New Jersey health insurance

NJ exchange options diminish as 3 carriers, CO-OP exit

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  • Contributor
  • September 19, 2016

New Jersey is predominantly a “blue” state, but its governor, Chris Christie, is a Republican and leadership hasn’t always seen eye-to-eye in terms of healthcare reform. Nevertheless, the state ranks relatively high in overall public health and has expanded Medicaid under the Affordable Care Act. A wide range of issues play a role in the health of a state’s residents.

Here’s a summary of health factors, outcomes and healthcare reform in New Jersey:

New Jersey health ratings

The Commonwealth Fund’s 2015 Scorecard on State Health System Performance rated New Jersey 20th out of the 50 states and District of Columbia – a downward tumble of five positions over last year. New Jersey’s scorecard includes details on how the ratings are calculated.

The state fared even better with America’s Health Rankings, which placed New Jersey in 11th in 2015. New Jersey’s rating is positively impacted by ready availability of dentists and primary care physicians, as well as a moderate uninsured rate.

Trust for America’s Health also compiled information on the prevalence of a multitude of illnesses and health indicators in New Jersey. The details are available in the 2015 listing of Key Health Data About New Jersey.

Within the state, health factors and outcomes vary from one county to another. You can see health data for New Jersey’s 21 counties with this interactive map created by the Robert Wood Johnson Foundation. In general, most of the northern half of the state ranks higher than most of the southern portion.

New Jersey and the Affordable Care Act

In 2010, New Jersey’s U.S. Senators – Democrats Frank Lautenberg and Robert Menendez – both voted yes on the ACA. In the U.S. House, eight Democrats voted yes, while five Republicans voted no. Lautenberg has since been replaced in the Senate by fellow Democrat Cory Booker, who is supportive of the ACA. The U.S. House now includes six Republicans and six Democrats from New Jersey.

New Jersey’s state legislature has a solid Democratic majority, although Republican Governor Chris Christie is not a fan of the ACA, calling it a “failed federal program” during a town hall meeting in 2014. But he did agree to expand Medicaid under the ACA and has said he’s proud of that accomplishment.

During the 2014 open enrollment period, the first Obamacare open enrollment period, New Jersey’s exchange enrolled nearly 180,000 people in Medicaid by mid-April. The state opted for a federally facilitated exchange, which means HHS runs New Jersey’s health insurance marketplace.

How did Obamacare help New Jersey residents?

New Jersey opted to let the federal government run its health insurance exchange but expanded Medicaid in 2014. Has access to affordable health insurance improved for its residents under the Affordable Care Act?

In 2013, about 14.9 percent of New Jersey residents were uninsured. By mid-2014, six months after most of the ACA’s provisions were implemented, that number had fallen by over three percentage points, to 11.7 percent. The New Jersey exchange enrolled nearly 342,000 people during the first open enrollment period, including Medicaid/CHIP as well as private plans.

In 2015, New Jersey’s percentage of uninsured residents dropped to 9.7 percent, a 5.2 percentage point decrease from 2013 to 2015. Among the other 28 states that did not implement a state-run marketplace or Medicaid expansion or only implemented on of those measures, the average decline was 5.3 percentage points.

New Jersey’s health insurance CO-OP

Health Republic Insurance of New Jersey is the trade name for Freelancer’s CO-OP of New Jersey, a Consumer Oriented and Operated Plan (CO-OP) established under the ACA. CO-OPs in 22 states received a total of $2 billion in grants from the federal government to establish their programs. Freelancer’s CO-OP of New Jersey received $109 million.

Several CO-OPs have announced closure, and New Jersey was among the seven still in operation as of early September 2016. However, on September 12, the NJ Department of Banking and Securities placed Health Republic into rehabilitation and the CO-OP will no longer sell new policies. Existing Health Republic policies will terminate at the end of 2016; as a result, nearly 35,000 individuals will need to find new health plans for 2017.

During the rehabilitation period, state regulators are working to stabilize the company enough for it to return to the marketplace in 2018.

2017 open enrollment plans, rates

Many New Jersey exchange carriers will make their exit after 2016. UnitedHealthcare, Oscar and Aetna have all made headlines in recent months after announcing they would cease to offer individual plans in certain markets.

Carriers that will offer plans through New Jersey’s exchange during 2017 open enrollment include:

  • AmeriHealth HMO
  • AmeriHealth Insurance Company
  • Freelancers CO-OP (Health Republic Insurance of NJ)
  • Horizon BCBS

While rates have yet to be finalized, proposed increases range from 1 percent to 26.3 percent.

New Jersey enrollment in qualified health plans

During 2014 open enrollment, 161,775 people had enrolled in qualified health plans through New Jersey’s exchange by mid-April, and 84 percent of them had received premium subsidies.

A Kaiser Family Foundation study released in the fall of 2013 found that about 628,000 New Jersey residents would be potential customers for the exchange, and that about 400,000 of them would be eligible to receive premium subsidies. So the state enrolled about a quarter of its eligible population in the first open enrollment period, leaving plenty of room for growth.

A total of 288,573 people enrolled in New Jersey exchange plans during the 2016 open enrollment period.

New Jersey Medicaid/CHIP enrollment

New Jersey’s acceptance of federal funding to expand Medicaid eligibility to 138 percent of poverty has played a significant role in reducing the state’s uninsured population. The ACA provided for Medicaid expansion in all states, but in 2012 the Supreme Court ruled that states could opt out, and 20 states have thus far avoided any type of Medicaid expansion.

In early 2014, a Kaiser Family Foundation report estimated that about 38 percent of the 1.3 million non-elderly uninsured residents in New Jersey would be eligible for Medicaid or CHIP under the expanded eligibility guidelines created by the ACA. As of mid-April 2014, 179,872 people had enrolled in Medicaid through the New Jersey exchange.

New Jersey Medicaid enrollment increased 37 percent from 2013 to June 2016. Enrollment in Medicaid is year-round, so that number has continued to increase, chipping away further at the state’s uninsured rate.

Medicare enrollment in the state of New Jersey

As of May 2015, New Jersey Medicare enrollment was nearly 1.5 million – about 17 percent of the state population compared with 17 percent of the U.S. population enrolled in Medicare.

About 87 percent of New Jersey Medicare beneficiaries qualified based on age alone, while the remaining 13 percent were eligible due to disability.

Per-enrollee Medicare spending for New Jersey trends higher than the national average at $9,686 per year compared with $8,970. As of 2009, the state ranked 9th in the nation for overall Medicare spending.

Medicare Advantage plans offer New Jersey Medicare participants a way to gain more healthcare benefits; they are an alternative to Original Medicare. In New Jersey, 15 percent of Medicare enrollees select a Medicare Advantage plan.

Medicare Part D plans offer New Jersey Medicare recipients stand-alone prescription drug coverage. In 2015, Part D enrollees accounted for 60 percent of New Jersey’s total Medicare population.

State healthcare legislation

Here’s a summary of recent New Jersey bills related to public health and healthcare reform: