One year after the first enrollments under the Affordable Care Act, recent reports have projected significant declines in the number of uninsured.
Those are very positive trends, but I would caution everyone that it’s much too early to declare victory in the fight to end the nation’s uninsured problem. We still have significant numbers of people in New Jersey without the security of health insurance coverage, and Garden State hospitals continue to provide more than $1 billion in charity care services annually to those individuals.
Last year, the healthcare.gov website signed up an estimated 7 million people. Now we’re in the midst of the 2015 open-enrollment period, and the latest reports indicate that about 202,000 New Jerseyans have signed up for coverage through January 9.
But we need some context for those initial numbers. More than half of those individuals are people who have reenrolled. And “signed up” does not mean “enrolled.” Those individuals who filled out the online forms must still pay their first month’s premium to be fully enrolled. If you account for those two issues, the actual number of newly covered New Jerseyans is just a fraction of that total.
Case in point: Federal officials reported that 161,775 New Jerseyans signed up for coverage through the health insurance marketplace through March 31, the end of last year’s open-enrollment period. However, only 58,520 of those people actually paid their premiums and completed enrollment, according to the NJ Department of Banking and Insurance. Looking further into the numbers, state reports that adjust for the “churn” of customers leaving one insurance plan and signing up for another show that the number of new enrollees in New Jersey plans was even less — 41,000 — as a result of last year’s open enrollment.
New Jersey started 2014 with roughly 1 million people without health insurance, so there remains a big gap in the number of New Jerseyans still without insurance. And that doesn’t include an estimated 525,000 undocumented immigrants who are not covered by the reform law.
The federal enrollment reports don’t include those who signed up for the state’s Medicaid program, and that’s where most of New Jersey’s residents enrolled. But Medicaid presents its own set of challenges, including long backlogs in covering new enrollees. In addition, Medicaid rates to hospitals and physicians are notoriously low. Medicaid payments to hospitals, for example, cover just 70 percent of the actual costs of providing the care. That means a hospital loses money each time it takes care of a Medicaid beneficiary.
Access to physicians is another significant concern under Medicaid. The U.S. Department of Health and Human Services recently released a report showing that only about half of physicians listed as Medicaid providers were willing and available to see a Medicaid patient. In New Jersey, one study found that just 40.4 percent of NJ physicians were accepting new Medicaid patients — the lowest percent in the nation. If our newly enrolled Medicaid beneficiaries can’t find a doctor, they end up back in the hospital emergency room, rather than giving them a “medical home” where they will receive primary care on an ongoing basis.
The ACA still faces additional legal hurdles, including an appeal before the U.S. Supreme Court that challenges whether states, including New Jersey, that used the federal marketplace for their enrollment are allowed to offer tax subsidies. In New Jersey, about 84 percent of enrollees qualified for subsidies, and their coverage could be jeopardized if those subsidies are shot down.
Hospitals were on board early in supporting the Affordable Care Act and its goals of insuring more Americans. In fact, New Jersey hospitals have conceded $4.5 billion in federal Medicare payments over 10 years to help fund the ACA’s reforms.
But I worry that if we declare victory prematurely in the fight for insurance coverage, our attention and government support will be diverted elsewhere before we’ve achieved real coverage. There’s a lot at stake — not only for millions of people without health insurance but also for the hospitals, physicians, and other healthcare providers who take care of all of us. This may be our last, best chance for redesigning our healthcare system for the future, and we need to be sure we get it right.