It’s become a sprint to the finish line before the December 23 deadline for New Jersey residents to enroll for Affordable Care Act insurance coverage starting on January 1.
However, it could also become a marathon lasting months and years before most of those who could get coverage actually receive insurance.
An estimated 901,289 New Jerseyans are eligible for insurance through either the federal marketplace or the related expansion of Medicaid, but only a small fraction have applied. Through November, the total number of state residents who had chosen a marketplace health plan was at 3,259, while another 25,286 people had learned they were newly eligible for Medicaid.
But that still amounts to only 3.2 percent of all eligible state residents.
Some health experts believe it could take two to three years to finish enrolling the uninsured.
Healthcare advocates are urging uninsured New Jersey residents to apply for coverage. Volunteers are staffing phone banks as part of the enrollment effort in the final days before the initial December 23 deadline.
A related area of uncertainty is how people who applied for Medicaid through the federal marketplace site will be enrolled in the state Medicaid program, known as New Jersey Family Care.
The files provided by the federal government were not compatible with the state system, according to Department of Human Services spokeswoman Nicole Brossoie. While state officials cannot immediately process these cases, they’re working with federal officials to get usable files “as soon as possible,” she wrote in an email.
Maura Collinsgru, health policy advocate for the nonprofit group New Jersey Citizen Action, said there are enough workers to help people apply for insurance, but not enough residents are aware that the insurance is available.
“We’re getting a sense on the ground that the capacity isn’t even being utilized,” Collinsgru said as she announced the launch of a website that lists events where people can sign up for insurance.
She added that volunteers have been calling people to inform them of their insurance choices. “We’re finding that people are very receptive to the message,” Collinsgru said.
Rutgers Center for State Health Policy Director Joel Cantor noted the inherent challenges in advertising the insurance marketplace in a state divided and dominated by broadcast media based in other states.
“It’s true that it’s been difficult to get the word out in New Jersey and it’s always tough here, because our media markets are so fractured,” Cantor said.
Cantor cited one reason why New Jersey has had more residents take advantage of the Medicaid expansion than the new marketplace – many of those people were previously enrolled in Family Care.
Gov. Chris Christie’s administration had limited Family Care eligibility, citing budget constraints. Now many people squeezed out of that program are again eligible for the program due to the Medicaid expansion, which is part of the ACA and which Christie agreed to.Note: An estimated 901,289 New Jerseyans are uninsured.
The marketplace, on the other hand, was marred by a dysfunctional website for its first two months.
“There’s already an apparatus in place for many years to enroll people in Medicaid and Family Care through the counties,” Cantor said. “The marketplace exchange is a brand new thing and it couldn’t be more confusing how the rollout happened.”
Collinsgru and other members of the New Jersey for Health Care coalition expressed frustration that the state isn’t using $7.6 million in received from the federal government to increase awareness of insurance options under the ACA.
The funds were originally intended to help build a state operated exchange, but Gov. Chris Christie instead chose to have a federally operated marketplace.
State officials have been in talks with the federal government for most of 2013 over how the federal money should be spent. Collinsgru called the handling of the $7.6 million in federal aid “a crime.”
In opting out of having a state-run insurance marketplace, Christie said that federal officials had left the state at risk for potential future costs.
Collinsgru added that the state could also increase awareness of the marketplace by posting notices about it in state offices.
“I think they’re definitely missed opportunities – the more saturation of the message you have, the better the awareness,” she said.
Raymond J. Castro, senior policy analyst with the nonprofit group New Jersey Policy Perspective, said it’s too early to read much into the reported enrollment numbers. He said the first important monthly report will be released in February, reflecting the number of residents who actually paid insurance premiums.
Castro said the early statistics do sketch out one unexpected trend: Most of those eligible for insurance through the marketplace aren’t eligible for federal tax credits to subsidize the purchase. Of the 50,458 New Jerseyans determined to be eligible for marketplace insurance through November, only 19,582 were deemed eligible for financial assistance from the federal government. Castro and other policy experts had projected that most people enrolling through the marketplace would be eligible for these subsidies.
Collinsgru said that while healthcare advocates would like to see higher enrollment numbers headed into the new year, “we feel there’s a momentum growing and an awareness that will drive these numbers up.”
She noted that many more people have filed applications through the marketplace than have chosen insurers. This can be a more time-consuming step, since some people are eligible for dozens of plans, which is one reason why it could be beneficial to work with people trained to help them enroll.
Castro said the next important deadline will be March 31, 2014, which will mark the last day of the open enrollment period. If people don’t enroll in a health plan by then, they won’t be able to enroll again until the fall of 2014.
March 31 also is the deadline for the vast majority of people to have insurance in order to avoid paying a penalty on the income tax return they will file in 2015.