In 2018, lawmakers in New Jersey are busy working on health care reform legislation that could have far-reaching effects, including a bill to create a state-based reinsurance program, a bill to implement an individual mandate at the state level, and various bills to address balance billing, out-of-network coverage, and ensure that the individual market remains robust in the state.
For 2018 coverage, 274,782 people signed up for private plans through the New Jersey exchange (HealthCare.gov) during open enrollment. That was a drop of nearly 7 percent from the year before, but open enrollment for 2018 coverage was only half as long as it had been for 2017. Enrollment was also hampered in states that use HealthCare.gov due to federal funding cuts in the budgets for Navigators and exchange marketing.
And consumer confusion about the status of the individual mandate also played a role in the lower enrollment for most states that use the federally-run exchange (for reference, the individual mandate penalty has been repealed, but that doesn’t take effect until 2019; people who are uninsured in 2018 will still face a penalty, unless they’re otherwise exempt).
Other than the impending repeal of the individual mandate, Obamacare remains in effect. Subsidies continue to be available to those living in New Jersey and elsewhere in the United States. 79 percent of those who enrolled in 2017 plans through New Jersey’s exchange were eligible for premium tax credits (aka, premium subsidies) and more than half received cost-sharing reductions as well.
Bills under consideration in the state legislature in 2018
Lawmakers in New Jersey are considering a variety of health care reform bills in 2018, including:
- S.564 — would prevent any health insurance policy from being sold in New Jersey unless it meets NJ statutes. This bill was introduced to prevent the proliferation of association health plans that could crop up as a result of Executive Order 13831, which President Trump signed in October 2017; short-term plans, which the EO calls for expanding, are already prohibited in New Jersey. But on the other end of the political spectrum, A.283 would allow out-of-state insurers to offer plans in New Jersey without having to comply with the full list of NJ regulations.
- S.1877 — would implement a state-based individual mandate in New Jersey, to replace the ACA’s individual mandate that will be eliminated at the end of 2018.
- S.1878 — would direct the state to propose a 1332 waiver in order to establish a reinsurance program to stabilize the individual market, using federal funding that would otherwise have been spent on higher premium subsidies.
- A.352 — would require that exchange insurers remain in the exchange if they wish to be contracted with the state to offer Medicaid managed care plans.
- A.469 — would allow sole proprietors to join a state-based small employer health benefits purchasing alliance, as opposed to only businesses with two or more employees.
- A.1343 / S.561 — would create a public health insurance option in New Jersey, which would compete with the private market options.
- A.2039 — would protect patients from surprise balance bills if they receive treatment from an out-of-network provider at an in-network facility.
- S.924 — if a primary care doctor leaves or is terminated from an insurer’s network, patients would be able to continue to receive in-network care from that doctor for up to 12 months.
- A.710 — out-of-network care for a catastrophically ill child would be covered as in-network (as long as referred by an in-network provider) under Medicaid, CHIP, and private plans.
- A.377 — would require hospitals to assist uninsured patients with the process of creating an exchange account on HealthCare.gov.
New Jersey’s legislative session continues throughout the year. Keep an eye on those bills.
2018 exchange insurers
In 2016, there were five insurers offering plans in the New Jersey exchange. For 2017, that fell to two, but Oscar rejoined the exchange for 2018, bringing the total number of insurers to three:
- Horizon Blue Cross Blue Shield of New Jersey
- AmeriHealth of New Jersey
- Oscar Health
New Jersey health ratings
The Commonwealth Fund’s 2017 Scorecard on State Health System Performance rated New Jersey 22nd out of the 50 states and District of Columbia. New Jersey’s scorecard includes details on how the ratings are calculated. Although the state performed well in the Healthy Lives metric (ranked 9th), they did poorly for Avoidable Hospital Use & Cost (ranked 45th).
The state fared better with America’s Health Rankings, in which New Jersey placed 12th in 2017—down three spots from 9th in 2016. New Jersey’s rating is positively impacted by a very high rate of high school graduation (2nd in the nation), the ready availability of dentists and primary care physicians, low prevalence of tobacco use, as well as a moderate uninsured rate. But the state is near the bottom of the country in terms of physical inactivity and has fairly low public health funding (ranked 39th).
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 2017 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 five Republicans and seven Democrats from New Jersey.
New Jersey’s state legislature has a solid Democratic majority, and a new Governor, Phil Murphy, who is a Democrat. Former Governor Chris Christie, a Republican, was 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 noted that he was proud of that accomplishment. In the first four years of ACA implementation, Medicaid/CHIP enrollment in New Jersey grew by 36 percent, mostly as a result of Medicaid expansion.
The state opted for a federally facilitated exchange, which means HHS runs New Jersey’s health insurance marketplace, and residents enroll via HealthCare.gov.
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, according to US Census data, 13.2 percent of New Jersey residents were uninsured. By 2016, that had fallen to 8 percent. Across all states, the uninsured rate started out higher than New Jersey—at 14.5 percent—and fell to an average of 8.6 percent.
There is no doubt that the reduction in the uninsured rate is due to the ACA, and to the state’s acceptance of federal funding to expand Medicaid.
New Jersey’s health insurance CO-OP
Health Republic Insurance of New Jersey was 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.
Most of the CO-OPs have since gone out of business; only four remain operational in 2018. New Jersey’s CO-OP was among the seven still in operation as of September 2016. But that month, the NJ Department of Banking and Securities placed Health Republic into rehabilitation and the CO-OP was no longer sell new policies. Existing Health Republic policies terminated at the end of 2016; as a result, nearly 35,000 individuals needed to find new health plans for 2017.
Initially, the hope was that state regulators would be able to stabilize the company enough for it to return to the marketplace in 2018, but that did not come to pass. On February 3, 2017, an order of liquidation for Health Republic was filed. All of the CO-OP’s assets were liquidated to repay creditors to the extent possible.
New Jersey enrollment in qualified health plans
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. Enrollment grew to 295,067 for 2017, but dropped down to 274,782 during the open enrollment period for 2018 coverage.
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. By November 27, net enrollment growth stood at 36 percent, indicating that Medicaid expansion enrollment had plateaued sometime in 2016-2017.
Medicare enrollment in the state of New Jersey
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, 21 percent of Medicare enrollees select a Medicare Advantage plan; nationwide, an average of 33 percent of Medicare beneficiaries select Medicare Advantage plans.
Medicare Part D plans offer New Jersey Medicare recipients stand-alone prescription drug coverage. In 2017, Part D enrollees accounted for 59 percent of New Jersey’s total Medicare population, as opposed to 44 percent nationwide. This makes sense, given that a larger portion of New Jersey’s Medicare enrollees have Traditional Medicare (versus Medicare Advantage) than the US population, and stand-alone Medicare Part D plans are designed to supplement Traditional Medicare.
State healthcare legislation
Scroll to the bottom of the page for details about recent New Jersey bills related to public health and healthcare reform
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.