As launch of insurance exchange nears, vision of NJ takeover in future

Andrew Kitchenman | September 23, 2013 | Health Care
At NJ Spotlight conference, participants discuss critical issues to address as Affordable Care Act is rolled out

State Sen. Nia H. Gill (D-Essex and Passaic) at NJ Spotlight Conference on Implementing the Affordable Care Act in New Jersey.
While the federal government will be operating New Jersey’s health insurance marketplace or exchange starting October 1, the state government should position itself to take over in the future, urges Sen. Nia H. Gill (D-Essex and Passaic).

A legislative task force that Gill sponsored will begin meeting in October and will “keep track of what is and may not be working in the state so that when — and I say when — we become a state-based exchange we can do it seamlessly,” she said.

State government, business, and healthcare-policy leaders are focusing on both the short-term rollout and the long-term implications of the marketplace, which is expected to be the primary way that insurance coverage is expanded under the 2010 Affordable Care Act.

The marketplace will allow residents to purchase insurance and learn about whether they are eligible for federal tax credits — via website, phone or mail or in person.

Gill may be laying the groundwork for a more active role for the state, but that goal may not be reached until there’s a different governor Chris Christie, who has opted for the federally run exchange, citing the potential cost to New Jersey and a lack of information from the federal government.

Dr. Jaime Torres, the regional administrator of the U.S. Department of Health and Human Services, said the federal system will be prepared on October 1 to supply information for the open enrollment period begin January 1, 2014 and run until March 31, 2014.

In the Spotlight

Both the marketplace and the expansion of Medicaid eligibility were the focus of the NJ Spotlight conference Implementing the Affordable Care Act in New Jersey, held on September 20.

Much of the discussion at the conference revolved around how New Jerseyans would learn about their insurance options under the marketplace and the Medicaid expansion, both of which are expected to reduce the number of uninsured residents. The Rutgers Center on State Health Policy published an often-cited report in 2011 that estimated that the number of uninsured New Jerseyans would drop from 1.092 million to 648,000 after the ACA is implemented.

The federal government, insurers and hospitals are planning advertising in the coming weeks to make the public more aware of the law and the exchange. These efforts are expected to be supplemented by nonprofit organizations.

New Jersey Primary Care Association President and CEO Katherine Grant-Davis said the state’s 20 federally qualified health centers — which her organization represents — are doing outreach to inform residents about their insurance options, as well as “inreach” to enroll uninsured residents who the centers are already serving.

In addition, the centers, which provide primary care to low-income residents, have been adding doctors and nurses to handle a wave of new patients, Grant-Davis said. The goal is to prevent patients from experiencing long delays for appointments.

“We don’t want that situation to happen here because people then get frustrated, they go back to the emergency room,” Grant-Davis said. She was referring to the venue that many uninsured residents have traditionally relied upon for healthcare. A goal of the ACA is to allow newly insured residents to receive regular primary care from providers located outside of hospital emergency rooms.

Two Questions to Answer

Amid much uncertainty, two major questions are expected to be answered by October 1: What will the insurance plans offered through the marketplace cover, and how much will they cost?

State Health Reform Assistance Network Director Heather Howard
noted that states operating their own exchanges have had widely variable differences in the costs of monthly insurance premiums when compared with current individual insurance plans. For example, New York’s premiums were lower than expected and much lower than existing rates.

“We obviously don’t know the New Jersey rates yet, but there’s hope that because we had already adopted many of these reforms — and maybe they’re already baked into our rates — that hopefully our rates will be good,” said Howard, the state commissioner of health and senior services from 2008 to 2010. She added that most residents who purchase insurance through the marketplace will not be paying the full premium rates, since they will be receiving tax credits to subsidize the purchase.

Howard said there will likely be issues rolling out the marketplace, but added that “October 1 is not a magical date,” and that residents will have six months to sign up for insurance.

“On October 1, if the server goes down for half an hour and you can’t sign up, that’s OK,” Howard said. She said the likely spikes in purchasing insurance would occur before January 1 and before the end of open enrollment on March 31.

“I’m encouraging people to take the long view, because that’s what matters,” she said, noting that both Medicare and Social Security were modified and improved over decades.

Howard also encouraged further attention the issue of residents who will “churn,” [cycle back and forth] between Medicaid eligibility and private insurance. She said it will be important that those residents receive continuous coverage. She noted that Maryland required insurers to continue to cover patients who are in the middle of treatment for an illness.

Another issue to watch for is whether the marketplace will have enough insurers competing in each state. In New Jersey, Horizon Blue Cross Blue Shield of New Jersey, AmeriHealth, and Health Republic Insurance of New Jersey are the only three plans that will participate from the beginning. Health Republic is the new name for the Freelancers Co-Op.

It’s Gill’s intent that federal officials aren’t the only ones monitoring whether the marketplace is working as intended. She wants the task force to play on ongoing role in gathering information about the its operations.

“Without this legislative task force, there is no partner in the state of New Jersey, because it is a total federal exchange,” Gill said, explaining that this is the function she expects her task force to serve. The federal government, however, has been working with state officials on implementation issues, even though the state has taken a hands-off approach when it comes to promotion.

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