Nearly half a million New Jerseyans stand to gain health insurance through the Affordable Care Act — unless they never hear about it.
That’s become a pressing issue for healthcare advocates who have expressed concern that the state – by opting for a federally run health insurance exchange or marketplace — may end up with not enough money to reach the target audience.
Those same healthcare advocates are expressing cautious optimism that outreach funding can be cobbled together from a variety of sources, including a $7.6 million federal grant that the state was awarded to plan for a state-operated exchange.
The state applied for and won the exchange planning grant before Gov. Chris Christie decided to opt for a federally operated exchange. In rejecting a state-operated exchange, Christie cited the uncertainty involved, including how much it would cost and how much authority the state would have over the exchange.
But that decision also reduced the state’s potential for federal aid to advertise the exchange, an online marketplace through which residents will be able to compare and buy insurance and learn whether they are eligible for federal subsidies.
Raymond Castro, a member of healthcare advocacy coalition New Jersey for Health Care, said the state would benefit from using the $7.6 million for outreach.
“Obviously, we don’t want to send the money back” to the feds, said Castro, who is senior policy analyst for the think tank New Jersey Policy Perspective. Castro has estimated, based on other states’ outreach budgets, that New Jersey should spend $18 million to reach residents..
According to a report by the Rutgers University Center for State Health Policy, that amount would be similar to the amount spent to reach residents in Massachusetts, the first state to launch healthcare reform. Massachusetts spent $3 million on a campaign with the Boston Red Sox that targeted young men; another $3 million for a broader outreach effort; and $11.5 million for targeted, culturally appropriate outreach and enrollment assistance
“We are clearly being shortchanged in the federal exchange, so the state has an opportunity to compensate for that in marketing and outreach,” Castro said, noting that the federal government has set aside only $1.5 million for “navigators,” nonprofit groups that will help targeted groups enroll through the exchange.
State Department of Banking and Insurance spokesman Marshall McKnight said state officials are in talks with the federal Centers for Medicare and Medicaid Services officials about how the state can spend the $7.6 million grant.
McKnight would not reveal details of the discussions.
Another piece of the funding puzzle has fallen into place with $3.3 million of federal aid for the state’s federally qualified health centers to enroll residents, both through the exchange and through the ACA-supported expansion of Medicaid.
Katherine Grant-Davis, president and CEO of the New Jersey Primary Care Association, said the money would allow each of the state’s 20 FQHCs to hire at least one new full-time staff member to enroll residents. Larger centers could hire as many as six workers dedicated to enrollment, said Grant-Davis, whose organization includes all of the centers.
“It helps to number one, get the word out, and number two, to do enrollment,” Grant-Davis said.
Grant-Davis said she hopes “that the outreach and the marketing piece” of the exchange is part of state discussions with CMS. She noted that a variety of techniques would be needed to inform some groups that are difficult to reach. “I can’t imagine that would not be part of the negotiation,” Grant-Davis said.
The statewide benefits in decreasing the ranks of the uninsured provide a good reason for state officials to make outreach a priority, according to Evelyn Liebman, another member of New Jersey for Health Care and the associate director of advocacy for AARP New Jersey. Benefits include reducing the cost of charity care, the assistance that the state provides to hospitals that treat the uninsured.
“We have hundreds of thousands of residents who could benefit from the exchange, but they need to know about it,” she said.
Castro said that if the state government is willing to contribute some funding toward outreach, added to funds from the other sources, it might be able to reach his target.
“It’s possible if the state does the right thing we could wind up close to the $18 million,” Castro said. “But the state would have to take action on this.”