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 put New Jersey in 11th place in 2014. New Jersey’s rating is positively impacted by a relatively low percentage of uninsured as well as a low incidence of infectious disease, a low prevalence of smoking and ready availability of dentists. But New Jersey has public health challenges as well: Obesity and tobacco use both increased from 2012 to 2013, and the state has high rates of physical inactivity, preventable hospitalizations, and low birthweight.
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?
Have New Jersey residents gained access to affordable health insurance? 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 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.
By the end of 2015 open enrollment, there were 254,316 individuals who had selected plans through the New Jersey exchange. As happens in all states, some of these enrollees dropped their coverage or failed to pay their monthly premiums. By June 30, 2015, there were 194,194 people with coverage from the state’s exchange. Of those remaining enrollees, 83 percent had a plan with an advanced premium tax credit and 50.7 percent received cost-sharing reductions.
A total of five carriers will offer 2016 plans through New Jersey’s exchange:
- Horizon Blue Cross Blue Shield
- Oxford Health Plan
- Health Republic Insurance of New Jersey (i.e., Freelancer’s CO-OP of New Jersey)
Of these carriers, Horizon Blue Cross Blue Shield, Oxford Health Plans and Health Republic Insurance of New Jersey requested double-digit rate increases – rate increases will be finalized by Nov. 1, when 2016 open enrollment begins.
However, Horizon Blue Cross Blue Shield also announced it would offer new health plans that have premiums about 15 percent lower than current plans.
Other ACA reform provisions in NJ
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.
While several CO-OPs have announced closure, New Jersey’s CO-OP remains in operation for the foreseeable future.
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 36 percent from 2013 to July 2015. 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 16.6 percent of the state population compared with 17 percent of the U.S. population enrolled in Medicare. About 85 percent of New Jersey Medicare beneficiaries qualified based on age alone, while the remaining 15 percent were eligible due to disability.
Medicare spends about $11,903 annually per enrollee in New Jersey. Each year, the state spends $15.5 billion total on Medicare, and the state ranks 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, 15.7 percent of Medicare enrollees select a Medicare Advantage plan. Nationally, about 32 percent of Medicare beneficiaries are enrolled in a Medicare Advantage plan.
Medicare Part D plans offer New Jersey Medicare recipients stand-alone prescription drug coverage. There were 876,915 Part D enrollees in 2015 – 59 percent of all New Jersey enrollees compared with 43 percent nationwide.
State-based health reform legislation
Here’s a summary of recent New Jersey bills related to public health and healthcare reform: