Healthcare Issues Drove Voters in November, Stand to Shape New Congress

Lilo H. Stainton | November 29, 2018 | Health Care
New Jersey’s blue wave — and its national counterpart — turns the tide on Trump administration’s attempts to undermine ACA

Credit: SenatorMenendezNJ
U.S. Rep. Frank Pallone (D-NJ) speaking at Medicaid/Medicare anniversary event earlier this year.
After serving as perhaps the primary motivator for voters in November, healthcare-related issues are unsurprisingly among their priorities for the new U.S. Congress — and federal elected officials from New Jersey appear ready to embrace this mission, with a particular focus on the Affordable Care Act.

U.S. Rep. Frank Pallone (D-NJ) spoke about these issues with dozens of public callers Tuesday evening during a “tele-town hall” hosted by New Jersey Citizen Action. He highlighted the impact of Republican efforts to erode or erase the ACA, or Obamacare, and discussed his plans to protect, and even build on, the 2010 federal law, which he helped draft.

Pallone and others are particularly concerned about protecting coverage for what they say are some 3.8 million residents with pre-existing conditions, whose coverage has been threatened by several reforms. The ACA added more than 800,000 New Jerseyans to the insurance rolls, reducing the state’s uninsured rate to historic lows, and extended additional coverage protections to millions more.

Holding Trump ‘accountable’

One of Pallone’s main goals is to advance the ACA stabilization legislation he drafted to provide additional subsidies to help consumers cover out-of-pocket costs — more than 100,000 New Jerseyans now benefit from this assistance — strengthen the insurance market itself; and reinstate funding to boost and support enrollment. And since they will be in the majority, “House Democrats will now have the opportunity to hold the Trump administration accountable and to strengthen the ACA,” Pallone said.

Earlier in October, U.S. Sen. Robert Menendez, (D-NJ), another author of the law, pledged to continue battling to safeguard coverage and protection gains achieved through the ACA, while also striving to extend coverage to all New Jerseyans. As of 2017, 8.7 percent of the state’s residents lacked health insurance, down from nearly 14 percent in 2013, before the federal law took effect, according to research by Rutgers professor Joel Cantor, the founder and director of the university’s Center for State Health Policy.

Full coverage in New Jersey “is still a mission which we have not fully achieved yet. It is a mission we are going to continue to fight,” Menendez said at an event with Pallone, and U.S. Reps. Bonnie Watson Coleman and Donald Payne Jr., (both D-NJ), to mark the opening of the new enrollment season for commercial plans associated with the Obamacare marketplace.

In fact, data released Wednesday showed that marketplace enrollment — which began November 1 — is lagging behind past years. Pallone and other House Democrats said the numbers show “Republicans’ sabotage of our nation’s healthcare system is working,” and urged eligible residents to sign up in the two weeks remaining.

NJ Dems fight off attacks on ACA

Despite attacks on the federal level, Democratic lawmakers in New Jersey and Gov. Phil Murphy have won praise for their efforts to shore up the Garden State’s marketplace. The state adopted an individual mandate, requiring people to purchase health insurance or pay a fee, in an effort to ensure there is a large pool of people to spread the insurance risk. The law takes effect in January, when the current federal mandate is scheduled to lapse. Murphy also approved a federally funded reinsurance program to offset the cost of major claims, another effort to stabilize the system.

Supporters also credit these moves with helping to temper increasing costs in the Garden State. A report released two weeks ago by progressive research group New Jersey Policy Perspective noted that not only was the average cost of marketplace plans declining by roughly 9 percent for next year, but also the premium prices for this coverage is among the lowest in the nation. (The study did not examine copays and other out-of-pocket costs; alternative research shows the overall cost of medical care here continues to rise faster than the national average.)

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But when it comes to federal officials, public surveys suggest Pallone and his colleagues are reading their audience well. Despite an initial push by President Donald Trump and some Republicans in Congress to repeal and replace the landmark law, a poll from the nonprofit Kaiser Family Foundation released Wednesday showed the public is now eager for members of Congress to do more to address healthcare issues and provide oversight of the Trump administration’s attacks on the program. One in five voters ranked healthcare as their top priority, and 53 percent viewed the ACA itself favorably, KFF found.

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“The 2018 midterm elections have major implications for both the future of the 2010 healthcare law known as the Affordable Care Act (ACA) as well as one of its most popular provisions — individual state’s expansion of the Medicaid program for low-income people,” the authors wrote. Three states passed ballot measures to embrace this provision, bringing the total to 37 states (including New Jersey) that have expanded Medicaid under the law.

Paying a price for pre-existing conditions

So-called healthcare voters were a force nationwide this fall, especially in New Jersey’s 3rd Congressional District, where efforts by the incumbent Republican Tom MacArthur to help dismantle Obamacare played a key role in his defeat, according to advocates for Democrat Andy Kim, who will replace him in January. In this race, Kim’s support for the law was less a driver than MacArthur’s authorship of a key amendment that critics said would make coverage too expensive for those with pre-existing conditions.

For members of the Communications Workers of America, who blanketed the district to campaign for Kim, all they had to do was tell potential voters about MacArthur’s role in efforts to eliminate the law, the union’s Seth Hahn told reporters earlier this month. “When we got done with those conversations, we barely had to talk about Andy Kim,” he said.

The election involved what some have termed a blue wave, ushering in the first Democratic majority in the U.S. House since 2010, when the then highly controversial ACA was passed. In New Jersey, 11 of 12 districts will now be represented by Democrats, versus five out of 12 in the current Congress.

“Voters made it loud and clear in the November midterm elections that healthcare was a top priority and that they wanted a stop to the ACA sabotage,” said Maura Collinsgru, healthcare program director for New Jersey Citizen Action. “Now that we’ve made the ACA safe from repeal, we can focus our energies on stabilizing the ACA and improving our nation’s healthcare system for everyone.”

Pallone and others agree there is more to be done — both to roll back damaging changes made by the Trump administration and to extend coverage further. He is also concerned about new regulations that could allow states to approve lower-cost insurance plans with limited coverage, which he said would leave patients vulnerable, and a proposal to support outreach around these products with federal funds.

Among Pallone’s priorities is advancing an amendment to the ACA, technically titled the “Undue Sabotage and Expand Affordability of Health Insurance Act of 2018,” which he introduced in March with congressional colleagues Richard Neal (D-MA) and Bobby Scott (D-VA.)

The bill calls for expanding access to subsidies that consumers can use to offset the cost of premiums and other out-of-pocket expenses for marketplace policies and making those benefits richer. It also rolls back Trump efforts to expand limited-coverage plans and reduce essential health benefits and protects ACA requirements that all marketplace plans cover preventive care, mental health, and a set of other issues. It would also provide federal funds to support enrollment marketing and outreach, something Trump ended last year.

“For the last two years the Trump administration and congressional Republicans worked tirelessly to sabotage the ACA and to remove protections for those with pre-existing conditions,” Pallone said, thanking Citizen Action for hosting the Tuesday night call. “It is essential that citizens remain engaged with our ongoing fight to provide quality healthcare for the American people.”