Hundreds of thousands of previously uninsured New Jersey residents have acquired health coverage in the past two years – and that’s a point of pride for the many healthcare advocates and counselors who helped make that happen.
But these same people says it’s going to be much more difficult to further reduce the ranks of the uninsured via the Affordable Care Act.
That’s why they’re already looking to next fall and the next open enrollment period, which will begin on Nov. 1 and will run through Jan. 31, 2016.
The two methods of increasing coverage through the ACA – the creation of a federally operated insurance market and expanding Medicaid eligibility -- both made gains this past winter.
The federally operated marketplace for individual and family insurance reached 254,316 people in the state after a special enrollment period – aimed at those who were unaware of the new federal requirement to have health insurance or pay a tax penalty -- to sign up for coverage during the tax-filing season.
In addition, NJ FamilyCare – the state’s primary Medicaid coverage program -- has added 463,463 residents to its rolls since December 2013, including 42,947 in April.
U.S. Department of Health and Human Service regional administrator Jackie Cornell-Bechelli said the enrollment effort continues to draw on a wide variety of organizations working together, ranging from countywide alliances to individual doctors’ offices.
“The stronger the local coalition, the more successful enrollment” has been, Cornell-Bechelli said at an HHS-sponsored conference in New York yesterday that brought together community groups from throughout New Jersey and New York.
She added that people who are already familiar with those who aren’t insured – such as doctors who serve in federally qualified health centers that treat many low-income residents – are in the strongest position to reach the remaining uninsured.
“You don’t trust anybody as much as you trust your doctor,” she said.
And trust is the operative word for those who are aware of marketplace insurance, but haven’t chosen to buy it yet. Cornell-Bechelli said that when these people ask themselves, “Do I pay for this or do I take the gamble” of going without insurance, it’s essential that they hear about the advantages of having insurance from someone they trust.
Federal officials have also been working to institutionalize various aspects of the ACA, with the goal of ensuring that people who got coverage in the past two years keep it well after President Barack Obama’s administration ends.
One way they’re seeking to add stability to the process is by looking to award three-year contracts to the “navigators” – federally funded organizations that help people sign up for coverage.
Heather Howard, a Princeton University faculty member, said a positive sign for the future is reflected in the way New Jersey residents who signed up for marketplace insurance in 2014 shopped for new plans this year.
“We want to encourage people to actively come back in, because there may be a better deal for them,” Howard said.
Of 133,215 people who renewed their insurance, 75,712 returned to the marketplace website, healthcare.gov, to pick a plan. Of those people, 45,197 switched plans, reflecting an actively engaged group of consumers.
“My takeaway is in New Jersey, we’re pretty discerning shoppers,” said Howard, who’s working on ACA issues across the country as the director of the State Health Reform Assistance Network.
Contributing to the trend was increased competition among insurers, with two more companies, UnitedHealthcare and Oscar Health Insurance, joining the three existing companies: Horizon Blue Cross Blue Shield of New Jersey, AmeriHealth New Jersey and Health Republic of New Jersey.
Howard said some insurers held back during the first year of the ACA, asking, “Is it safe to go into the water?” Now that some companies have had success, competition is growing.
But Howard said another issue still needs to be addressed: increasing the public’s “health literacy,” including their understanding of common health insurance terms like deductibles – the amount that consumers must pay for healthcare before their insurance kicks in – and premiums, the amount that consumers must pay each month to have insurance.
A Kaiser Family Foundation survey found that half of the people participating couldn’t answer more than six of 10 questions about basic healthcare terminology.
“Are they spending money on something that they don’t understand well?” Howard asked.
Howard noted that some states are developing outreach campaigns targeting difficult-to-reach populations, after reaching the “low-hanging fruit” of people who were readily interested in buying insurance during the first two years of the ACA marketplace.
New York is in a better position to do this kind of outreach, since it operates its own exchange instead of relying on the federal marketplace like New Jersey.
The fate of the marketplace itself is very much in question, since the U.S. Supreme Court is expected to issue a ruling next month on whether the ACA allows for residents of states using the federal marketplace to receive federal tax subsidies to buy coverage.
If the court disallows these subsidies, analysts predict that roughly 200,000 New Jerseyans couldn’t afford their insurance.Cornell-Bechelli said her office wants to hear from New Jersey navigators and others who have been trained to helpwith enrollment about people they’ve met who have encountered roadblocks in trying to get coverage -- such as people whose income puts them on the cusp between marketplace and Medicaid eligibility.
Someone in that situation, for example, could miss out on the marketplace open-enrollment period while they wait for the state to determine whether they’re eligible for Medicaid.
Seton Hall law professor John Jacobi is working through the New Jersey Sentinel Project to help people who’ve already gotten insurance. He’s preparing to make recommendations related to whether insurers are offering adequate networks of providers. One measure of whether insurance coverage is adequate is whether a health plan covers high-quality specialists for diseases such as leukemia and substance-use disorder, Jacobi said.
Maura Collinsgru, who directs the healthcare program for New Jersey Citizen Action, added that New Jersey is at a disadvantage in increasing enrollment because it hasn’t had as much federal funding as states like New York with state-based exchanges.
She said community organizations could draw inspiration for future marketplace enrollment efforts from the year-round outreach that’s done to enroll seniors in Medicare, which also has a limited fall open-enrollment period.