With key features of the Affordable Care Act going into effect January 1, 2014, the impact of the law was at the center of New Jersey’s health policy debates throughout 2013.
Gov. Chris Christie struck a middle course compared with other Republican governors, opting to participate in a Medicaid expansion that was ardently supported by healthcare advocates, while otherwise taking a hands-off approach to the law.
While public health advocates expressed frustration with the state deciding against actively promoting the federal health insurance marketplace, or exchange, they were pleased with the outcome of other policy debates, including Christie’s decision to back a law intended to avoid overdose deaths from heroin and other drugs.
Not all of these debates were concluded this year, and the state’s role in relation to the ACA promises to remain a hot topic among policymakers and analysts well into the future.
1. New Jersey expands Medicaid
When U.S. Supreme Court Justice John Roberts decided that each state would choose for itself whether it would participate in the expansion of Medicaid in 2012, he also opened up a policy debate that lasted until Christie’s announcement to expand coverage to an additional 104,000. Another 130,000 who were already eligible for the program are expected to sign up due to the media attention to the ACA.
Along with the coverage expansion, the decision saved the state $227 million over the next six months, since the federal government will now pay 100 percent of the costs for many adults who are already in New Jersey Family Care, the state’s Medicaid program.
2. “Good Samaritan Law” enacted after Christie’s initial veto
A bill granting protection from drug possession arrests to drug overdose victims and those who call emergency aid didn’t seem likely to draw support from former federal prosecutor Christie. And when he issued a conditional veto, calling for an 18-month study of the issue, it appeared like it wasn’t going anywhere.
But advocates for the bill, including the families of deceased OD victims, never gave up hope. Their personal appeals, as well as those of rock star Jon Bon Jovi and New Jersey First Lady Mary Pat Christie, for the governor to reconsider the bill ultimately helped sway Christie. The administration worked with Sen. Joseph Vitale (D-Middlesex) on a compromise bill that also includes protections for administering a heroin overdose antidote.
3. No federal-state partnership for ACA marketplace
While Christie vetoed legislation to have a state-operated health insurance exchange in 2012, it wasn’t until mid-February that he chose not to have a state-federal partnership. The decision frustrated advocates for expanding healthcare access, since states were seen as playing a key role in advertising and engaging consumers in purchasing insurance through the marketplace.
The decision didn’t end advocacy over the issue, as the New Jersey for Health Care coalition pressed for the state to spend $7.6 million the federal government had given to establish an exchange. While these advocates want the state to spend the money on advertising the marketplace, state officials have other plans for the money and remain in talks with federal officials about how it will be spent.
4. For-profit hospital expansion prompts union concerns
Prime Healthcare’s plans to purchase St. Mary’s Hospital in Passaic and Saint Michael’s Medical Center in Newark prompted opposition from the Health Professionals and Allied Employees union that raged through much of the year. This led to some intra-labor tussling, when JNESO — the union for St. Mary’s workers — reached an agreement with Prime and criticized HPAE officials for getting involved in the sale.
Union and legislative leaders also were concerned with other for-profit hospital operations, including Meadowlands Hospital Medical Center owner MHA LLC’s handling of hospital finances and the refusal of Memorial Hospital of Salem County owner Community Health Systems to negotiate with the union.
5. Medical marijuana’s sluggish rollout
For much of 2013, medical marijuana remained unavailable in New Jersey, more than three years after the law allowing pot prescriptions was enacted.
While there were several suspected culprits behind the delays, the combination of towns being unwilling to host marijuana treatment centers and few doctors choosing to register for the program have helped slow its implementation.
However, Gov. Chris Christie — who opposed the program while running for office — and the Legislature reached agreement on a law that allows children to receive medical marijuana in an edible form, and for treatment centers to grow more strains of the plant. While the opening of more treatment centers may allow greater access, it appears that Christie has signaled that he will stop any further expansion in eligibility to the program.
6. Safety-net, other hospitals battle over tax
New Jersey’s safety-net hospitals are worried about looming cuts to federal funding for charity care as part of ACA, since there remains uncertainty about how many low-income residents will enroll in Medicaid or the insurance marketplace and offset the charity-care cuts. That’s one reason why they support a local hospital tax that would give safety-net hospitals greater federal funding.
But their position is staunchly opposed by hospitals that aren’t in urban areas, which say it would set a precedent for greater taxes on hospitals. The issue wasn’t resolved in December, and the two sides continue to spar over the tax.
7. Extension of individual, small group plans
October was a rough month for the new insurance marketplace, beginning with the faltering launch of the website and ending with complaints from individuals and small businesses that their existing insurance plans were being cancelled. This prompted President Barack Obama to ask state insurance commissioners and insurers to extend these expiring plans. While New Jersey Commissioner of Banking and Insurance Kenneth Kobylowski allowed insurers to make the decision, Horizon Blue Cross Blue Shield of New Jersey opted out of the extension.
Policy analysts said ending the current plans will likely make the marketplace stronger by forcing healthy residents who currently have plans to share the costs of the new plans. But Obama’s promise that those who were happy with their plans would be able to keep them will remain unfulfilled for those with canceled plans.
8. Participation in the state Prescription Monitoring Program
A growing focus on abuse of prescription drugs caught the attention of policymakers and was highlighted by a State Commission of Investigation report that found some doctors have been involved in criminal schemes to bilk Medicaid and hand out illegal prescriptions.
One potential answer, advocated by First Assistant Attorney General Thomas Calgagni and former Gov. James E. McGreevey, is to have every doctor in the state participate in the New Jersey’s Prescription Monitoring Program, which tracks when every opiate prescription is filled out and sold. This would aid doctors in knowing if a patient has been shopping around for prescriptions and help law enforcement investigate both patients and doctors involved in criminal schemes. But proposals to make participation mandatory are raising concerns among some doctors, who question whether it will be necessary for those doctors who rarely prescribe powerful painkillers.
9. Proposal for mandatory paid sick leave
Supporters of mandatory sick leave argue that it will be better for both workers and employers, since it would cut the transmission of infectious illnesses in the workplace. The effort led to Jersey City becoming the first municipality to pass an ordinance mandating the practice.
But business community leaders argue that there is no evidence of a problem and that it will be a costly administrative burden for employers. A bill is advancing in the closing days of this legislative session.
10. Increased state supervision of emergency medical services
Professional EMS workers have been pushing for increased state regulation of ambulance squads, including requiring state licensure and criminal background checks of emergency medical technicians and paramedics.
Christie rejected two bills on the issue, taking the side of volunteers who see the legislation as part of a broader effort to make it more difficult for them to continue to serve.