Rep. Andrea Romero (Moore, Journal)

Welcome back.

At the Roundhouse: ICE may not melt away here even as the bill banning local governments from contracting with the three ICE detention centers is on the fast track to the Governor. . .

Dem legislators are sending a strong message of disapproval--led by Santa Fe Rep. Andrea Romero--of the agency's conduct. The House passed the ICE ban on a 40-29 vote, despite ardent opposition from rural Republicans who say the resulting lost jobs would be a severe economic hit and also warned of possible Trump retaliation.

But will those jobs really be lost? Probably not.

The three centers in Torrance, Cibola, and Otero counties are privately managed so they could keep running via direct ICE-private contracts, which the bill doesn't touch. The New Mexico law is similar to those in California and Maryland where facilities adapted and which seems the likely outcome here. 

If Santa Fe was intent on closing the centers it could do what a new California proposal does--impose a 50% tax on profits made by corporations running ICE-funded detention centers.

While the impact may be more symbolic than substantial, the stirring and important debate over ICE and passage of HB9 may be the most-remembered event of the 30 day session. 

It could also be the most politically impactful in determining who will be the next Governor. Deb Haaland and Sam Bregman have been locked in a contest over who would best respond to the Trump administration on immigration. The issue continues to send demonstrators to the streets of ABQ and soon will be sending them to the June primary polls. 

AN APPLE A DAY

The state's doctor shortage, especially primary care physicians, is not just about malpractice laws or quality of life issues. The fact is compared to other states too many New Mexicans don't take care of themselves. and that creates more demand for doctor visits.

The state's elevated rates of poverty, obesity, drug addiction and related chronic conditions amplify the shortages beyond what's seen in healthier states. 

New Mexico ranks near the bottom nationally in obesity with a 32-35% adult rate and has a poverty rate at 18-20 percent. Opioid and fentanyl overdoses remain among the highest per capita, straining behavioral health services statewide.

All this health dysfunction drives heavy demand for primary care, addiction treatment, and specialists and compounds the impact of the doctor exodus.

Multiple state departments have been working on the obesity and drug issues but to muted effect. Is it time for lawmakers to double down on outreach programs, including more bilingual messaging on personal health? After all, it's still true that "an apple a day keeps the doctor away."

MISSING MD'S (CONT.)

More now on what keeps the doctors away--or maybe doesn't--depending on what statistics are being passed around. 

Reader Ron Nelson wrote here Thursday of the inability of the state to nail down just how may docs are practicing and in doing so mentioned the role of the NM Medical Board. A member of that Board since 2019 responded while opting for anonymity: 

Our roles are to license and discipline physicians and other health care providers. We have no responsibility to recruit or retain physicians. We license applicants that have met all the qualifications. We only collect data on licensees but not what they are doing in NM if anything. 

We are licensing a record numbers of providers. However, this is in large part a function of the increase in telemedicine and temporary/traveling providers. Often, these providers work for large companies and may have over 40 licenses to their name. They may not even know all of the places where they are licensed. And often it is a staff person filling out the applications.

Having a valid license here does not mean the provider practices here. Finding that out requires data about billing. If it is a cash only business, there will not be billing records. If there are billing records, they

are often traced to the company that employs the provider and one cannot be sure it is the provider himself providing care. We often encounter providers who have a license here but have never practiced in NM. They have the license just in case. And if they are telemedicine, they do not need to have a physical address in NM to be licensed. So using address changes is not reliable either. 

This is a challenge all states are facing. Workforce numbers are difficult to pin down with accuracy. So having high numbers of licensees and a scarcity of providers can both be true. And we have good reason to believe that both are true. What is curious is that the state does collect surveys asking what the licensee is doing and what their practice is like. But as your reader pointed out, the big computer hack to the Regulation and Licensing Department database a few years ago has caused much of that data to disappear. 

All of the board members are volunteers and we spend many many hundreds of hours a year collectively trying to sort this and other issues out. 

This is the Home of New Mexico Politics.