The Affordable Care Act has led to better healthcare outcomes nationwide and states like New Jersey that chose to embrace the federal law have seen greater improvements than those that did not, according to a national ranking released Thursday.
Researchers at the Commonwealth Fund found Garden State residents have better access to healthcare and generally lead healthier lives than citizens of many other states, but patients here are less likely than those elsewhere to avoid re-hospitalization and re-admission to nursing homes. New Jersey tied five other states, including Pennsylvania, to rank 22nd this year overall in the organization’s 2017 Scorecard on State Health System Performance.
In New Jersey, as result of the ACA — which added nearly 800,000 people to state health insurance rolls — some 41,000 fewer children and 349,000 fewer adults were uninsured as of 2015; 197,000 fewer adults went without care over the previous year because of cost concerns, the group found. The Garden State did well in many public health measures — ranking fourth overall — in suicide rates, infant mortality, and adult smoking and had the third lowest rate nationwide for obese children ages 10 to 17.
But the scorecard also showed low-income New Jerseyans and individuals of color living here have not seen the same health outcomes as their wealthier or white neighbors. And nearly half a million more adults would have more accessible, better-coordinated care if the Garden State’s healthcare system could be improved to the level of the top performing state (Vermont), according to Commonwealth, a 99-year-old foundation focused on improving healthcare, particularly for vulnerable populations.
Results closely tied to the ACA
Designed to measure change over time, the scorecard includes some 40 measures in five different categories: access and affordability; prevention and treatment; avoidable hospital use and costs; healthy lives; and equity. Researchers calculated a baseline number for each indicator using data from 2011 through 2013, then compared that to findings from 2014 and 2015 to show the trend in outcomes; baseline data and updates were not available for all indicators.
While the analysis included measures outside the scope of the ACA — it examined hospital re-admissions, reimbursement rates and prescription use among Medicare patients, who were not significantly impacted by the federal law — the researchers made clear that the results are closely tied to its implementation, largely completed in 2014. And they used their findings as a challenge to Republican leaders in Washington, D.C. now seeking to repeal and replace the landmark law with a new plan, the American Health Care Act.
“Millions are better able to get their healthcare needs met since the law was passed and the quality of healthcare has improved for many,” Commonwealth Fund president, Dr. David Blumenthal, said Wednesday. “There are clear parallels between the expansion of Medicaid and improvements on the state level,” he said. “The data speaks for itself on that question.”
In New Jersey, the ACA expanded Medicaid coverage to some 550,000 working-poor residents and enabled access to discounted commercial insurance to nearly 300,000 more, many of whom received subsidies to offset the costs. Millions of others benefitted from various insurance reforms; the healthcare industry and supporting businesses added tens of thousands of jobs; and the state received some $3 billion in additional federal funding each year, while saving hundreds of millions of dollars on payments to help hospitals cover the bill for uninsured patients.
‘…puts the onus on people who would change’ ACA
The AHCA, which has passed several Congressional committees but faces growing opposition from Democrats and Republicans, would drastically reform how the federal government funds Medicaid and would reduce government subsidies for those purchasing commercial insurance. Many experts suggest these changes, when combined with proposed regulatory changes, would make coverage far more expensive for older, sicker and lower-income patients.
“The bottom line is, any plan must hold onto the gains we’ve made and build upon them to improve healthcare even more,” Blumenthal added. “I think that puts the onus on people who would change the current law to be sure that the proposals they’re making will maintain or accelerate that progress.”
Nationwide, Commonwealth found the uninsured among working-poor adults dropped an average of 14.1 percentage points in states that expanded Medicaid, like New Jersey, compared with 8.9 points ithose that did not. Expansion states also saw declines in the percentages of low-income adults who avoided healthcare because of cost (down 5.5 points) and those who lack a regular healthcare provider (down 2.7 points) that more than doubled the drop in non-expansion states. (The Commonwealth Fund also created several interactive tools that enable online users to customize the data or create maps that show certain outcomes.)
New Jersey saw the greatest improvement in the “access and affordability” category, where it ranked 16th nationwide in report, thanks in part to the low number of uninsured children and efforts to ensure that older adults and those with chronic health conditions saw a doctor within the past two years.
NJ scored in top half of most categories
The Garden State scored in the top half of all states in almost every indicator in the “healthy lives” category and ranks ninth nationwide, results that may reflect the growing focus on population health under state Department of Health Commissioner Cathleen Bennett, who has prioritized programs that help communities provide nutrition education, farmers markets, healthy choices at local stores, and walking trails, bike racks and other improvements to encourage physical activity.
“Obesity rates are definitely trending downward in New Jersey,” Bennett said Wednesday. “We are encouraged by recent news about positive trends in obesity rates. The Department and its partners continue to invest in our communities — our towns, nonprofits and hospitals to build a culture of health.”
But the public health indicators paint a less positive picture when it comes to low-income residents or individuals of color in the Garden State; while the state ranks 16th overall in the “equity” category, several of these indicators are trending downward. Low-income children here are less likely to get the vaccines they need than those in many other states, and more likely to be hospitalized for asthma. And black adults here are more likely to have lost at least a half-dozen teeth than those in other states, Commonwealth found, a problem that appears to be growing.
(The DOH said that overall New Jersey’s vaccination rate, as reported by school and preschool facilities, is more than the 95 percent required for these immunizations and the department has worked hard to educate healthcare providers, public health officials and parents about the importance of these vaccines — and to dispel myths about their potential dangers. The Commonwealth report may not reflect recent upticks in immunization coverage for all groups, the DOH noted.)
The state ranked 20th nationwide for “prevention and treatment,” gaining points for the total number of children — of all races and income groups — to have received all their vaccines and the ability of home health providers to get patients up and moving. But New Jersey lagged in other indicators in this category, including providing mental healthcare for disabled children and communications between hospital staff and patients about their daily needs and discharge plans.
High rates of hospital re-admissions and nursing home re-admittance and costlier care drove down the Garden State’s national ranking to 45th on the “avoidable hospital use and cost” category, according to Commonwealth. But the report also shows that the trend in re-admissions and re-admittance is improving, and the state continues to do well in helping Medicare patients avoid emergency room visits.