury therapy. According to the Brain Injury Association, 1.5 million Americans a year suffer traumatic brain injury. This is six times the annual incidence of breast cancer, HIV/AIDS, spinal cord injuries and multiple sclerosis combined. The leading causes are vehicle crashes, falls and sports injuries, and all are increasing.
The Army disclosed late last year that U.S. casualties in Iraq showed a surprisingly high incidence of brain injuries – involving about 67 per cent as compared with the usual combat figure of 20 percent. An Army release blamed the new tactics of combat in which terrorists unleash high explosives rather than use firearms. The release noted that brain injuries, though invisible in themselves, show up in cognitive or emotional symptoms,

Patients who survive brain injuries often are released from the hospital in a couple of weeks after regaining consciousness. Insurance will pay for a few weeks of outpatient therapy, but the rest is usually left to family and and family, often with tragic consequences. Author Cathy Crimmins has written a moving account (“Where Is the Mango Princess?”) of life with her husband in the two years following his boating accident. A main theme is how brain injury can alter personality. Victims who appear normal in public can be terror tales at home and unmanageable at work. Like no other disease, severe traumatic brain injury attacks the soul. Immediate and continued treatment is essential. Yet the health insurers will not cover long term therapy. Crimmins calls it a hidden epidemic.

The vetoed bill would have entered New Mexico in a discretionary program under Medicaid called the brain injury “waiver.” Medicaid is for the poor, but with brain injury, families qualify when their income drops to 300 per cent of the poverty level. And, as Crimmins testifies, even an upper-bracket family (her husband was a bank lawyer) can exhaust its resources in a few months of therapy if the main salary earner is cut off or reduced to part time work.

The only reliable refuge is government. “It’s in the category of catastrophic cost that I think government ought to have a role in,” Smith said. “It’s something that nobody can afford, middle class or upper income. It’s not an expense you can handle. There’s no barrier in regard to financial background.”

Smith doesn’t have to be reminded. “I had a brother that had brain injury, and it wrecked my folks financially,” he said.

But this personal stake was never exploited by the governor, to his credit. “We’ve never had a governor that’s exercised legislative clout like this one. I don’t pick up the phone and call the governor, but I do know that you’ve got to be up front with him and never cross the line on personal attack. When you get personal with him, that’s the straw that broke the camel’s back,” said the senator, not taking anything personally.