Obamacare Turns 6 Years Old: Transforming Healthcare Coverage in NJ

For more than 700,000 residents, the Affordable Care Act has meant a marked change to their quality of life

Credit: Children’s Specialized Hospital
From left: Uma Mena, mother of “Addy,” and Amy Mansue, of Children’s Specialized Hospital
When President Barack Obama signed the landmark Affordable Care Act in 2010, he may well have had children like Aditya “Addy” Mena of North Brunswick in mind.

Born prematurely at just 33 weeks, Addy struggled from the start with life-threatening complications from a rare anemia that took months to diagnose. His mother, Uma Mena, credited PSE&G Children’s Specialized Hospital in New Brunswick for diagnosing the disease and saving her son’s life. (She now works at the hospital part-time helping other families.)

Mena also praised the ACA for enabling her family to secure affordable health insurance when her husband lost his employee-sponsored coverage. The plan pays for a complex web of treatment for her seriously disabled son, who will be six later this spring: 13 specialist physicians; speech and physical therapy; 16-hour nursing care; prescription formula; and a variety of medical equipment, from oxygen monitors to feeding machines to a pint-sized walker.

“The insurance provided by the ACA has allowed us to make sure Addy will grow up to be the healthiest young man he can be,” said Amy Mansue, president and CEO of Children’s Specialized Hospital, a multisite organization that has won national acclaim for its treatment of children with complex health challenges.

This week marks the sixth anniversary of the ACA, which has helped more than 20 million Americans who previously couldn’t afford health insurance — including 5 million in the past year alone. More than 700,000 of these newly insured people live in New Jersey. Mansue joined state healthcare advocates, key lawmakers, and the regional director of the U.S. Department of Health and Human Services on Wednesday to mark the anniversary and to detail some of the successes achieved in the Garden State.

Obamacare has greatly expanded Medicaid, the federal insurance program for impoverished and disabled residents. It also has provided a mix of tax credits and subsidies to help lower-income New Jerseyans who couldn’t previously afford insurance purchase to buy commercial plans through carefully regulated state-run markets. In addition, it has allowed young adults to remain on their parents’ plan and ended restrictions on lifetime benefits, among other reforms.

Strong numbers — and more

“We’ve made tremendous strides here in New Jersey,” said Jackie Cornell-Bechelli, HHS regional director. She said half of the Garden State residents seeking coverage through the state’s exchange, the marketplace for ACA plans, were eligible for coverage that cost as little as $75 a month, after rebates and subsidies. Not all selected these plans, however. Some healthcare advocates have raised questions about the quality of some low-cost insurance.

[related]“Every year, there are more and more options. And every year, they are lower in cost,” Cornell-Bechelli said. “But this goes way beyond the numbers” of expanded insurance coverage. The law challenged insurance companies to create better insurance plans in many ways, ensured men and women were charged the same rates for procedures, and created a wealth of incentives for doctors and hospitals to provide more personalized, better-coordinated care. These are protections that are now embedded into our health system,” she said.

Also frequently overlooked are the mandates to improve the quality of care, suggested New Jersey Hospital Association president and CEO Betsy Ryan. NJHA was chosen as one of 27 groups nationwide to participate in a Center for Medicaid Studies pilot project designed to promote better care while reducing costs.

Ryan credited the association members with “really stepping up to the plate” to embrace changes, like open visiting hours and far more family engagement with medical teams. “It’s an exciting component of the ACA that frankly we don’t talk about enough.”

Patient benefits

Assemblyman Herb Conaway (D-Camden), a physician who chairs the health committee, said he has seen how the ACA provides relief for families and working individuals. He has also witnessed how it improved care for indigent patients who had in the past been bounced around to unconnected doctors, recalling a woman with a bleeding disorder that her previous providers had failed to diagnose as cancer.

“It’s a very important day in history,” Conaway said, praising Gov. Chris Christie for his support for the Medicaid expansion portion of the law, which several Republican governors opposed to protest the plan. “I sort of see [the landscape] as ‘before the ACA’ and ‘after the ACA.’”

Sen. Joseph Vitale (D-Middlesex), who created NJ Family Care, the state’s first low-cost health-insurance plan, some 20 years ago, criticized the ongoing call from Republicans nationwide to overturn Obamacare. “It’s awful to say those things when these individuals who never had access before, in a manner that was affordable, are concerned about losing everything” through a personal bankruptcy, Vitale said, “just because they need healthcare. Because their children are sick.”

Several speakers praised Vitale for his longtime fight to protect Family Care and the patients it serves. Cecilia Zalkind, executive director of Advocates for Children of New Jersey, said that Vitale’s program provided a “great foundation” for the ACA, which allowed the state to reach even more people in need of coverage. The benefits of insurance goes beyond healthcare, Zalkind added, noting healthy kids do better in school and, eventually, in life.

“This is an incredible victory,” Zalkind said, “and we look forward to reaching those kids who are not yet insured as we look toward the future.”

Nationwide, some 10 million Americans still don’t have coverage, officials said. This includes hundreds of thousands in New Jersey, many of them children.