Repeal and Replace Takes Its Toll: NJ ACA Enrollment Dips in 2018

Some 20,000 fewer Garden State residents signed on for insurance coverage via federal marketplace, as some healthcare advocates predicted

ACA individual mandate
Reports show 20,000 fewer New Jersey residents signed up for health insurance coverage for 2018 through the federal Affordable Care Act marketplace, something advocates warned might happen given the Trump administration’s lack of support for the program.

The federal Centers for Medicare and Medicaid Services, or CMS, released data late last month that showed 8.74 million people nationwide enrolled in the program last fall, or 3.5 million less than were covered in 2017. That included nearly 6.3 million who were insured through the program last year and 2.4 million new customers.

In the Garden State, some 275,000 signed up for one of several plans offered through the marketplace between November 1 and December 15, down from more than 295,000 last year. The 2017 enrollment period lasted twice as long, a full three months from November through January.

Under the ACA, or Obamacare, New Jersey is one of 39 states that uses this federal healthcare exchange to enable qualified residents who don’t get insurance at work and earn too much to get government plans like Medicaid to purchase discounted commercial policies. The 2010 law also allowed millions more to qualify for Medicaid, including more than 500,000 additional Garden State residents.

Repelling repeal and replace

Ongoing efforts to repeal and replace the landmark measure, led by President Donald Trump and Republicans in Congress, have prompted calls in New Jersey for state leaders to do what they can to protect the program by providing new funding or creating tax incentives to support the insurance market. Gov.-elect Phil Murphy, a Democrat who takes office next week, has already picked several cabinet members with federal experience who he hopes can help defend Garden State programs against attacks from Washington, D.C.

New Jersey Policy Perspective, a progressive policy organization that has tracked the ACA’s impact, plans to soon join Sen. Joseph Vitale, (D-Middlesex), the longtime health committee chairman who has led efforts to expand Medicaid, to release a new proposal to expand healthcare coverage for children. (Originally scheduled for last week, the event was postponed by the storm.)

NJPP’s leaders and other Obamacare supporters had feared that a shorter, six-week sign-up period, reduced federal support for advertising and enrollment support, and higher prices would lead to fewer people obtaining coverage this year. The enrollment website was also closed for maintenance on several Sundays during the sign-up period, they noted, and customers were unsure about the ACA’s status, given the turmoil in Congress.

Navigators lose funding

New Jersey nonprofits that served as navigators, helping individuals get coverage, saw an average 60 percent cut in their federal funding this year, with some losing almost 90 percent. Those reductions prompted efforts by nonprofit organizers, elected officials, and insurance providers, including Horizon Blue Cross Blue Shield, the state’s largest, to boost enrollment.

Continued concern about the ACA repeal has also prompted insurance companies to hike their prices for 2018, industry leaders said, leading to double-digit increases in some New Jersey markets. And federal tax reform, which ended the tax penalty for not having insurance coverage, could lead to even higher prices in the future, many experts warn.

For many consumers, these increases are largely offset by public assistance. In New Jersey, eight in 10 customers in the marketplace have received help paying the premium costs and six in 10 got money to cover out-of pocket costs. (The Trump administration withheld federal funds for 2018 that had previously been used to reimburse insurance agencies for these costs, but consumers will still get the break.)

Another 100,000 Garden State residents without employee coverage have historically purchased these “individual market” insurance policies directly from the companies involved; these customers are not eligible for premium or cost-sharing assistance, forcing them to cover any cost increases on their own. Enrollment figures for 2018, compiled by the state Department of Banking and Insurance, won’t be available for several more months.

CMS has also yet to make available a detailed breakdown of the 2018 enrollment, but data from the 2017 plan showed that, in New Jersey, more than one-third of the consumers were under age 35; another one-third-plus were 35 to 54; and more than one-quarter were over 55. More than eight in 10 were from nonrural areas and nearly half were white, while Asians and African-Americans made up just 7 percent each.