The Affordable Care Act continues to generate controversy nationwide, but federal officials are maintaining their annual investment in outreach efforts in hopes of enrolling even more Americans who currently lack health insurance. And these consumers may prove hardest to reach – especially without more resources, some said.
New Jersey has made real progress under the ACA, with more than 700,000 additional patients added to Medicaid or low-cost private plans since the federal law took effect in 2014. Nationwide, the number of uninsured fell from nearly 18 percent in 2013 to a low of 11 percent this spring, according to a Gallup poll of 46,000 people.
But an estimated 1 million Garden State residents still lack coverage and, even with government subsidies to keep costs low, many products remain unaffordable to consumers, experts agreed. To help chip away at that number, the Centers for Medicare and Medicaid Services will give roughly $2 million to a handful of non-profit organizations to help New Jersey residents still lacking health insurance to get signed up for coverage they can afford.
The money – part of a $67 million package CMS announced Tuesday – will pay to train and deploy enrollment counselors who work with those without health insurance to help them navigate the system and secure an appropriate plan. The annual enrollment period begins November 1 for plans that take effect in January.
Ray Castro, a healthcare analyst who has tracked the ACA’s progress for New Jersey Policy Perspective, said these outreach workers are doing what they can, but additional resources are needed to enroll the bulk of the remaining uninsured residents. “The funding is the same each year, but the challenge is greater each year,” he said. (CMS has provided close to $2 million to New Jersey outreach programs each year since 2013.)
Although the pool of uninsured residents is shrinking, those who remain without coverage are the most difficult to get signed up, Castro explained, whether because of language, or cultural barriers, or lifestyle. Outreach workers are now focusing on homeless individuals and chronic drug users, who have been tough to track down and enroll in the past, as well as the “young invincibles” – the currently healthy, active, single young people who never envision the need for health insurance.
“These are the folks who have chosen not to participate, and while there are fewer of them, they are harder to reach,” Castro said.
When the ACA was enacted in 2014, Gov. Chris Christie opted to embrace a federal provision that allowed states to expand access to their Medicaid program, which has added nearly half a million patients to the New Jersey rolls in the years since.
Christie also opted to let the federal government operate New Jersey’s health insurance exchange, another ACA feature that required each state to provide an online marketplace for discount health insurance plans. These virtual markets are open to consumers who earn too much to qualify for Medicaid, but still depend on government subsidies to afford policies through the exchange. Nearly 300,000 state residents have now obtained coverage this way.
The governor heralded the success of these efforts at a recent press conference and thanked Human Services Commissioner Elizabeth Connolly and her predecessor, Jennifer Velez, for their work on the Medicaid expansion. Christie reiterated his commitment to the program and said not only are more people getting healthcare, but the process is costing taxpayers less, thanks to federal assistance and state reforms. (As a result of these enrollments, the state also trimmed $150 million from the budget to reimburse hospitals for charity care, or care from under and uninsured residents.)
The state has received nearly $9 million in federal funding, according to the Health and Human Services Administration, to help operate the exchange. HHS found that 83 percent of these marketplace consumers received subsidies – through the form of a tax credit – that equaled more than $300 a month. More than one-third paid $100 or less for their monthly coverage, after the subsidy.
Castro said that, despite the discounts, costs – either premiums or co-pays – often discourage lower-income residents from signing up. “We need to do a better job of expanding outreach,” he said, “but ultimately we are not going to reach everyone until we reduce the costs sharing in the program.”
This year the CMS grants include $805,000 for the Center for Family Services, a non-profit organization that provides help with housing, job training, and other needs to lower income residents in the southern half of the state. This year’s funding will allow CFS to focus on enrolling minority residents, those with limited English skills, LGBTQ individuals, people with chronic diseases and disabilities, former prisoners, drug users and the all important “young invincibles,” according to their application.
CMS also provided $325,008 to the Orange ACA Navigator Project, focused on Essex, Union, Hudson and Middlesex counties. In addition to targeting homeless individuals and families, the group seeks to enroll those with language barriers, LGBTQ residents, and college-age youth. It partners with a Korean community organization and small business groups to extend its reach.
The FoodBank of Monmouth and Ocean Counties received $300,000 to work in its two home counties and neighboring Middlesex to reach low-income residents, particularly Latinos with limited English skills, as well as young adults. Foodbank navigators visit health fairs, libraries, malls, clinics, churches, hospitals, and other sites to enroll as many eligible residents as possible.
The Family Resource Network – one of the state’s leading service providers for disabled individuals and their families – was given $347,327 this year to focus on enrolling African-American residents, disabled individuals and their caregivers, and others in Monmouth, Ocean, and Middlesex counties.
The Jewish Renaissance Medical Center, a federally qualified health center – or FQHC – based in Newark, received $124,797 to focus on underinsured residents in northern New Jersey, particularly Union and Essex counties.