Lawmakers tackled New Mexico’s crisis of rural health care workers. It wasn’t enough.

As the crow flies, the Pojoaque Primary Care Center is about 20 miles from New Mexico’s 400-plus-year-old capital, Santa Fe, with its art galleries, well-known opera and tourist destinations. But it’s 45 minutes by car from Dr. Mario Pacheco’s home on Santa Fe’s south side. 
With roots in a small northern New Mexico town himself, Pacheco makes the drive from Santa Fe to serve a rural clientele that largely comes from northern Hispanic communities in the greater Pojoaque Valley. “I’m serving patients that I could really see as being my uncle or my aunt or my dad or my mom,” he said.  “These are people who can relate to me and I can relate to them.”
New Mexico has a severe shortage of healthcare workers like Pacheco, particularly in the state’s rural and frontier areas, where a third of the state’s 2.1 million people live. Lawmakers and the governor invested millions to close the gap earlier this year, but advocates say it’s not enough. “We don’t have enough doctors anywhere in New Mexico, but especially in rural New Mexico,” Pacheco said. 

 
The challenge is large: in July the state was short 1,000 physicians and almost 7,000 nurses, according to published job announcements around the state. 
And the need is only expected to grow as baby boomers retire and strain the already-overburdened system, without a guarantee that a new generation will replace retiring medical professionals.  Every state is confronting too few medical professionals.

How a 25¢-per-drink alcohol tax fell apart

The Santa Fe New Mexican chronicled how efforts to increase taxes on alcohol over the past 30 years have hit a brick wall at the Roundhouse. Lawmakers budged in 2023, raising the tax per drink by a penny — far short of a 25 cent proposal. Illustration by Marjorie Childress. Ever seen someone make a quarter disappear? You did if you watched this year’s legislative session, where advocates seeking to stem the state’s tide of alcohol-related deaths proposed a 25¢-per-drink tax — and lawmakers shrank it down to hardly a penny.

Lawmakers water down alcohol proposals amid public health crisis

ALBUQUERQUE, NEW MEXICO – JUNE 26, 2022: The alcohol department at a grocery store Albuquerque, NM on June 26, 2022. CREDIT: Adria Malcolm for New Mexico In Depth

The alcohol industry notched a victory Saturday as the Legislature approved an alcohol tax hike of less than a penny-a-drink on beer and hardly more than that for liquor and wine, a fraction of the 18- to 20-cents public health advocates pushed for in this year’s session. 

Lawmakers also rejected a $5 million request from the Department of Health for a new Office of Alcohol Prevention, despite the state’s historic budget surplus. A DOH spokesperson said its epidemiology division would create a smaller version of the office anyway, using an additional $2 million lawmakers added to the agency’s budget. 

Public health experts say the tax increase is so small that it’s unlikely to have any effect on excess drinking, let alone tackle New Mexico’s worst–in-the-nation rate of alcohol-related deaths. The chair of the House tax committee, Rep. Derrick Lente, D-Sandia Pueblo, who had rejected a compromise 5¢-per-drink proposal passed by his counterparts in the Senate, acknowledged the final increase was minor on the floor of the House of Representatives on Saturday morning. “If we want to call it minimal, we can call it minimal,” he said.

Lawmakers tackle raising the alcohol tax

A bill to impose a 25-cent tax on alcoholic drinks goes before its first legislative hearing of the session Friday. Looming over it is the 2017 defeat of a similar bill by the alcohol industry.Much has changed in six years. The mood of the Legislature appears different in 2023. Greater awareness of alcohol’s harms seems to have permeated the legislative body. Partly because the stats are so stark.

Proposed Office of Alcohol Prevention steps up ambition, but is short on vision

The New Mexico Department of Health has asked the legislature for $5 million to build an Office of Alcohol Prevention, which would expand the staff focused on reducing excess drinking from a single epidemiologist to a team of 13. If created, the office would represent a significant increase in resources and personnel focused on the state’s epidemic of alcohol-related deaths, by an agency long cowed into inaction against the challenge. But some experts who reviewed an internal description of the proposed office, which New Mexico In Depth obtained by public records request, said the plan was not bold enough to meet the crisis. Tim Naimi, who directs the Canadian Institute for Substance Use Research at the University of Victoria, said that to reverse the state’s climbing death rate would require sustained strategies that influence drinking by everyone in the state, not just those who have already developed serious problems with alcohol. But he said the activities highlighted in the plan were redundant with existing practices and lacked focus and resolve.

Deaths due to drinking rose sharply in 2021

More than 2,200 New Mexicans died of alcohol-related causes in 2021, according to new estimates from the Department of Health, capping a decade in which such fatalities nearly doubled and setting a new high-water mark in a state already beset by the worst drinking crisis in the nation. The updated data arrive as lawmakers draft legislation to reduce alcohol’s harms for the upcoming session. 

Laura Tomedi, an assistant professor at the University of New Mexico College of Population Health, drew on the data at a late-November hearing of the interim Legislative Health and Human Services Committee. Tomedi, who from 2013 to 2018 led the health department’s substance abuse epidemiology section and served as its alcohol epidemiologist, told lawmakers the state’s death rate had been “going up and up and up” for years. But she described the latest trends — a 17% uptick in 2020 and another 13% jump in 2021 — as a “concerning, sharp increase.”

This spike in deaths coincided with the pandemic, she said, when “​early indications are showing that alcohol use increased quite a bit.”

The mortality data, which are the most comprehensive estimates of alcohol’s full impact on New Mexicans’ health, account for all causes of death brought on by drinking including injuries in motor-vehicle crashes and violence in which the victim was intoxicated, and illnesses such as liver disease and cancer. Illness deaths due to chronic drinking made up a growing share of alcohol-attributable deaths, accounting for 62% in 2021, compared to 38% resulting from acute intoxication such as injuries and poisonings.

Legislators consider key questions on alcohol tax reforms

Lawmakers concerned about New Mexico’s worst-in-the-nation rate of alcohol-related deaths are focused on revising how the state taxes alcohol. Last month, the Legislative Health & Human Services Committee chose an alcohol tax increase as one of its top priorities for 2023 and next week, another committee will hear tax experts present on the topic. Several top lawmakers agree the state’s alcohol taxes should be higher but they don’t know how much to increase them, whether to change how the taxes are levied, and what to do with the revenues raised. “Everyone needs to understand the landscape before we have a serious conversation about how it should be changed,” said Rep. Christine Chandler, D-Los Alamos, who chairs the Revenue Stabilization and Tax Policy Committee that meets next Thursday and Friday. Like many states, New Mexico taxes alcohol wholesalers a fixed amount per volume of beverage they sell to retailers, who raise prices on consumers to cover the upcharge.

The toxic legacy of uranium mining in New Mexico

ProPublica, a national news organization, published A Uranium Ghost Town in the Making yesterday, about an important topic many Americans, including New Mexicans, still know little about: the legacy of uranium in our state and the greater Southwest. The story focuses on the residents of the small northwest New Mexico communities of Murray Acres and Broadview Acres, near Grants, who continue to suffer the potential effects of a uranium mill operated by Homestake Mining of California. Those include decades of sickness, including thyroid disease and lung and breast cancer. Homestake processed ore from a nearby mine beginning in the 1950s in an area known as the Grants Mineral Belt, a rich deposit of uranium ore that runs through the northwest corner of New Mexico. Nearly half of the uranium supply used by the United States for nuclear weapons in the Cold War came from the region.