NJ Spotlight

Signing up for health insurance under the Affordable Care Act


New Jersey has made strides in expanding and strengthening health insurance coverage in recent years but protecting those gains and addressing the rising cost of care long-term is going to take more work and stakeholders might not agree on what the next steps should be.

Those were among the takeaways from the New Jersey Association of Health Underwriters 10th annual conference, held Friday in Monroe, which featured state and national industry leaders, regulators, healthcare providers and policy experts.

Throughout the event speakers referenced the federal Affordable Care Act, the landmark law adopted nearly a decade ago; many said it has had a positive impact on the state by expanding and improving the quality of insurance coverage. They also noted New Jersey has made important moves to protect and enhance these benefit

The ACA has been under attack from Republicans, who have worked with President Donald Trump to roll back some aspects of the law, but the primary structure remains in place, especially in New Jersey.

Participants at the NJAHU conference disagreed over the pros and cons of these changes and over what tweaks or protections would improve the outcome of what’s left of the law over time. They also differed on the need for a more robust federal insurance program — like a single-payer system in which one entity, likely the government, insures everyone, regardless of job status or income. (Some healthcare providers are in favor of such a program, others not, and insurance industry representatives view it as a significant threat.)

New state mandate

“We know there is a shifting healthcare landscape in this country, and in New Jersey we have a responsibility to make sure that, despite the ever-changing policies at the federal level, we are doing everything possible to create an environment that provides access to quality and affordable coverage,” said state Department of Banking and Insurance Commissioner Marlene Caride. State regulators have taken an active role in overseeing policies related to the ACA in an effort to help protect consumers.

Caride and others praised efforts by Gov. Phil Murphy to push back against the changes to the ACA, including the end of a federal insurance mandate, or tax penalty for those who don’t have coverage; this mechanism was designed to encourage healthy individuals to participate in the insurance system, spreading the risk and costs for everyone involved.

In June Murphy signed a bill to create a state version of this mandate, making New Jersey only the second state to do so; he also approved a measure to create a federally funded reinsurance system that would help Garden State insurance companies offset the burden of their most costly medical claims.

These “two big policies adopted this year have given a big shot of adrenaline to our market,” noted professor Joel Cantor, founding director of Rutgers University’s Center for State Health Policy, who has studied the law. “The impact of the reinsurance program is already clear” in the drop in premium prices anticipated for the 2019 individual market, Cantor said, for which state officials predict a 9.2 percent decline. These savings benefit all consumers, he noted, not just those receiving federal subsidies as part of the ACA.

Under the ACA, or Obamacare, which passed in 2010 and took full effect in 2014, New Jersey has been able to extend insurance coverage to more than 800,000 residents; some 500,000 of these were added to the state’s Medicaid program and close to 300,000 were able to purchase commercial policies on the individual market, many with premium assistance from the federal government. The law also created new standards for what insurance plans must provide; supporters said this has created more robust coverage, while critics blame these mandates for further driving up the price of insurance.

Adapting to the ACA requirements has been a struggle for some providers, noted Larry Downs, CEO of the New Jersey Medical Society, and most doctors are even more wary of a single-payer type system, he said. U.S. Sen. Cory Booker (D-NJ) is among those who has called for such a plan nationwide, but the issue remains an uphill battle.

“It’s certainly a dialog that’s going on,” Downs said of the single-payer, or Medicare-for-all debate. “If you ask physicians if they like the current system, they hate it; if you ask physicians if they like single payer they say “no way;” If you ask physicians what they want, it’s something in between.”

Lobbying against a Medicare-for-all system remains a priority for the National Association of Health Underwriters, noted Chris Hartman, the organization’s vice president for governmental affairs, who warned it is “not the warm and fuzzy program” our grandparents enjoy. “We are living with the existential threat of Medicare-for-all and single payer out there,” he said. (Medicare-for-all would be run by the government, while single-payer models could be overseen by a quasi-governmental or nongovernmental agency.)

Less strain on hospitals

Participants in the NJAHU conference — titled “Midterm Madness” to reflect the intense competition of the current federal election season but which focused primarily on industry-related policy issues — praised the state’s work to reduce the number of uninsured residents. Cantor said that, as of 2017, 8.7 percent of residents under age 65 were without healthcare coverage, down from nearly 14 percent in 2013, the year before the ACA expansion took effect.

This change has also eased some of the financial strain on hospitals, which must care for patients regardless of their coverage, and protecting the federal law has become a focus for hospital officials nationwide. As hospital costs declined, so did the state’s share of their charity-care bills, down more than $400 million since 2015 alone.

Better insurance coverage “leads to a healthier society,” said Sean Hopkins, senior vice president with the New Jersey Hospital Association, who said he made more than a dozen trips to Washington, D.C. to advocate on behalf of the program, which had been under attack by Republicans in recent years.

“People are receiving better medical care because they have insurance,” said Assembly Speaker Craig Coughlin, (D-Middlesex). Protecting gains made under the ACA has “been a constant challenge. And we have done what we can to buffer that challenge,” he said.

Coughlin led the fight to pass a controversial measure, also signed by Murphy in June, to better control the cost of out-of-network care, or services provided by doctors, hospitals and other professionals that are not part of a patient’s regular system of providers. The measure, which many physicians strongly opposed, was designed to protect patients and taxpayers from what advocates claim are hundreds of millions of dollars in unnecessary annual costs.

No one law is enough to address the cost concerns, experts agreed. Healthcare costs are now growing at double-digit rates — 15 percent nationwide and 18 percent in the Garden State, according to the New Jersey Health Care Quality Institute, which will release additional findings this week. The issue remains the top concern for small businesses year after year, studies show, and weighs heavily on the minds of many individual consumers.

“If we don’t get our arms around what is driving this 18 percent increase, we’re not going to get to affordability,” said Linda Schwimmer, president and CEO of the Quality Institute. “We need to have the right conversations together to get to the cost of healthcare.”

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