Make no mistake – while the 2010 Affordable Care Act’s full impact on New Jersey is still unfolding, many more state residents have health insurance.
That’s the central finding of a recently completed statewide survey, which indicated the uninsured population dropped significantly during the months that key ACA provisions debuted.
The percentage of state residents between 18 and 65 years old without insurance fell from 21.2 percent in September 2013 to 13.2 percent in March 2014, according to the Robert Wood Johnson Foundation’s Health Monitoring Survey.
That was the lowest percentage of uninsured residents since at least 1990.
“The numbers are quite robust,” said Joel Cantor, director of the Rutgers Center for State Health Policy, which worked with the Plainsboro-based foundation on the New Jersey survey report. The Urban Institute conducted the survey nationwide.
New Jersey’s figures were similar to the national numbers and also matched up with . It also was in line with previously announced enrollment figures for the federal health-insurance marketplace and Medicaid expansion.
Those two programs, which are the primary ways that the ACA expanded coverage, began enrolling residents in October for coverage that started in January.
Cantor noted that the lack of funding to reach out to residents about the insurance marketplace didn’t prevent major gains in the number of people with coverage.
“While many folks were expecting lower enrollment, at least initially, due to the lack of resources for public outreach, this is good news,” Cantor said.
If anything, the survey may have underestimated the number of newly insured residents, since the survey was completed in early March, ahead of a last-minute surge of enrollees.
In the March survey, 9 percent said they had enrolled in insurance through the marketplace website, healthcare.gov.
Cantor added that roughly two-thirds of those residents received coverage through the Medicaid expansion, which covers adults with incomes below 138 percent of the poverty line, which currently amounts to $16,105 yearly for an individual and $32,913 for a family of four.
“It suggests that Medicaid played a huge part in the decline of the uninsured,” said Cantor, who added that the survey subtotals for Medicaid and the marketplace were less accurate than the overall percentage of insured residents, because the sample size was smaller.
The survey report noted that New Jersey’s marketplace enrollment as a share of eligible residents — 26 percent — was slightly lower than the 28 percent figure for New York, but better than Pennsylvania’s 22 percent.
Open enrollment in the marketplace was closed on March 31 and will not open again until November 15. Until then, residents can only buy marketplace insurance if their insurance status changes. Eligible people can enroll at any time in Medicaid.
“It will be interesting to keep watching and see how the states compare in terms of retention, renewals, and the next open enrollment period,” said Katherine Hempstead, director of coverage activities at the Robert Wood Johnson Foundation and coauthor of the survey report with Cantor.
Hempstead noted in a statement that other northeastern states like New York operate state-based exchanges, New Jersey achieved a comparable performance with the federal marketplace. State-based exchanges received additional money from the federal government for outreach.
“Looking ahead, there are many questions to be answered regarding access to care, cost sharing, and premium levels for those with marketplace plans, and it remains to be seen whether coverage levels will increase further, stay the same, or decline,” according to the report.
Cantor said it could become increasingly challenging to continue to reduce the number of uninsured residents, since many of those who enrolled in recent months were those most interested in insurance.
“In the fall of this coming year, there will be a (uninsured) group who be perhaps tougher to convince,” Cantor noted. He added that federal enrollment numbers show that Latino residents have been less likely than other groups to enroll, which will draw more targeted outreach efforts later this year.
A factor that could reduce the number of newly insured residents is the need for residents who bought marketplace plans to make their monthly premium payments. Early indications are that roughly 10 percent did not make the first payment.
Others may stop making payments once they find that they are still responsible for significant out-of-pocket costs.
Roughly 450 state residents were interviewed for the survey every three months, resulting in a margin of error in which the actual percentages could be 3 or 4 points higher or lower than the reported totals, Cantor said. He added that the survey reached a significant sample of state residents – in comparison, national presidential opinion polls generally reach only 1,200 residents.
“If the sample is designed well — and in this case it is — you can draw pretty strong inferences about what is going on,” Cantor said.
The next survey will be completed in June, drawing on a larger sample of residents that will provide a more definitive picture of enrollment in the state, Cantor said.
Disclosure: The Robert Wood Johnson Foundation provides funding for NJ Spotlight’s health coverage.