Number of Jerseyans with Insurance Grows, But Gains Don’t Match Forecasts

Andrew Kitchenman | September 17, 2015 | Health Care
Employer-based coverage climbs, however, defying predictions by Affordable Care Act critics

Many New Jerseyans now have health insurance as a direct result of the Affordable Care Act, but new Census numbers show the increase was less than previously projected.

But the new Census data released Wednesday had other good news for ACA supporters. More New Jersey residents obtained insurance through their employers last year – that statistic undermined claims by ACA critics that the law would result in a decline in employer-provided coverage.

This data is included in the annual American Community Survey conducted by the U.S. Census Bureau.

It provides the most accurate look yet at how health insurance has changed statewide and nationally since key provisions of the ACA – the expansion of Medicaid eligibility and the federally operated individual insurance marketplace — took effect in January 2014.

Healthcare experts say the report largely reinforces earlier survey data showing that the ACA is mostly working as intended, even though the gains aren’t as large as expected.

The report also includes some details, including demographic and local enrollment breakdowns that will be essential to nonprofit organizations that are heading up marketplace enrollment efforts this fall.

According to the survey, the number of New Jersey residents with insurance increased by 234,200 from 2013 to 2014, from 7.63 million to 7.87 million. The percentage of state residents without insurance fell from 13.2 percent in 2013 to 10.9 percent in 2014.

A 520,000-person enrollment increase had been forecast in an Urban Institute survey last year.

The drop in the share of residents without insurance varied across the state, with Passaic County having the largest drop, from 19.1 percent in 2013 to 14 percent last year. Ocean County had the smallest drop, from 9.3 percent in 2013 to 9 percent in 2014.

[related]The differences at the municipal level were even greater for the state’s largest cities and townships. The city of Passaic had its uninsured rate drop the most, from 34 percent of its residents to 24.1 percent, followed by Union City and Paterson. East Orange had the worst results, with the uninsured rate actually rising 1.7 percent. Information for 21 large municipalities was released yesterday, but complete information won’t be available until later this year.

Rutgers Center for State Health Policy Director Joel Cantor said the state and the nation have reversed a long-term trend in which the ranks of the uninsured grew every year.

“I would say the Affordable Care Act is achieving its goal, but in terms of the private insurance expansion, it’s a little slower than a lot of people hoped,” Cantor said, adding that early problems with the federal marketplace may have contributed to the slower-than-expected growth.

Employer-provided insurance rose statewide by 43,000.

“The sky didn’t fall,” Cantor said. He noted that 2014 was a transitional year for employer-based insurance, since workers faced penalties for the first time if they didn’t have insurance, but a similar mandate for employers was delayed until this year.

“The people who had access to employer-sponsored insurance were very likely to take it,” Cantor said, adding that employers apparently didn’t decide to cut back on coverage even though they were not required to offer it last year.

Cantor added that aside from the ACA, a fundamental factor driving employer-provided insurance is the state’s economy.

“In 2014, we’re seeing the recovery going on coming out of the recession, so that may have contributed to the increase as well,” Cantor said.

Raymond J. Castro, senior policy analyst for New Jersey Policy Perspective, noted that the share of residents insured through their employers rose at a faster rate nationally than it did in New Jersey, possibly reflecting the fact that New Jersey’s economy has been growing at a slower pace than the nation’s economy.

“It clearly shows the Affordable Care Act is very compatible with employment-based coverage,” Castro said.

Castro said the increase is likely because employers primarily offer insurance as a way to attract and retain workers, not as a response to federal regulations.

“Employers look at the big picture; they don’t (just) look at any one piece of legislation,” he said.

Castro said he expects to see another increase next year, since the census numbers reflect only part of the increase in Medicaid enrollment. That’s because the census release is based on surveys taken throughout 2014, rather than just at the end of the year.

Enrollment in NJ FamilyCare, the state’s primary Medicaid coverage program, rose from 400,000 over the course of 2014, from 1.28 million to 1.68 million. It has [link|risen by another 75,000] this year.

Castro said New Jersey’s Medicaid increase has helped fill a void in the state’s sluggish economy.

“I think this shows just how important the Affordable Care Act is to our state,” said Castro.

Castro added that the enrollment outreach and navigator agencies will be poring over the statistics as they plan their outreach for the marketplace open enrollment season, which begins November 1 and runs through January 31 of next year.

Castro said the information will make it possible to tailor sign-up efforts to specific demographics, like race and age, as well as by county.

“The uninsurance rate continues to affect all areas of our state and all types of individuals,” Castro said. “These folks aren’t just in Newark and Jersey City — they’re in our suburbs and they’re in some of our affluent suburbs as well.”